运动康复对脑梗死局部脑血流的影响

Evaluation of the effects of rehabilitation exercise on cerebral infarction with ^(99) Tc^m-ECD SPECT brain imaging

目的 探讨99Tcm 双半胱乙酯 (ECD)局部脑血流 (rCBF)显像评价运动对偏瘫的治疗效果。方法 初发脑动脉硬化性脑梗死患者 5 9例 ,均接受运动治疗 ,其中单桥运动组 30例 ,被动运动组 2 9例。患者均于静息状态下行首次99Tcm ECDSPECT显像 ,显像结束后立即做 1次运动 ,包括单桥或下肢被动运动 ,运动结束时再次静脉注射99Tcm ECD 74 0MBq ,同一体位、同一条件下行第 2次脑显像 ,2次图像在相同条件下进行处理。以目测法、半定量分析法对其运动前后rCBF(后者以半定量值R表示 )进行比较和分析 ,并与Fugl Meyer评分和Barthel指数评定方法进行相关性分析。结果 2组患者运动后99Tcm ECDrCBF显像均示原放射性分布稀疏缺损区有不同程度填充 ,单桥运动组较被动运动组更明显 ;2组患者运动后R值均高于运动前 (P均 <0 0 1) ,运动后单桥运动组R值比被动运动组高 ,差异有显著性 (P <0 0 1)。运动前后R改变值与 2次Fugl Meyer评分和Barthel指数评定差值间均呈正相关。结论 99Tcm ECDrCBF显像可作为判断脑梗死偏瘫患者康复的有效方法 ;单桥运动比被动运动能更好地改善病灶rCBF。

Objective To investigate the therapeutic effects of motor therapy on hemiplegia with SPECT brain perfusion imaging. Methods The study population consisted of 59 patients with cerebral infarction,and all patients were treated with motor therapy.Among them, 30 cases were assigned to undertake single bridging exercise and 29 cases passive exercise. SPECT brain perfusion imaging was performed before and after motor therapy under the same condition, and the regional cerebral blood flow (rCBF) changes were compared and analysed with visual and semi quantitative methods; in addition, the relationship between rCBF changes and scores of Fugl Meyer or Barthel index were also analysed. Results After motor therapy, various degrees of radioactivity increase were compared with the pretreatment radioactivity hypoperfusion in patients with cerebral infarction, and showed that motor therapy could evidently improve rCBF of regional hypoperfusion. The posttreatment rCBF was higher than the pretreatment level ( P <0.01), and the rCBF of group of single bridging was higher than that of passive exercise group. And the changes of rCBF were all significant after motor therapy. In addition,the variation of the rCBF after motor therapy was positively correlated with the variation of Fugl Meyer and Barthel score. Conclusions SPECT brain perfusion imaging can serve as a useful method for evaluating the effectiveness of motor therapy in cerebral infarction rehabilitation. The single bridging exercise and the passive exercise are both beneficial to brain rehabilitation, but the former improves the rCBF in lesions better than the later does.