脑卒中后运动功能康复过程中脑皮质功能的改变

Changes of cortical activity in motor recovery after stroke

目的:观察脑卒中后运动功能恢复过程中脑皮质功能改变的规律,及其与康复效果间的关系。方法:60例累及上肢的脑梗死偏瘫患者,分为康复治疗组35例和单纯药物治疗组25例,并与20例健康者做对照。分别在康复治疗前、康复治疗后2周和1个月时,用经颅多普勒(TCD)测定被动运动肘关节时双侧大脑中动脉(MCA)的血流速度,并用Fugl-Meyer量表评定患侧上肢的运动功能。结果:对照组和2组脑梗死患者正常肢体被动运动时均为对侧MCA的血流速度明显增快,且3次结果类似。患侧肘关节被动运动时,治疗前除对侧MCA血流速度明显增快外,同侧血流速度也明显增快(P<0.05)。但治疗2周和1个月时,单纯药物治疗组同侧血流速度逐渐减慢,而康复治疗组则一直维持在较快的水平。上肢运动功能Fugl-Meyer得分,单纯药物治疗组与同侧血流速度呈负相关(r=-0.89341,P<0.05),康复治疗组则与双侧流速均呈正相关(r=0.99139,0.88812,P<0.05)。结论:正规的康复治疗可以促进卒中运动功能的恢复,机理可能与募集皮质范围加大有关。

Objective:To observe the changes of cortical activity in motor recovery of upper limb after stroke and the relationship between motor recovery and cortical activity changes.Method:60cerebral infarction patients with upper limb paralysis were divided into rehabilitative group(35cases)and drug treatment group(25cases).20normal subjects were considered as controls.Before rehabilitation and2week and1month after-therapy the cerebral blood velocities of bilateral middle cerebral arteries(MCA)were synchronously evaluated with TCD during passive elbow movement and an upper limb evaluation were performed with Fugl-Meyer.Result:Significant increases of cerebral blood velocity were found in the contralateral MCA in control.In both rehabilitation group and drug treatment group the increases were in bilateral MCA.The velocity increases in ipsilateral MCA reduced at2week and1month in drug treatment group,which results were significantly slower than that before rehabilitation,but in rehabilitation group the velocity increase in ipsilateral MCA were sustained.The Fugl-Meyer scale of upper limb was correlative negatively with increase of ipsilateral MCA velocity in drug treatment group,and positively with bilateral MCA velocity increase in rehabilitation group.Conclusion:Rehabilitative training can improve the effect of motor recovery after stroke and may associate with recruitments of cortical area.