强化多通道功能性电刺激对偏瘫患者下肢运动功能的影响及表面肌电研究

Effects of Enhanced Multi-Channel Functional Electrical Stimulation on Lower Limb Motor Function and Surface Electromyography in Patients with Hemiplegia

摘要: 目的：探讨脑卒中偏瘫患者给予强化多通道功能性电刺激(FES)治疗后下肢运动功能的变化及表面肌电研究。方法：选择符合入组标准的60例脑卒中偏瘫患者，随机分为对照组、常规刺激组、强化刺激组，每组20例。3组患者均给予常规药物治疗及康复训练，对照组给予偏瘫肢体运动疗法(PT)训练每次30 min；常规刺激组PT治疗每次30 min，同时予以FES 10 min，一天一次；强化刺激组PT治疗每次30 min，FES 20 min，一天一次。分别于治疗前及治疗后对患者进行Fugl-Meyer运动评定量表中下肢部分(FMA-LE)、TUGT (“起立–行走”计时测试)、步态参数中患者的步长(患侧)和步频进行评定，同时利用表面肌电图测量3组患者治疗前后患侧腓肠肌内侧头中位频率(MF)数值变化。结果：三组患者治疗4周后进行评估，组内比较FMA-LE、TUGT、步长(患侧)、步频、MF数值均较治疗前改善，差异有统计学意义(P < 0.05)。常规刺激组、强化刺激组FMA-LE、TUGT、步长(患侧)、步频、MF数值均较对照组改善，差异均有统计学意义(P < 0.05)；强化刺激组较常规刺激组上述指标改善，差异均有统计学意义(P < 0.05)。结论：多通道功能性电刺激可以改善脑卒中偏瘫患者下肢的运动功能，增强肢体抗疲劳性，且通过增加治疗时间下肢运动功能改善更明显，可以将此研究方法广泛应用于临床中。

Abstract: Objective: To investigate the changes of lower limb motor function and surface electromyogramphy in stroke patients with hemiplegia after intensive multi-channel functional electrical stimulation (FES). Methods: Sixty stroke patients with hemiplegia who met the inclusion criteria were randomly divided into control group, conventional stimulation group and intensive stimulation group, with 20 cases in each group. The patients in the three groups were given routine drug treatment and rehabilitation training, and the control group was given hemiplegic limb movement therapy (PT) training for 30 min each time. The conventional stimulation group was treated with PT for 30 min each time and FES for 10 min once a day. The intensive stimulation group was treated with PT for 30 min each time and FES for 20 min once a day. Before and after treatment, the lower limb part of Fugl-Meyer motor assessment scale (FMA-LE), TUGT (“standing-walking” timing test), step length (affected side) and step frequency of patients in gait parameters were evaluated. At the same time, surface electromyography was used to measure the median frequency (MF) of the medial head of the gastrocnemius muscle on the affected side of the three groups before and after treatment. Result: After 4 weeks of treatment, the FMA-LE, TUGT, step length (affected side), step frequency and MF values of the three groups were improved compared with those before treatment, and the difference was statistically significant (P < 0.05). After 4 weeks of treatment, the FMA-LE, TUGT, step length (affected side), step frequency and MF values of the conventional stimulation group and the intensive stimulation group were improved compared with the control group, and the differences were statistically significant (P < 0.05); the above indexes in the intensive stimulation group were improved compared with those in the conventional stimulation group, and the differences were statistically significant (P < 0.05). Conclusion: Multi-channel functional electrical stimulation can improve the motor function of lower limbs in stroke patients with hemiplegia, enhance the anti-fatigue of limbs, and improve the motor function of lower limbs more obviously by increasing the treatment time. This research method can be widely used in clinical practice.