脑卒中恢复期患者偏瘫上肢康复治疗后肌电F波变化及其临床意义

发布时间：2018-07-08 18:11

本文选题：脑卒中 + 痉挛　；参考：《安徽医科大学》2017年硕士论文

【摘要】：目的本研究的目的是通过探究脑恢复早期患者偏瘫侧上肢经过康复治疗后运动功能改变情况及观察偏瘫上肢康复治疗过程中正中神经F波参数变化规律,探讨运动功能恢复与肌电F波之间的联系,指导临床运动功能障碍评估。方法选择安徽医科大学第二附属医院康复医学科住院的脑卒中偏瘫患者30例。所有入选患者均接受为期4周的常规康复治疗,包括神经内科常规药物、运动疗法、物理因子治疗及作业治疗等;分别于开始康复治疗前及治疗4周后,采用丹麦产丹迪牌Keypoint型肌电图仪在我院肌电图室由经验丰富的医师对患者双上肢进行正中神经F波参数检测,同时采用改良Ashworth量表(MAS)评定患侧上肢的肘关节屈侧的痉挛程度,采用Fugl-Meyer量表(FMA)上肢部分评估偏瘫侧上肢运动功能,另外选取10名年龄、性别与入选对象匹配的健康人进行F波参数检测,留作正常对照。观察康复治疗效果,记录肌电F波参数值和功能能评分得分,并将最终收集数据汇总并采用SPSS16.0统计软件进行统计学分析。结果治疗前患侧正中神经F波较健测及正常者明显低平,健侧也较正常者低平。患侧上肢的F波波幅、出现率均低于健侧肢体和正常组,阈值高于健侧及正常组,差异有统计学意义(P0.05);治疗后患侧肢体正中神经F波波幅明显升高,患侧肢体F波波幅、出现率均较治疗前明显上升,阈值下降,差异有统计学意义(P0.05)。偏瘫上肢治疗前后MAS得分分别为1.13±0.973和1.83±0.834,偏瘫上肢经康复治疗后较治疗前,MAS评分有所上升,差异有统计学意义(Z=4.001,P0.05)。就患者功能评估而言,治疗前FMA为(12.80±10.104)分,治疗后为(24.53±11.605)分,治疗后患者FMA均较治疗前有明显上升,差异有统计学意义(t=10.136,P0.01)。将治疗前后的F波的各参数与改良Ashworth评分进行相关性分析,显示治疗前F波波幅、阈值、及Fmean/M比值与改良Ashworth评分存在相关性(r=0.543、-0.688、0.459,P0.05),治疗后同样存在着相关性(r=0.473、-0.499、0.503,P0.05);F波出现率仅在治疗后与MAS评分呈正相关性(r=0.412,P0.05)。而治疗前仅有F波阈值与上肢FMA积分呈负相关性(r=0.411,P0.05),F波其他各参数与上肢FMA积分无明显相关。改良Ashworth评分和F波波幅、出现率、阈值等参数均有相关性(P0.05)。结论1.康复治疗后脑卒中患者偏瘫侧上肢运动功能改善明显,肘屈肌痉挛恢复早期有所增加,符合Brunnstrom运动功能恢复规律。2.脑卒中恢复早期康复治疗后患侧肢体F波波幅、出现率较治疗前明显升高,阈值下降,提示患者偏瘫侧脊髓前角运动神经兴奋性增高。3.改良Ashworth评分和F波参数存在相关性,两者可结合用于临床上肢功能障碍的评估。
[Abstract]:Objective to investigate the changes of motor function in the upper limbs of hemiplegic patients after rehabilitation and to observe the changes of F-wave parameters of median nerve in the rehabilitation of hemiplegic upper limbs. To explore the relationship between motor function recovery and myoelectric F wave, and to guide the clinical evaluation of motor dysfunction. Methods 30 stroke patients with hemiplegia in the Department of Rehabilitation Medicine, second affiliated Hospital of Anhui Medical University were selected. All patients received 4 weeks of routine rehabilitation therapy, including routine neuromedicine, exercise therapy, physical factor therapy and occupational therapy, respectively before and after 4 weeks of rehabilitation. The F-wave parameters of median nerve were measured in the electromyography room of our hospital by using Dandi Keypoint electromyography instrument made in Denmark. At the same time, modified Ashworth scale was used to assess the degree of spasticity of the elbow flexion of the affected side. The motor function of hemiplegic upper limb was evaluated by Fugl-Meyer scale (FMA), and F wave parameters were measured in 10 healthy subjects of age, gender and subjects for normal control. To observe the effect of rehabilitation therapy, to record the F-wave parameters and the score of functional energy, and to collect the final data and use SPSS 16.0 statistical software for statistical analysis. Results the F wave of median nerve of the affected side was significantly lower than that of the healthy and normal side before the treatment, and the level of the healthy side was lower than that of the normal side. The F wave amplitude of the affected upper limb was lower than that of the healthy limb and the normal group, and the threshold value was higher than that of the healthy side and the normal group (P0.05), and the F wave amplitude of the median nerve of the affected side was obviously increased after treatment, and the F wave amplitude of the affected side was significantly higher than that of the healthy side and the normal group (P0.05). The occurrence rate was significantly higher than before treatment, the threshold decreased, the difference was statistically significant (P0.05). Mas scores of hemiplegic upper limbs before and after treatment were 1.13 卤0.973 and 1.83 卤0.834, respectively. After rehabilitation treatment, MAS scores of hemiplegic upper limbs were higher than those of pre-treatment (P 0.05). In terms of patients' functional evaluation, the scores before and after treatment were (12.80 卤10.104) and (24.53 卤11.605), respectively. The correlation between the parameters of F-wave before and after treatment and the modified Ashworth score was analyzed to show the amplitude and threshold of F-wave before and after treatment. There was also a correlation between Fmean-M ratio and modified Ashworth score (r = 0.543- 0.688U, 0.459P 0.05), and there was also a correlation after treatment (r = 0.473U -0.499U 0.503P 0.05). The occurrence rate of F wave was only positively correlated with Ashworth score after treatment (r = 0.412P0.05). Before treatment, only the F-wave threshold was negatively correlated with the upper limb FMA score (r = 0.411P). There was no significant correlation between the other parameters of F wave and the upper limb FMA score. The improved Ashworth score was correlated with F wave amplitude, occurrence rate and threshold (P0.05). Conclusion 1. The motor function of hemiplegic upper limb was improved obviously after rehabilitation treatment, and the early recovery of elbow flexor spasm was increased, which was in accordance with Brunnstrom motor function recovery rule. 2. After early rehabilitation treatment, the amplitude of F wave in the affected side of the limbs was significantly increased and the threshold value was decreased, indicating that the excitability of motor nerve in the anterior horn of the hemiplegic side was increased by .3. The improved Ashworth score was correlated with F wave parameters and could be used in the evaluation of clinical upper limb dysfunction.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R743.3

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