脑梗死患者急性期神经康复治疗的功能磁共振研究

目的 观察急性期神经康复治疗对脑梗死患者脑组织重塑、肢体功能以及生活质量的影响研究。 方法 72例急性期脑梗死患者随机分为观察组与对照组,其中对照组单纯给予药物治疗(降颅压、抗血小板聚集、稳定斑块、清除氧自由基、改善微循环、营养神经、维持内环境稳定等),而观察组给予药物+神经康复治疗(体位训练、被动运动、翻身练习、搭桥练习、牵张练习、平衡训练、步行训练等),共治疗4周。治疗后2组分别采取血氧水平依赖型功能磁共振成像(BOLD-f MRI)对梗死灶ADC和FA值,大脑皮层激活区位点和面积定量检测,客观评价脑组织重塑变化。同时采用运动功能Fugl-Meyer量表与生活质量诺丁汉健康量表进行临床疗效评定。 结果 治疗后观察组与对照组患者f MRI结果提示,观察组患者梗死灶ADC和FA值升高数值大于对照组,差异有统计学意义(P<0.05)。观察组大脑皮层激活区位点和面积增加大于对照组,差异有统计学意义(P<0.05)。2组临床疗效比较,2组Fugl-Meyer运动功能量表、生活质量诺丁汉健康量表评分组间比较,差异均有统计学意义(P<0.05)。 结论 脑梗死急性期神经康复治疗可以进一步改善脑功能,提高临床效果,功能磁共振成像可以定量、敏感、准确给予评价。 

Functional magnetic resonance imaging for neurological rehabilitation during acute stage after cerebral infarction

Objective To observe the effect of neurological rehabilitation on brain tissue remodeling, body function and quality of life of patients during the acute stage after cerebral infarction. Methods Total 72 patients during acute stage after cerebral infarction were randomly divided into observation group and control group. The control group received simple drug therapy (intracranial decompression, antiplatelet aggregation, plaque stabilization, scavenging oxygen free radicals, improving microcirculation and nerve nutrition, maintaining a stable internal environment, etc.); while the observation group received drug therapy and neurological rehabilitation (postural training, passive exercise, roll exercise, bridge exercises, stretching exercise, balance training and walk training, etc.). The course of treatment was 4 weeks. Blood oxygen level dependent functional magnetic resonance imaging (BOLD-f MRI) was used to detect the ADC and FA values, the activation area and the size of the cerebral cortex in the two groups after the treatment, to evaluate objectively the changes of brain tissue remodeling. At the same time, The Fugl-Meyer Assessment of Motor Recovery after Stroke and Nottingham Health Profile (NHP) were used to evaluate the clinical efficacy. Results After the treatment, f MRI indicated that ADC and FA values in the observation group were increased significantly as compared with those in the control group, the difference was statistically significant (P < 0. 05). The increase of the activation area and the size of the cerebral cortex in the observation group was greater than that in the control group, the difference was statistically significant (P < 0. 05). The clinical effects were compared between the two groups through Fugl-Meyer Assessment of Motor Recovery after Stroke and Nottingham Health Profile (NHP), the difference was statistically significant (P < 0. 05). Conclusion The neurological rehabilitation during the acute stage after cerebral infarction can further improve the brain function of patients. The functional magnetic resonance imaging can give a quantitative, sensitive and accurate evaluation on the clinical efficacy.