功能性电刺激改善急性脑卒中患者肢体功能的随机对照研究

目的研究功能性电刺激(FES)对急性脑卒中偏瘫患者下肢运动和步行能力的影响。方法 46例初发脑卒中患者,年龄71岁±8岁,发病后9d±4 d,随机分为 FES 组(13例)、安慰电刺激组(15例),对照组(13例)。3组常规治疗相同,FES 组给予功能性电刺激治疗,每天1次,每次30 min,共3周(15次);安慰组给予没有电流输出的电刺激,对照组不给电刺激。用综合痉挛量表(CSS)评定踝跖屈肌群肌张力,用表面肌电图评定踝背伸和跖屈肌群最大等长收缩(MIVC)时的力矩、积分肌电图和肌肉的协同收缩率,以及患者在住院期间独自行走的能力。结果 3组患者一般资料及治疗前各项评定结果的差异无统计学意义。治疗3周后,FES 组踝跖屈肌群痉挛增加程度最低,CSS 增加率3组分别为30%±35%、50%±88%、65%±65%。踝背伸时胫前肌 MIVC 明显增加(9 Nm±5 Nm、5 Nm±3 Nm、4 Nm±5 Nm),踝背伸时的协同收缩率明显降低(8%±5%、27%±26%、28%±19%)。治疗3周内,FES 组恢复行走能力的时间较其他2组平均早2～3 d(18 d±8 d,20 d±7 d,21d±8 d)。结论 FES 能明显改善初发脑卒中急性期偏瘫患者下肢的运动功能和步行能力。

Effects of functional electrical stimulation on the improvement of motor function of patients with acute stroke: a randomized controlled trial

OBJECTIVE: To investigate the effects of functional electrical stimulation (FES) on the improvement of motor and walking ability of the lower extremities of the patients with acute stroke. METHODS: Forty-six patients with stroke (including cerebral infarction and hemorrhage), aged 71 +/- 8 (45 - 84), hospitalized within 2 weeks (9 +/- 4 days) after the onset, matched with one another in the baseline measurements before treatment, were assigned randomly into 3 groups: FES group (n = 13), receiving standard rehabilitation combined with FES 30 minutes per day, 5 days per week for 3 weeks, placebo stimulation group (n = 15) receiving standard rehabilitation combined with the installment of the FES apparatus, operated in the same manner as mentioned above, however, without real electric stimulation, and control group (n = 13), receiving standard rehabilitation alone. The score of the composite spasticity scale (CSS) was measured, electromyography was conducted to measure the maximum isometric voluntary contraction (MIVC) of the ankle dorsi-flexors and planter-flexors, and walking ability by the test of timed "Up and Go" before treatment, weekly during the 3-week treatment, and 8 weeks after the onset of stroke. RESULTS: After 3 weeks of treatment, the percentage of CSS score of the FES group was 31% +/- 35%, significantly lower than those of the placebo and control groups (50% +/- 88% and 65% +/- 65% respectively, both P < 0.05); the ankle dorsiflexion torque of MIVC of the FES group was 9 Nm +/- 5 Nm, significantly higher than those of the placebo and control groups (5 Nm +/- 3 Nm and 4 Nm +/- 5 Nm respectively, both P < 0.05), and the electromyogram co-contraction ratio of the FES group was 8% +/- 5%, significantly lower than those of the placebo and control groups (27% +/- 26% and 28% +/- 19% respectively, both P < 0.05). The time needed to recover the walking ability after the stroke onset of the FES group was 18 +/- 8 days, shorter by 2 approximately 3 days than those of the placebo and control groups (20 +/- 7 and 21 +/- 8 days respectively). The percentage of the patients able to walk with the help of a stick 3 weeks after treatment of the FES group was 85%, significantly higher than those of the placebo and control groups (60% and 46% respectively, both P < 0.05). 84.6% of the patients of the FES group returned home, a percentage significantly higher than those of the placebo and control groups (53% and 46% respectively, both P < 0.05). CONCLUSION: FES, plus standard rehabilitation, is effective in improving the motor and walking ability of the patients with acute stroke, to the degree that most patients are recovered to be able to return home.