经皮电神经刺激对周围神经再生的影响

目的　探讨经皮电神经刺激 (TENS)对周围神经再生的影响。方法　将 18只健康白兔按术后取材时间的不同随机分为A、B、C 3组 ,将各组白兔双侧腓总神经切断后与同侧外膜开窗的胫神经作端侧缝合。白兔左后肢为实验侧 ,术后给予TENS ,每天 1次 ,右后肢不给予电刺激 ,作为对照侧。 3组白兔分别于术后 3、6、16周取材 ,进行大体观察、神经组织学、透射电镜和电生理检查。结果　A、B、C组白兔实验侧腓总神经有髓纤维数 ,C组实验侧运动神经传导速度、肌肉复合电位波幅均高于相应各组对照侧 (P <0 .0 5 ) ,各组白兔实验侧腓总神经髓鞘成熟程度优于对照侧。结论　TENS具有促进周围神经再生 ,提高神经侧支萌出率的作用     

经皮神经电刺激促进周围神经再生的肌电图变化

目的：观察经皮神经电刺激(Tens-21)对桡神经、正中神经、尺神经损伤的再生作用，为临床研究提供客观依据。方法：选择由创伤等原因引起神经损伤36例46根神经根据接受门诊治疗前后随机分为2组，A组接受经皮神经电刺激治疗，B组接受弥可保治疗，疗程两个月。治疗前后进行肌电图检测，测定桡神经、正中神经、尺神经运动电位潜伏期和波幅。结果：两组治疗前后周围神经运动电位潜伏期及波幅对比均有显性差异。结论：经皮神经电刺激对周围神经损伤有促进神经再生作用，可作为周围神经神经损伤保守治疗的一种方法。     

经皮电刺激大鼠骨骼肌失神经肌萎缩时成肌调节因子基因的表达

背景:在去神经早期大鼠骨髂肌成肌调节因子(MyoD)表达明显上调,有明显延缓骨骼肌肌萎缩的作用.临床实验证实电刺激是治疗失神经肌萎缩的有效方法.尚未有实验证实电刺激对失神经肌萎缩MyoD表达的影响.目的:验证电刺激对大鼠骨骼肌MyoD基因表达的影响.设计、时间及地点:随机对照动物实验,于2008-07/11在山西医科大学动物实验中心完成.材料:健康的SD大鼠36只,雌雄不限.随机分成3组,即空白对照组、去神经组、电刺激组,每组12只.方法:空白对照组不做任何处理;去神经组和电刺激组大鼠制作右侧坐骨神经离断,腓肠肌失神经支配模型.用电刺激对电刺激组进行刺激,1次/d,30 min/次.分别于去神经第2,7,14,28天,处死大鼠,取小腿的腓肠肌肉标本.主要观察指标:用反转录聚合酶链式反应技术检测MyoD mRNA的表达变化,免疫组织化学检测MyoD蛋白表达的变化.结果:在去神经支配后第2,7,14,28天,去神经组和电刺激组标本中MyoDmRNA和蛋白含量表达上调,与空白对照组比较差异有显著性意义(P＜0.05),电刺激组表达高于去神经组(P＜0.05).结论:通过电刺激可以上调大鼠腓肠肌失神经模型MyoD的表达,说明电刺激是延缓骨骼失神经肌萎缩的有效方法.     

经皮神经电刺激促进周围神经再生的肌电图变化

目的:观察经皮神经电刺激(Tens-21)对桡神经、正中神经、尺神经损伤的再生作用,为临床研究提供客观依据。方法:选择由创伤等原因引起神经损伤36例46根神经根据接受门诊治疗前后随机分为2组,A组接受经皮神经电刺激治疗,B组接受弥可保治疗,疗程两个月。治疗前后进行肌电图检测,测定桡神经、正中神经、尺神经运动电位潜伏期和波幅。结果:两组治疗前后周围神经运动电位潜伏期及波幅对比均有显著性差异。结论:经皮神经电刺激对周围神经损伤有促进神经再生作用,可作为周围神经神经损伤保守治疗的一种方法。     

神经肌肉电刺激预防老年肌萎缩的机制研究

随着全球人口老龄化, 老年肌萎缩患者数量逐渐增多, 其发生运动障碍、跌倒、骨折甚至死亡的风险明显增加, 给患者个人及社会带来沉重负担。抗阻训练能对抗肌萎缩, 但老年人常由于各种原因而无法有效进行抗阻训练, 亟待改进康复手段。神经肌肉电刺激(NMES)可作为抗阻训练的替代疗法来预防、减轻因衰老导致的肌肉质量及力量下降, 但其确切作用机制仍需探讨。本文拟对近年来采用NMES预防老年肌萎缩的相关研究进行简要总结, 以期为进一步实验研究提供便利, 为临床应用NMES防治老年肌萎缩提供理论依据及指导。     

经皮神经肌肉电刺激促进周围神经再生的应用价值

背景周围神经损伤后的变性与再生是一个很复杂的病理生理过程,关于电刺激对神经再生恢复的促进作用仍需要探讨.目的比较经皮神经肌肉电刺激治疗促进不同部位周围神经再生的作用与效果.设计以患者为观察对象,病例分析.单位一所医学院附属医院的神经电理室和骨科.对象1999-10/2003-06宁夏医学院附属医院骨科、神经内科门诊及住院的周围神经损伤患者中,选择经临床诊断和肌电图证实的78例周围神经不全损伤患者.方法对入选78例周围神经不全损伤患者采用丹迪Cantata型肌电图仪对,进行经皮神经肌肉电刺激治疗,观察受损周围神经功能恢复情况,并行治疗前、后肌电图对比分析及不同病程治疗后的疗效对比分析.主要观察指标①治疗前后肌电图变化.②神经传导速度变化.③神经功能恢复情况.结果78例臂丛神经、坐骨神经不全损伤者,经1～10个疗程的治疗,53例患者肢体运动、感觉功能恢复正常,18例患者肢体运动、感觉功能明显改善,有效率91%(71/78).治疗后失神经电位,运动神经传导速度,感觉神经传导速度均较治疗前有明显改善.结论经皮神经肌肉电刺激治疗,可促进周围神经的再生,改善受损神经局部血液循环,提高神经肌肉的兴奋性.     

神经肌肉电刺激与经皮神经电刺激治疗慢性腰背痛

为探讨电刺激治疗慢性腰背痛的效果,应用双盲的随机的重复测量的设计,比较神经肌肉电刺激(NMES)、经皮神经电刺激(TENS)、NMES与TENS综合及安慰治疗的作用。研究结果提示:综合治疗不仅在疼痛减轻或疼痛缓解方面都比安慰治疗显著有效,而且也比单用TENS或NMES显著有效。此外,为评价长期应用TENS、NMES和综合治疗的作用及副作用,必须随访观察包括疼痛、精神状况和功能在内的临床征候的变化。     

经皮神经电刺激对周围神经侧侧缝合后神经再生作用的实验研究

目的：研究经皮神经电刺激对周围神经侧侧缝合后神经再生的影响.方法：健康大耳白兔18只,显露坐骨神经及其分叉处,胫神经和腓总神经相邻神经束膜及外膜缝合.将动物肢体分为实验侧与对照侧.实验侧术后第2天,经皮神经电刺激右下肢,刺激参数：方波,波长0.3ms,频率5Hz,电流峰值3-10mA.刺激时间：每日1次,每次30min,持续6周.左后肢不给予电刺激.实验动物分组：A组（术后电刺激3周）,B组（术后电刺激6周）,C组（术后电刺激16周）;每组6只.结果：通过观察电镜、肌电图,实验侧明显优于对照侧.神经侧侧吻合各组在各时间点依次切开原手术切口,检测C组动物腓总神经的运动传导速度,CAMP的振幅及潜伏期,实验侧神经传导速度及CAMP振幅均优于对照侧,两者差异有显著性意义（P＜0.05）.实验侧CAMP的潜伏期慢于对照侧,两者差异无显著性意义（P＞0.05）.切断各组标本,距吻合口处下方5mm,腓总神经中再生有髓纤维数目实验侧再生有髓纤维均多于对照侧,两者差异有显著性意义（P＜0.05）.结论：神经侧侧吻合后有神经侧支发芽生长,可作为修复神经损伤的一种方法;经皮神经电刺激在提高神经侧侧吻合后神经侧支发芽能力有积极作用.     

低频电刺激面肌预防面神经损伤致肌萎缩的实验研究

目的　探讨电刺激面肌有无预防废用性肌萎缩的作用。方法　制作实验性面神经麻痹模型 ,电刺激眼轮匝肌 (简称眼肌 ) 3周后 ,测试眼肌肌纤维径、神经纤维径、再生神经纤维数 ,扫描电镜观察眼肌次级突触间隙面积。结果　电剌激和非电刺激侧眼肌细胞横断面积分别为 (4 6 6 .7±2 8.2 ) μm2 和 (4 78.2± 13 .6 ) μm2 ,差异无显著性。眼肌支配神经纤维数 ,电刺激侧平均 (10 6 .2± 8.1)根 ,非剌激侧平均 (187.6± 1.2 )根 ,显著小于非刺激侧 (t=2 .2 36 ,P <0 .0 5 )。电刺激侧神经纤维横断面积平均 (5 .32± 0 .30 ) μm2 ,非刺激侧平均 (9.6 6± 0 .90 ) μm2 ,非常显著小于非刺激侧 (t=2 .96 9,P <0 .0 1)。电刺激侧眼肌次级突触间隙面积比非刺激侧明显减小。结论　电刺激面肌无预防肌萎缩作用 ,反而抑制了面神经纤维再生。     

经皮神经肌电刺激治疗周围神经损伤的疗效观察

目的：探讨经皮神经肌电刺激中运用设定的电参数治疗周围神经损伤的可行性及有效性。方法：采用TERESA-神经肌体仪（低频脉冲治疗仪）对23例周围神经损伤患者进行经皮神经肌肉电刺激治疗。治疗中应用设定好的刺激参数，观察受损神经功能恢复情况并进行治疗前、后肌电图对比分析。结果：23例桡神经、正中神经、尺神经、腓总神经及胫神经损伤患者，经1-2个疗程治疗后受损神经功能有明显恢复，神经纤维平均再生距离达21．3cm（2．03mm/d）。再生速度显著快于1-1．5cm/d的平均速度（P〈0．05）。其中21例（91．31％）感觉、运动功能达S3M3以上。肌电图检查发现经电刺激治疗后17例（73．91％）患者出现再生电位。结论：以设定的经皮神经肌电刺激治疗周围神经损伤可有效促进周围神经再生，改善受损的神经支配的肢体功能。     

A preliminary investigation into the effect of coffee on hypolagesia associated with transcutaneous electrical nerve stimulation

Transcutaneous electrical nerve stimulation (TENS) is a non‐invasive, inexpensive analgesic technique used to relieve pain. It has been suggested that caffeine, an adenosine antagonist, may interfere with TENS action. This double‐blind controlled pilot study investigated the effect of coffee on response to TENS in healthy human participants experiencing experimentally induced pain. Twelve participants (7 female, age range = 20–41 years) took part in two experiments separated by 24 h. Each experiment lasted 80 min and consisted of 3 × 15 min cycles: pre‐TENS, during TENS predrink and during TENS postdrink [coffee (100 mg caffeine) or decaffeinated coffee randomized across experiments]. During each cycle, thresholds for electrical (EPT), mechanical (MPT) and cold pressor (CPT) pain were recorded. The statistical analysis modelled the responses for the coffee and decaffeinated coffee conditions during TENS (i.e. as a standard crossover) and detected no statistically significant effects between coffee and decaffeinated drinks for the natural logarithm (ln) transformed values of electrical pain threshold [ln EPT Coffee?ln EPT Decaffeinated coffee mean (standard error) = 0·0147 (0·2159)], mechanical pain threshold [ln MPT Coffee?ln MPT Decaffeinated coffee mean (standard error) = 0·1296 (0·0816)] and cold pain threshold [ln CPT Coffee?ln CPT Decaffeinated coffee mean (standard error) = 0·0793 (0·1139)]. We conclude that a single cup of coffee (100 mg caffeine) had no detectable effect on TENS outcome. Reasons why coffee did not produce a detectable effect on pain threshold are discussed.     

阴极经皮电刺激促进周围神经功能恢复的电生理学研究

目的:研究经皮电刺激对大鼠坐骨神经损伤后的神经电生理学的影响,探讨电刺激促进周围神经功能恢复的有效性。方法:手术横断大鼠坐骨神经后行显微外科神经吻合术并进行经皮电刺激,采用电生理学方法观察电刺激对周围神经再生的影响,并与对照组进行比较。结果:电刺激组受损坐骨神经的潜伏期(0.58±0.33ms)较对照组(2.27±0.88ms)缩短,差异有显著意义。结论:经皮电刺激可能具有促进受损周围神经再生和传导功能恢复的作用。     

综合康复治疗肩周炎的疗效观察

目的：观察口服普瑞巴林联合经皮电刺激治疗腹部带状疱疹后遗神经痛（PHN）的临床效果。方法：腹部PHN患者52例,随机分为2组各26例。对照组口服普瑞巴林300mg,每天2次;观察组在此基础上给予患处经皮神经电刺激（TENS）治疗。用视觉模拟疼痛评分（VAS）和睡眠质量评分（QS）评价效果,并观察治疗后的不良反应。结果：治疗1、2、3及4周后,2组VAS和QS评分均显著下降（均P〈0．05）,观察组降低较对照组更明显（均P〈0．05）。2组不良反应比较差异无统计学意义。结论：口服普瑞巴林300mg联合TENS治疗可有效缓解腹部PHN,改善睡眠质量。且无明显不良反应。     

经皮电神经刺激对脑卒中患者脑局部血流量的影响初报

目的：观察单次经皮电神经刺激(TENS)对脑卒中患者脑局部血流量的影响。方法：4例初发脑卒中患者(男、女各2人，55—73岁，发病42-131天)随机分为治疗组和对照组。2组对象分别接受2次脑局部血流量(rCBF)的检测，2次检测间隔60min，治疗组在2次检测之间接受60min的TENS冶疗。用不对称指数和变化率分析治疗前后患侧病灶及其周边半暗带区以及病灶对应的健侧脑组织及其周边区域(镜像部位)rCBF的变化。结果：单次TENS冶疗后，治疗组不对称指数增加，患侧和健侧rCBF变化率增加，虽然与对照组相比统计学上无显著性差异，但治疗组的变化较对照组明显。结论：单次TENS治疗可以改善脑卒中患者患侧和健侧半球的rCBF，推测对脑卒中患者的功能改善具有积极的促进作用。     

Conventional versus acupuncture-like transcutaneous electrical nerve stimulation on cold-induced pain in healthy human participants: effects during stimulation

Objectives: To compare the hypoalgesic effects of conventional transcutaneous electrical nerve stimulation (TENS) (high frequency, low intensity) and acupuncture‐like TENS (AL‐TENS, low frequency, high intensity) on cold‐induced pain. Design: Randomized controlled parallel group study comparing the effects of strong non‐painful AL‐TENS, conventional TENS and placebo (no current) TENS on cold‐pressor pain threshold (CPT) and pain intensity. Two baseline (pre‐intervention) measures and three during intervention measures of CPT and cold pain intensity (four point category scale) were recorded. Setting: Physiology laboratory in Leeds Metropolitan University. Participants: One hundred and twenty‐one healthy participants. Interventions: Each participant received one of three TENS interventions over their flexor digitorum profundus: (i) high pulse rate TENS with a strong non‐painful paraesthesia (conventional), (ii) low‐rate burst mode TENS that caused strong non‐painful phasic muscle twitching (acupuncture like) or (iii) no current (placebo) TENS. Main outcome measure: Difference between conventional TENS and AL‐TENS in cold pain threshold relative to pre‐TENS baseline after 25 min of stimulation. Results: No differences were detected for CPT or cold pain intensity during conventional TENS compared with AL‐TENS. When compared with placebo TENS, the confidence intervals for the ratio of intervention CPT to baseline CPT, for both AL‐TENS (0·966, 1·424) and conventional TENS (0·948, 1·401), were close to the positive side of one, although neither reached statistical significance. Conclusions: Unlike some previous studies, the present study detected no differences in hypoalgesia between AL‐TENS, conventional TENS and placebo (no current) TENS during stimulation.     

The effects of unilateral transcutaneous electrical nerve stimulation of the median nerve on bilateral somatosensory thresholds

Transcutaneous electrical nerve stimulation (TENS) is used to relieve acute and chronic pain. TENS electrodes are applied at the site of pain or in segments related to the pain, although there is limited research to support either approach. This study investigated the effects of unilateral TENS on mechanical and thermal thresholds at ipsilateral and contralateral sites in healthy human participants. Sensory perception thresholds were measured on the ipsilateral and contralateral thenar eminence of 16 volunteers for von Frey filaments, sharpness, warm, cold and heat pain. TENS was administered over the right median nerve for 10 min at 100 pulses per second (pps) and an intensity which elicited mild tingling in the hand. During TENS, ipsilateral threshold was greater than contralateral threshold for all sensory modalities, although differences were less marked for thermal stimuli. TENS effects had disappeared 30 min after TENS had been switched off although there was a tendency for thermal thresholds to remain elevated. We conclude that during stimulation, TENS elevates somatosensory thresholds within the distribution of the stimulated nerve. The rapid and short-lived ipsilateral effect is consistent with findings from animal studies and suggests a central segmental mechanism.     

经皮电神经刺激穴位治疗对脑卒中患者偏瘫侧上肢体感诱发电位的影响

目的：比较单次（45min）经皮电神经刺激（TENS）穴位治疗对脑卒中患者偏瘫侧上肢体感诱发电位（SEP）的影响。方法：符合入选条件并签署知情同意书的29例初发脑卒中患者分层后随机分为治疗组和安慰组。治疗组患者接受1次45minTENS治疗,刺激电极放在患侧上肢穴位上,刺激频率为100Hz,脉宽为200μs,强度为患者最大耐受量;安慰组患者接受45min安慰治疗,仪器与治疗组相同,有指示灯闪,但无电流输出。两组患者分别在治疗前后接受1次SEP检测,并比较其治疗前后的差异。结果：治疗前两组患者偏瘫侧与健侧SEP值相比,除N9潜伏期外差异均有显著性意义（P〈0.05）;治疗组治疗前后SEP值差异有显著性意义（P〈0.05）;治疗后两组患者组间SEP值N20潜伏期差异有显著性意义（P〈0.05）。结论：单次45minTENS治疗能改善脑卒中患者偏瘫侧上肢的SEP,推测TENS改善脑卒中偏瘫患者肢体功能可能与TENS增加脑电活动,改善SEP,激活脑细胞的功能活动有关。     

The effects of transcutaneous electrical nerve stimulation on joint position sense in patients with knee joint osteoarthritis

The Tampa Scale of Kinesiophobia (TSK) has been used for a decade and is a valuable tool in researching pain-related fear. A variety of different factor models exist, however, and there are inconsistencies as to which model to use. The purpose of the study was twofold: 1) to thoroughly review existing factor models and 2) to empirically evaluate the previously proposed factor models in a large sample with persistent musculoskeletal pain. Subjects included 578 of 711 (81%) consecutive patients (aged 18-65 years) with persistent musculoskeletal pain from three different orthopedic outpatient clinics. We reviewed all existing factor models and performed confirmatory factor analyses on the existing models. Our review identified 11 factor models of the TSK. The identified models were tested on a large Swedish sample. All models were rejected because of unacceptable goodness-of-fit statistics in that specific sample. This study supports the fact that TSK is a multidimensional construct. Rather than searching for new factor solutions, future research should be devoted to forming a consensus for the conceptual and operational definitions of the construct kinesiophobia and the application of the Tampa Scale for Kinesiophobia. Physiotherapists are encouraged to take part in building new theories.     

激光星状神经节照射联合经皮神经电刺激治疗脑卒中后吞咽障碍的疗效观察

目的：观察激光星状神经节照射配合经皮神经电刺激治疗脑卒中吞咽障碍的临床疗效。方法：脑卒中吞咽障碍患者100例随机分为A组33例、B组33例及C组34例,A组接受常规神经内科治疗及冰刺激疗法,B组在A组治疗基础上给予经皮神经电刺激疗法,C组在B组治疗基础上增加激光照射星状神经节。分别于治疗前后采用洼田饮水试验对3组患者进行吞咽功能评定,并比较总疗效和胃管留置率的变化情况。结果：治疗4周后,3组患者吞咽功能均较治疗前明显改善（P〈0.05）;且C组优于B组,B组优于A组,组间差异有统计学意义（P〈0.05）。治疗后3组临床疗效比较,C组总有效率高于B组,B组高于A组（94.12%、72.73%、36.36%,P〈0.05）。A、B、C组的胃管留置率均较治疗前明显下降（30.30%、27.27%、41.18%和6.06%、3.03%、0,P〈0.05）,但组间差异无统计学意义。结论：吞咽障碍患者在冰刺激及经皮神经电刺激治疗的基础上辅以激光照射星状神经节治疗效果明显,能进一步提高患者的吞咽功能,明显降低胃管使用率。