头部低频电刺激对脑性瘫痪儿童运动功能及脑血流的影响

目的 探讨双乳突法头部低频电刺激对脑性瘫痪（脑瘫）儿童运动功能及脑血流的影响。方法 将90例脑瘫患儿随机分为电刺激治疗组与康复对照组，另选取30例健康儿童作为正常对照组。康复对照组患儿给予常规康复治疗，电刺激治疗组患儿在上述治疗基础上给予双乳突法头部低频电刺激，2组患儿总疗程均为3个月。应用粗大运动功能测试量表（GMFM）评估2组患儿治疗前、后的运动功能改善情况及临床疗效；采用彩色经颅多普勒超声技术检测治疗前、后2组患儿大脑前、中、后动脉（ACA，MCA，PCA）的平均血流速度。结果 2组患儿经治疗后，发现电刺激治疗组共显效19例（42．2％），好转24例（55．4％），有效率为95．6％；康复对照组共显效10例（22．2％），好转27例（60．0％），有效率为82．2％；2组患儿显效率和有效率比较，差异均有统计学意义（均P〈0．05）。治疗后电刺激治疗组患儿GMFM评分明显高于康复对照组（P〈0．01）。2组患儿治疗前，其ACA、MCA及PCA平均血流速度均明显低于正常对照组（P〈0．001），治疗后电刺激治疗组患儿ACA、MCA及PCA的平均血流速度均较治疗前明显增加（P〈0．001或P〈0．05），而康复对照组与治疗前比较，差异无统计学意义（P〉0．05）。结论 双乳突法头部低频电刺激可明显改善脑瘫患儿的运动功能，增强疗效，并提高脑瘫患儿颅内血流速度，改善脑循环状况，是针对脑瘫患儿安全、有效的临床治疗手段之一，值得进一步推广、应用。

Effects of low frequency electric stimulation at bilateral mastoid processes on motor function and cerebral blood flow of children with cerebral palsy

Objective To explore the effects of low frequency electric stimulation at bilateral mastoid processes on motor function and cerebral blood flow of children with cerebral palsy (CP). Methods Ninety children with CP were randomly divided into two groups: an electric stimulation group (group 1) and an conventional rehabilitation control group (group 2), thirty healthy children served as the normal control group. The children of group 1 were treated with FES in addition to the routine rehabilitation treatment. The children of group 2 were given of the routine rehabilitation treatment only. All the patients were treated successively with the above protocol for 3 months. The clinical effect and motor development were evaluated with the gross motor function measure (GMFM), and the blood flow velocities of anterior cerebral artery (ACA), middle cerebral artery (MCA), posterior cerebral artery (PCA) were measured by transcranial doppler (TCD) ultrasound before and after treatment. Results In group 1, significant or some improvement were achieved in 19 and 24 CP children, respectively, with an effective rate of 95.6% . In group 2, significant or some improvement were achieved in 10 and 27 CP children, respectively, with an effective rate of 82.2%. There was significant difference between the two groups with regard to the significant effective rate (P<0.05). The GMFM score of group 1 was significantly higher than that of group 2 after treatment (P< 0.01 ). Before treatment, the cerebral blood flow velocities of ACA, MCA, PCA in the two patient groups were all significantly lower than that of the normal controls (P<0.001). After treatment, the blood flow velocity of ACA, MCA, PCA in group 1 were significantly increased (P<0.001 and P<0.05,respectively), while that in group 2 had no change when compared with that before the treatment. Conclusion Low frequency electric stimulation at bilateral mastoid processes can improve the motor function and increase cerebral blood flow velocity of children with CP. It could serve as a safe and effective clinical rehabilitation intervention for the CP children.