近红外光谱仪在脑卒中瘫痪康复评定中的应用

目的：评价运动疗法对脑血流的影响，探讨脑卒中后瘫痪康复的机制，客观评估脑卒中后瘫痪的结局。方法：应用近红外光谱仪（near infrared spectroscopy,NIRS)观察23例脑卒中后偏瘫患者及9例无脑部疾病者4项不同的主动及被动运动局部脑血流变化，结果：运动时可见脑血流随时间而上升，。在运动末达到峰值，休息时逐渐下降，主动运动引起的局部脑血流比被动运动增加更明显，肢体近端运动引起的脑血流变化明显高于肢体远端运动。对照组左侧肢体与右侧肢体运动时引起的脑血流血流血氧变化无明显差异，病例组患侧肢体运动时比健侧血流增加更多。结论：脑卒中后患肢的主动运动比被动运动更有利于改善脑血流状况，脑卒中后早期NIRS观察运动相关的脑血流变化可以提示预后，运动疗法可改善患侧大脑的侧支循环和局部微循环，达到神经康复的目的。

Evaluation of the hemiplegic motor rehabilitation in poststroke patients by nearinfrared spectroscopy

Objective:To investigate the change of brain hemodynamics in poststroke patients after different motor stimulation by using near infrared spectroscopy(NIRS) and to evaluate the motion related brain hemodynamics during neurological rehabilitation.Method:23 cases of stroke patients with hemiplegia as a study group and 9 cases without brain disease people as a control group all of them were observed. Four kinds of tasks of passive and active motion were performed,while the change of left prefrontal cortical hemodynamics was measured with NIRS.Result:Significant increase in total hemoglobin and blood oxygenation were observed when the subjects did the movements.For the hemiplegic patient greater increase of cerebral blood volume and oxygenation was detected in active motor stimulations than in passive ones.Proximal limb motion induced more cerebral blood flow increase than distal limb motion.In the control group there was no difference in brain hemodynamics when they did the tasks by left or right limb.In the stroke group the cerebral blood volume increased more obviously when patients used their affected limbs than the normal ones.Conclusion:Active motion by affected limbs in poststroke patients played a more important role in improving cerebral blood supply than passive motion, and it was helpful for neurological reorganization. The motor related cerebral hemodynamical change observed in the early stage after stroke by NIRS may suggest better prognosis. Motor therapy may improve the collateral circulation and microcirculation to achieve the goal of neurological rehabilitation.