镜像疗法联合神经肌肉电刺激对脑卒中偏瘫患者下肢功能恢复的影响

胡军; 林源绍; 徐超群; 吕海月; 徐淑芬

doi:10.16766/j.cnki.issn.1674-4152.002540

镜像疗法联合神经肌肉电刺激对脑卒中偏瘫患者下肢功能恢复的影响

doi: 10.16766/j.cnki.issn.1674-4152.002540

1.
温州医科大学附属衢州医院(衢州市人民医院)神经内科，浙江衢州 324000
2.
温州医科大学附属衢州医院(衢州市人民医院)针灸理疗科，浙江衢州 324000

基金项目:

浙江省自然科学基金项目 LY19H090012

详细信息

通讯作者:
胡军, E-mail: shuzigemen@163.com

中图分类号: R743.3 R454.1
计量
- 文章访问数: 234
- HTML全文浏览量: 115
- PDF下载量: 6
- 被引次数: 0
出版历程
- 收稿日期: 2021-08-10
- 网络出版日期: 2022-09-23

Effect of mirror therapy combined with neuromuscular electrical stimulation on functional recovery of lower limbs in stroke patients with hemiplegia

1.
Department of Neurology, Quzhou Hospital Affiliated of Wenzhou Medical University, Quzhou, Zhejiang 324000, China

摘要

摘要: 目的探讨与研究将镜像疗法(MT)与神经肌肉电刺激(NMES)联合应用于脑卒中偏瘫患者对下肢功能的康复疗效和价值，旨在为改善脑卒中偏瘫患者下肢功能，提升患者满意度提供数据支撑。方法将温州医科大学附属衢州医院(衢州市人民医院)神经内科2019年10月—2020年7月期间收治的脑卒中偏瘫患者64例纳入研究并采用随机数字表法分为对照组和观察组，各32例，对照组接受常规治疗和NMES干预，观察组在常规治疗的基础上给予NMES联合MT治疗，采用Berg平衡量表(BBS)评分及Fugl-Meyer量表下肢部分评分(FMA-LE量表)对2组患者治疗前后下肢运动功能和平衡功能进行测量，同时采用本院自拟患者满意度调查表对2组患者满意度进行调查，采用相应统计学方法进行统计分析。结果 2组患者治疗后BBS评分和FMA-LE评分均有所改善，且观察组患者上述指标的改善效果明显优于对照组[BBS评分：(30.78±6.03)分vs. (26.65±5.22)分；FMA-LE评分：(18.53±3.42)分vs. (16.43±2.94)分]，差异有统计学意义(t_BBS=2.634，P=0.011；t_FMA-LE=2.929，P=0.005)；观察组患者满意度为100.00%，对照组满意度为75.00%，观察组满意度明显高于对照组(χ²=9.143，P=0.005)。结论将镜像疗法联合神经肌肉电刺激应用于脑卒中偏瘫患者的康复治疗，可显著改善下肢功能，提升患者满意度，具有在临床推广应用的现实意义。
- 脑卒中 /
- 偏瘫 /
- 镜像疗法 /
- 神经肌肉电刺激
Abstract: Objective To investigate the therapeutic effect and value of mirror therapy (MT) combined with neuromuscular electrical stimulation (NMES) on lower limb function of stroke patients with hemiplegia, and provide data support for improving lower limb function and improving patient satisfaction. Methods A total of 64 cases of stroke patients with hemiplegia who met the requirements in the Quzhou Hospital Affiliated of Wenzhou Medical University from October 2019 to July 2020 were included in the study, and randomly divided into observation group and control group, with 32 cases in each group. The control group received conventional treatment and NMES intervention, and the observation group received NMES combined with MT treatment on the basis of conventional treatment. Berg balance scale (BBS) and FuGL-Meyer scale (FMA-LE) were used to measure the lower limb motor function and balance function of patients in the two groups before and after treatment. Meanwhile, the self-designed patient satisfaction questionnaire used in our hospital was used to investigate the satisfaction of patients in the two groups, and corresponding statistical methods were conducted for statistical analysis. Results BBS score and FMA-LE score improved in the two groups after treatment, and the improvement effect of the above indicators in the observation group was significantly better than that in the control group [BBS score: (30.78±6.03) points vs. (26.65±5.22) points; FMA-LE score: (18.53±3.42) points vs. (16.43±2.94) points], and the difference was statistically significant (t_BBS=2.634, P=0.011; t_FMA-LE=2.929, P=0.005). Statistical analysis showed that the satisfaction degree of the observation group (100.00%) was significantly higher than that of the control group (75.00%, χ²=9.143, P=0.005). Conclusion The application of mirror therapy combined with neuromuscular electrical stimulation in the rehabilitation of patients with hemiplegia after stroke can significantly improve the function of lower limbs and enhance patient satisfaction, indicating that it has practical significance in clinical application.
- Stroke /
- Hemiplegia /
- Mirror therapy /
- Neuromuscular electrical stimulation

HTML全文

表 1 2组脑卒中偏瘫患者一般资料比较

Table 1. Comparison of general data of hemiplegic stroke patients between two groups

组别	例数	性别(例)		疾病分类(例)		年龄(x±s, 岁)	病程(x±s, d)
组别	例数	男性	女性	脑梗死	脑出血	年龄(x±s, 岁)	病程(x±s, d)
观察组	32	20	12	21	11	52.45±5.15	31.43±4.65
对照组	32	21	11	20	12	51.89±4.92	32.05±5.02
统计量		0.068^a		0.068^a		0.445^b	-0.513^b
P值		0.794		0.794		0.658	0.610
注：^a为χ²值，^b为t值。

下载: 导出CSV

表 2 2组脑卒中偏瘫患者治疗前后BBS评分和FMA-LE评分比较(x±s, 分)

Table 2. BBS score and FMA-LE score were compared between the two groups before and after treatment

组别	例数	FMA-LE评分		BBS评分
组别	例数	治疗前	治疗后	治疗前	治疗后
观察组	32	11.64±4.31	18.53±3.42^a	17.12±7.03	30.78±6.03^a
对照组	32	11.32±3.81	16.43±2.94^a	16.55±5.87	26.65±5.22^a
t值		0.315	2.634	0.352	2.929
P值		0.754	0.011	0.726	0.005
注：与同组治疗前比较，^aP＜0.05。

下载: 导出CSV

表 3 2组脑卒中偏瘫患者满意度比较

Table 3. Comparison of satisfaction between two groups of stroke patients with hemiplegia

组别	例数	非常满意(例)	基本满意(例)	不满意(例)	满意度(%)
观察组	32	28	4	0	100.00(32/32)
对照组	32	15	9	8	75.00(24/32)
注：2组满意度比较，χ²=9.143，P=0.002。

下载: 导出CSV

参考文献(22)

[1]	路来冰, 马忆萌. 等速肌力训练对脑卒中偏瘫患者上肢运动功能的影响[J]. 科学技术与工程, 2019, 19(21): 99-103. https://www.cnki.com.cn/Article/CJFDTOTAL-KXJS201921014.htm LU L B, MA Y M. Effects of isokinetic muscle strength training on upper limb motor function in stroke patients with hemiplegia[J]. Science Technology and Engineering, 2019, 19(21): 99-103. https://www.cnki.com.cn/Article/CJFDTOTAL-KXJS201921014.htm
[2]	夏雪, 王立娟, 马文静. 个性化护理联合神经肌肉本体促进技术在提升脑卒中急性偏瘫患者运动能力中的价值[J]. 中国急救复苏与灾害医学杂志, 2020, 15(z1): 105-106. doi: 10.3969/j.issn.1673-6966.2020.z1.046 XIA X, WANG L J, MA W J. Value of personalized nursing combined with neuromuscular body promotion technology in improving motor ability of stroke patients with acute hemiplegia[J]. China Journal of Emergency Resuscitation and Disaster Medicine, 2020, 15(z1): 105-106. doi: 10.3969/j.issn.1673-6966.2020.z1.046
[3]	高静, 冯勇, 彭建新. 针灸疏经调脏法联合康复训练促进脑卒中偏瘫早期患者运动功能恢复的研究[J]. 贵州医药, 2020, 44(12): 1885-1886. doi: 10.3969/j.issn.1000-744X.2020.12.017 GAO J, FENG Y, PENG J X. Acupuncture and moxibustion Shujing Regulating Zang method combined with rehabilitation training promotes motor function recovery in early stroke patients with hemiplegia[J]. Guizhou Medical Journal, 2020, 44(12): 1885-1886. doi: 10.3969/j.issn.1000-744X.2020.12.017
[4]	王身芳, 王身林, 李长君, 等. 全身振动训练联合肌电生物反馈治疗对脑卒中偏瘫患者康复的影响[J]. 护理学杂志, 2021, 36(9): 16-18. doi: 10.3870/j.issn.1001-4152.2021.09.016 WANG S F, WANG S L, LI C J, et al. Effect of whole body vibration training combined with electromyographic biofeedback therapy on rehabilitation for stroke patients with hemiplegia[J]. Journal of Nursing Science, 2021, 36(9): 16-18. doi: 10.3870/j.issn.1001-4152.2021.09.016
[5]	周键, 张波, 顾楠楠, 等. 不同次数功能性电刺激对老年脑卒中后偏瘫患者步行能力、MAS评分的影响[J]. 中国老年学杂志, 2021, 41(1): 25-27. doi: 10.3969/j.issn.1005-9202.2021.01.007 ZHOU J, ZHANG B, GU N N, et al. Effects of different times of functional electrical stimulation on walking ability and MAS score in elderly patients with hemiplegia after stroke[J]. Chinese Journal of Gerontology, 2021, 41(1): 25-27. doi: 10.3969/j.issn.1005-9202.2021.01.007
[6]	马静, 刘功聚, 王健. 不同步速下脑卒中患者偏瘫侧与健康者对照侧下肢肌肉活动差异[J]. 中国运动医学杂志, 2015, 34(9): 850-853. https://www.cnki.com.cn/Article/CJFDTOTAL-YDYX201509007.htm MA J, LIU G J, WANG J. The Differences in Muscles Activity under the Different Gait Speeds between Hemiplegic and Healthy Lower Extremity[J]. Chinese Journal of Sports Medicine, 2015, 34(9): 850-853. https://www.cnki.com.cn/Article/CJFDTOTAL-YDYX201509007.htm
[7]	马丁莹, 吕晓, 何结石, 等. 肌内效贴辅助康复训练改善脑卒中后偏瘫恢复期患者上肢功能的临床疗效观察[J]. 中华物理医学与康复杂志, 2021, 43(1): 37-39. MA D Y, LV X, HE J S, et al. Clinical effect of intramuscular patch assisted rehabilitation training on improving upper limb function in patients with hemiplegia after stroke[J]. Chinese Journal of Physical Medicine and Rehabilitation, 2021, 43(1): 37-39.
[8]	张玲玲, 黄彩霞. 八段锦康复训练对老年脑卒中偏瘫患者肢体运动功能、日常生活和生活质量的影响[J]. 中国老年学杂志, 2021, 41(21): 4620-4622. doi: 10.3969/j.issn.1005-9202.2021.21.006 ZHANG L L, HUANG C X. Effects of Baduanjin rehabilitation training on limb motor function, daily life and quality of life in elderly stroke patients with hemiplegia[J]. Chinese Journal of Gerontology, 2021, 41(21): 4620-4622. doi: 10.3969/j.issn.1005-9202.2021.21.006
[9]	张浩天, 次仁卓玛, 赵清华, 等. 等速肌力训练对脑卒中偏瘫患者下肢步行能力康复影响的Meta分析[J]. 重庆医学, 2021, 50(13): 2274-2282. doi: 10.3969/j.issn.1671-8348.2021.13.024 ZHANG H T, CIREN Z M, ZHAO Q H, et al. Effect of isokinetic muscle strength training on rehabilitation of lower limb walk ability for patients with stroke hemiplegia: a meta analysis[J]. Chongqing Medicine, 2021, 50(13): 2274-2282. doi: 10.3969/j.issn.1671-8348.2021.13.024
[10]	林希丹. 穴位埋线对中风偏瘫患者足底压力及下肢运动功能的影响[D]. 福州: 福建中医药大学, 2019. LIN X D. Effect of acupoint catgut embedding on plantar pressure and lower limb motor function in patients with apoplexy and hemiplegia[D]. Fuzhou: Fujian University of Traditional Chinese Medicine, 2019.
[11]	陶冶. Berg平衡量表在康复医学科患者防跌倒坠床的应用[J]. 健康之路, 2018, 17(5): 52. https://www.cnki.com.cn/Article/CJFDTOTAL-JKZL201805071.htm TAO Y. Application of Berg balance scale in prevention of falling down in rehabilitation medicine[J]. Health Way, 2018, 17(5): 52. https://www.cnki.com.cn/Article/CJFDTOTAL-JKZL201805071.htm
[12]	全俊, 黄墩兵, 郑绍敏, 等. 脑卒中偏瘫患者膝关节屈/伸力矩比值与平衡及步行功能的相关性研究[J]. 中华物理医学与康复杂志, 2021, 43(1): 17-20. QUAN J, HUANG D B, ZHENG S M, et al. The ratio of hamstring to quadriceps peak torque predicts balance and walking quality among hemiplegic stroke survivors[J]. Chinese Journal of Physical Medicine and Rehabilitation, 2021, 43(1): 17-20.
[13]	张璐, 毛芝芳. 功能针刺联合手持续被动运动对脑卒中后手功能障碍康复质量的影响[J]. 中华全科医学, 2020, 18(8): 1365-1368. doi: 10.16766/j.cnki.issn.1674-4152.001508 ZHANG L, MAO Z F. Effect of functional acupuncture combined with continuous passive hand movement on rehabilitation quality of hand dysfunction after stroke[J]. Chinese Journal of General Practice, 2020, 18(8): 1365-1368. doi: 10.16766/j.cnki.issn.1674-4152.001508
[14]	赵钟. 滋水涵木法针刺结合常规康复训练对卒中后患者上肢运动功能恢复的影响[J]. 山西医药杂志, 2021, 50(15): 2339-2341. https://www.cnki.com.cn/Article/CJFDTOTAL-SXYY202115032.htm ZHAO Z. Effect of Zishuanmu acupuncture combined with conventional rehabilitation training on the recovery of upper limb motor function in patients after stroke[J]. Shanxi Medical Journal, 2021, 50(15): 2339-2341. https://www.cnki.com.cn/Article/CJFDTOTAL-SXYY202115032.htm
[15]	凌晴, 胡世红, 王田尧, 等. 镜像疗法促进脑卒中上肢功能恢复和皮质脊髓束重塑的弥散张量成像研究[J]. 中国康复理论与实践, 2021, 27(1): 31-36. https://www.cnki.com.cn/Article/CJFDTOTAL-ZKLS202101004.htm LING Q, HU S H, WANG T Y, et al. Effects of Mirror Therapy on Upper Limb Motor Function and Corticospinal Tract Remodeling after Stroke: A Diffusion Tensor Imaging Study[J]. Chinese Journal of Rehabilitation Theory and Practice, 2021, 27(1): 31-36. https://www.cnki.com.cn/Article/CJFDTOTAL-ZKLS202101004.htm
[16]	吴明霞, 曾西, 王留根, 等. 改良镜像疗法在脑卒中后上肢偏瘫病人中的应用效果[J]. 护理研究, 2021, 35(11): 2042-2045. https://www.cnki.com.cn/Article/CJFDTOTAL-SXHZ202111038.htm WU M X, ZENG X, WANG L G, et al. Application effect of modified mirror therapy in patients with upper limb hemiplegia after stroke[J]. Chinese Nursing Research, 2021, 35(11): 2042-2045. https://www.cnki.com.cn/Article/CJFDTOTAL-SXHZ202111038.htm
[17]	张文洁, 张永祥, 王强, 等. 镜像疗法和动作观察疗法对脑卒中患者上肢运动功能疗效的影响[J]. 中华物理医学与康复杂志, 2021, 43(5): 414-417. ZHANG W J, ZHANG Y X, WANG Q, et al. Effect of mirror therapy and motion observation therapy on upper limb motor function in stroke patients[J]. Chinese Journal of Physical Medicine and Rehabilitation, 2021, 43(5): 414-417.
[18]	孙树乾, 张源源, 王华, 等. 高压氧联合任务导向性镜像疗法对脑梗死患者上肢运动功能恢复及运动诱发电位的影响[J]. 中华航海医学与高气压医学杂志, 2021, 28(3): 315-318. SUN S Q, ZHANG Y Y, WANG H, et al. Effects of hyperbaric oxygen combined with task-oriented mirror therapy on upper limb motor function recovery and motor evoked potentials in patients with cerebral infarction[J]. Chinese Journal of Nautical Medicine and Hyperbaric Medicine, 2021, 28(3): 315-318.
[19]	江方辉, 应忠明, 施玲玲. 揿针埋针联合吞咽康复训练治疗脑卒中后吞咽障碍的效果观察[J]. 中华全科医学, 2021, 19(3): 483-485. doi: 10.16766/j.cnki.issn.1674-4152.001841 JIANG F H, YING Z M, SHI L L. Observation on the effect of pressing needle embedding acupuncture point combined with swallowing rehabilitation training on dysphagia after stroke[J]. Chinese Journal of General Practice, 2021, 19(3): 483-485. doi: 10.16766/j.cnki.issn.1674-4152.001841
[20]	余红, 陈正君. 镜像疗法联合经颅直流电刺激对脑卒中偏瘫患者上肢运动功能的影响[J]. 中华物理医学与康复杂志, 2021, 43(9): 801-803. YU H, CHEN Z J. Effect of mirror therapy combined with transcranial direct current stimulation on upper limb motor function in stroke patients with hemiplegia[J]. Chinese Journal of Physical Medicine and Rehabilitation, 2021, 43(9): 801-803.
[21]	柳忠, 梁天佳. 镜像疗法联合减重平板步行训练对脑卒中偏瘫患者步行功能的改善效果研究[J]. 中国全科医学, 2021, 24(21): 2680-2685. https://www.cnki.com.cn/Article/CJFDTOTAL-QKYX202121010.htm LIU Z, LIANG T J. Effect of Mirror Therapy Combined with Body Weight Supported Treadmill Training on Walking Function in Post-stroke Hemiplegia Patients[J]. Chinese General Practice, 2021, 24(21): 2680-2685. https://www.cnki.com.cn/Article/CJFDTOTAL-QKYX202121010.htm
[22]	黎伟雄. 镜像疗法联合神经肌肉电刺激对脑卒中偏瘫患者下肢功能的康复效果研究[D]. 南宁: 广西医科大学, 2019. LI W X. Rehabilitation effect of mirror therapy combined with neuromuscular electrical stimulation on lower limb function in stroke patients with hemiplegia[D]. Nanning: Guangxi Medical University, 2019.