基于肌电、肌动信号评估不同频率电针对脑卒中病人上肢痉挛的干预作用

摘要

目的 观察不同频率电针对脑卒中后上肢痉挛性瘫痪的治疗效果.方法 将30例脑卒中上肢痉挛性瘫痪病人随机分为两组,即低频电针组(2 Hz)与高频电针组(100 Hz),每组15例.针对病人痉挛性瘫痪上肢进行电针治疗,治疗前后利用表面肌电图(sEMG)、肌动图(MMG)记录肘关节屈曲最大等长收缩时肱二头肌与肱三头肌表面肌电、肌动活动,采用改良Ashworth量表、Fugl-Meyer量表、改良Barthel指数作为疗效观察指标.结果 治疗前,两组病人肌肉表面肌电积分值(IEMG)比较,差异无统计学意义(P>0.05);治疗后,两组病人在肘关节屈曲最大等长收缩时,肱二头肌的IEMG均下降,肱三头肌IEMG均提高,且差异有统计学意义(P<0.05);与低频组比较,高频组病人在肘关节屈曲最大等长收缩时,肱二头肌IEMG低于低频组,肱三头肌IEMG高于低频组,差异有统计学意义(P<0.05).治疗前,两组病人肱二头肌表面肌动信号均方根值(RMS)比较,差异无统计学意义(P>0.05);治疗后,两组病人肘关节屈曲最大等长收缩时,肱二头肌的RMS均下降,差异有统计学意义(P<0.05);与低频组比较,高频组病人肘关节屈曲最大等长收缩时,肱二头肌RMS低于低频组,差异有统计学意义(P<0.05).治疗前,两组病人改良Ashworth量表评分、Fugl-Meyer量表评分(上肢)、改良Barthel指数评分比较,差异无统计学意义(P>0.05);治疗后,两组病人改良Ashworth量表评分均下降,Fugl-Meyer量表(上肢)与改良Barthel指数评分均提高,且差异有统计学意义(P<0.05).治疗后,高频组与低频组比较,改良Ashworth量表评分明显下降,Fugl-Meyer量表评分(上肢)、改良Barthel指数评分均明显提高,且差异有统计学意义(P<0.05).结论 不同频率电针均能有效改善脑卒中病人上肢痉挛程度、运动功能及提高病人日常生活活动能力;高频电针组作用疗效明显优于低频电针组.%Objective To observe the therapeutic effects of different frequency electroacupuncture on upperlimb spasticity in patients with stroke based on EMG and MMG signal evaluation.Methods Thirty patients with upper limb spastic paralysis after stroke were randomly divided into two groups: group A (n=15) treated with low frequency electroacupuncture (2 Hz),group B (n=15) treated with high frequency electroacupuncture (100 Hz).Before and after treatment,we used surface electromyography,mechanomyography to record,the biceps and triceps methods of electricity and motor activity when elbow flexion maximum isometric contraction.Ashworth Scales,Fugl-Meyer Scales,Barthel Index number and the overall clinical perimeters were used to evaluate therapeutic effect.Results Before the treatment,there was no significant difference in IEMG between two groups (P>0.05).After the treatment,during maximum isometric voluntary contraction of elbow flexion,the IEMG of biceps was decreased,the IEMG of triceps was increased in two groups,and there was a difference between two groups (P<0.05).Compared with group A,during maximum isometric voluntary contraction of elbow flexion,the IEMG of biceps in group B was lower than that in group A,the IEMG of triceps in group B was higher than that in group A (P<0.05).Before the treatment,there was no difference in RMS between two groups (P>0.05).After the treatment,during maximum isometric voluntary contraction of elbow flexion,the RMS of biceps was decreased in two groups,and there was a difference between two groups (P<0.05).Compared with group A,the high frequency group during maximum isometric voluntary contraction of elbow flexion,the RMS of biceps was lower than that in group A (P<0.05).Before the treatment,there no significant difference in the scores of Ashworth Scales,Fugl-Meyer Scales and Barthel Index between two groups (P>0.05).After the treatment,the scores of Ashworth scales were decreased in two groups while the scores of Fugl-Meyer Scales and Barthel Index were increased in two groups (P<0.05).After the treatment,the scores of Ashworth Scales,the Fugl-Meyer Scales and Barthel Index in group B was better than that in group A (P<0.05).Conclusion Different frequency of electroacupuncture can effectively improve the degree of the upper limb spasm,motor function and the patients' daily life activities ability.The therapeutic effects of high frequency electroacupuncture is better than that of low frequency electric acupuncture.