CAJ | 학술논문

目的：观察脑卒中患者上肢H反射的H最大波幅/M最大波幅(Hmax/Mmax)、H发展斜率/M发展斜率(Hslp/Mslp)和H阈值/M阈值(Hth/Mth)等指标与痉挛的相关性。方法采用改良Ashworth量表(MAS)评定34例恢复期脑卒中患者上肢痉挛情况。对双上肢正中神经进行H反射检测，记录各项参数，并比较Hmax/Mmax、Hslp/Mslp和Hth/Mth。结果患侧上肢Hmax/Mmax为(0.35±0.17)，健侧为(0.14±0.07)，患侧高于健侧(P<0.05)；患侧上肢Hslp/Mslp为(0.72±0.40)，健侧为(0.26±0.22)，患侧高于健侧(P<0.05)；患侧上肢Hth/Mth为(0.93±0.14)，健侧为(0.98±0.12)，两者间无显著性差异(P>0.05)；患侧上肢Hmax/Mmax与MAS评分呈线性正相关(r=0.608, P<0.05)；患侧上肢Hslp/Mslp与MAS评分亦呈线性正相关(r=0.917, P<0.05)；患侧上肢Hth/Mth与MAS评分不相关(r=-0.128, P>0.05)。结论Hmax/Mmax和Hslp/Mslp可作为脑卒中上肢痉挛程度评价的电生理指标。
목적：관찰뇌졸중환자상지H반사적H최대파폭/M최대파폭(Hmax/Mmax)、H발전사솔/M발전사솔(Hslp/Mslp)화H역치/M역치(Hth/Mth)등지표여경련적상관성。방법채용개량Ashworth량표(MAS)평정34례회복기뇌졸중환자상지경련정황。대쌍상지정중신경진행H반사검측，기록각항삼수，병비교Hmax/Mmax、Hslp/Mslp화Hth/Mth。결과환측상지Hmax/Mmax위(0.35±0.17)，건측위(0.14±0.07)，환측고우건측(P<0.05)；환측상지Hslp/Mslp위(0.72±0.40)，건측위(0.26±0.22)，환측고우건측(P<0.05)；환측상지Hth/Mth위(0.93±0.14)，건측위(0.98±0.12)，량자간무현저성차이(P>0.05)；환측상지Hmax/Mmax여MAS평분정선성정상관(r=0.608, P<0.05)；환측상지Hslp/Mslp여MAS평분역정선성정상관(r=0.917, P<0.05)；환측상지Hth/Mth여MAS평분불상관(r=-0.128, P>0.05)。결론Hmax/Mmax화Hslp/Mslp가작위뇌졸중상지경련정도평개적전생리지표。
Objective To evaluate the relationship between the ratio of the maximal value of the H-reflex to the maximal value of the M response (Hmax/Mmax), the ratio of the developmental slope of the H-reflex to the slope of the M response (Hslp/Mslp), and the ratio of the thresh-old of the H-reflex to the threshold of the M response (Hth/Mth) and upper-extremity spasticity in stroke patients. Methods Upper-extremity spasticity in 34 stroke patients was assessed by modified Ashworth Scale (MAS). H-reflex was recorded in flexor carpi radialis muscle on both sides. Hmax/Mmax, Hslp/Mslp and Hth/Mth in the spastic side were compared to the unaffected side. Results The mean of Hmax/Mmax (spastic side, 0.36±0.17;unaffected side, 0.14±0.07) and Hslp/Mslp (spastic side, 0.72±0.40;unaffected side, 0.26±0.22) showed significant difference between 2 sides (P<0.05). The mean of Hth/Mth (spastic side, 0.93 ± 0.14;unaffected side, 0.98 ± 0.12) showed no significant difference (P>0.05). Hmax/Mmax and Hslp/Mslp were correlated positively with score of MAS in the stroke patients (r=0.608, P<0.05;r=0.917, P<0.05), while there was no correlation between Hth/Mth and score of MAS (r=-0.128, P>0.05). Conclusion Hmax/Mmax and Hslp/Mslp could be sensitive elec-trophysiologic parameters to evaluate upper-extremity spasticity after stroke.