CAJ | 학술논문

目的：观察前列地尔联合神经肌肉电刺激（neural muscular electric stimulation，NMES ）对急性缺血性脑卒中（acute ischemic stroke，AIS）偏瘫患者平衡和步行能力的影响。方法选取2008年8月～2013年8月间宁津县人民医院收治的82例AIS偏瘫患者，随机分为3组。常规治疗对照组26例，给予常规康复治疗；NMES对照组30例，给予常规康复治疗＋NMES治疗（每日4次，每次15min）；观察组26例，给予常规康复治疗＋NMES（每日4次，每次15min）＋前列地尔（2 mL＋10 mL生理盐水缓慢静注，每日1次），均治疗3周。采用综合痉挛量表（Comprehensive spasm scale，CSS ）评定踝跖屈肌群张力，进行表面肌电图（surface electromyography，sEMG）检测，评定踝背伸、跖屈肌群的最大等长收缩（top isometric plantar flexors，TIVC）时的力矩、定量检测“积分”肌电图和几组肌肉的协同收缩率，对患者的平衡能力与行走能力进行评估。结果3组患者治疗前基础状况、各项指标评分的差异均无统计学意义。治疗3周后，观察组患者踝跖屈肌群痉挛情况最轻，CSS 增高率最高，与其他2组比较差异均有统计学意义（P＜0．05）。踝背伸时胫前肌MIVC明显增加，3组分别为（10±6）Nm、（6±4）Nm、（5±4）Nm。踝背伸时，协同收缩率明显降低，分别为（9±0．5）％、（28±0．27）％、（27±0．19）％。治疗3周，观察组患者恢复平衡力、行走力的时间较对照组提前3～4 d。结论低频电刺激联合前列地尔在提高AIS偏瘫患者的运动功能方面，有着显著的作用。
목적：관찰전렬지이연합신경기육전자격（neural muscular electric stimulation，NMES ）대급성결혈성뇌졸중（acute ischemic stroke，AIS）편탄환자평형화보행능력적영향。방법선취2008년8월～2013년8월간저진현인민의원수치적82례AIS편탄환자，수궤분위3조。상규치료대조조26례，급여상규강복치료；NMES대조조30례，급여상규강복치료＋NMES치료（매일4차，매차15min）；관찰조26례，급여상규강복치료＋NMES（매일4차，매차15min）＋전렬지이（2 mL＋10 mL생리염수완만정주，매일1차），균치료3주。채용종합경련량표（Comprehensive spasm scale，CSS ）평정과척굴기군장력，진행표면기전도（surface electromyography，sEMG）검측，평정과배신、척굴기군적최대등장수축（top isometric plantar flexors，TIVC）시적력구、정량검측“적분”기전도화궤조기육적협동수축솔，대환자적평형능력여행주능력진행평고。결과3조환자치료전기출상황、각항지표평분적차이균무통계학의의。치료3주후，관찰조환자과척굴기군경련정황최경，CSS 증고솔최고，여기타2조비교차이균유통계학의의（P＜0．05）。과배신시경전기MIVC명현증가，3조분별위（10±6）Nm、（6±4）Nm、（5±4）Nm。과배신시，협동수축솔명현강저，분별위（9±0．5）％、（28±0．27）％、（27±0．19）％。치료3주，관찰조환자회복평형력、행주력적시간교대조조제전3～4 d。결론저빈전자격연합전렬지이재제고AIS편탄환자적운동공능방면，유착현저적작용。
Objective To observe the effect of concomitant low-frequency neural muscular electric stimulation (NMES)and alprostadil on the motion and balance in paralysis patients with acute ischemic infarction (AIS ).Methods 82 cases with AIS admitted in Ningjin Country People's Hospital,from August 2008 to August 2013 were divided into three groups.Conventional treatment group (n =26)were received conventional rehabilitation,NMES control group (n=30)were received conventional rehabilitation+NEMS(4 times a day,every 15 min)and observation group were received conventional rehabilitation+NEMS(4 times a day,every 15 min)+alprostadil (2 mL+10 mL normal saline intravenously slowly,1 times a day),all patients were treated for three weeks.Ankle dorsi-flexors tension were evaluated by comprehensive spasm scale (CSS).The ankle dorsiflexion and plantar flexor of top isometric voluntary contraction (TIVC)were tested by surface electromyography(sEMG).Quantitative detection of“integrator”EMG and the cooperative shrinkage rate of muscles were detected to evaluate patients'balance level and walking ability.Results Each index score of patients in three groups before treatment had no difference.3 weeks after treatment,the ankle plantar flexion muscle spasm in patients of observation group were aggravating,and CSS had increased highest,there were significant differences with other two groups(P<0.05).After treatment, the ankle back of MIVC pretibial muscle were increased in all three groups,which were respectively 10 ±6 nm,6 ±4 nm,5 ±4 nm.When ankle dorsiflexion,co-contraction rate were significantly lower,respectively at (9 ±0.5)%,(28 ±0.27)%,(27 ±0.19)%.3 weeks treatment,patients in observation group walk to restore balance and walking force time was 3~4 d ahead than two control groups.Conclusion Low frequency electric stimulation combined alprostadil can improve the movement function in AIS hemiplegia patients.