经皮耳迷走神经电刺激对缺血性卒中患者的康复疗效观察

Efficacy of transcutaneous auricular vagus nerve stimulation for rehabilitation of patients with ischemic stroke

关键词:  缺血性卒中  经皮耳迷走神经电刺激  康复

Key words:  ischemic stroke  transcutaneous auricular vagus nerve stimulation  rehabilitation

摘要:

目的探讨不同频率的经皮耳迷走神经电刺激（transcutaneous auricular vagus nerve stimulation, taVNS）结合康复运动对缺血性卒中患者康复疗效的影响。 方法选取2023年6月—10月同济大学附属养志康复医院神经内科收治的80例缺血性脑卒中后伴上肢偏瘫患者，随机分为taVNS 0Hz（n=20）、taVNS 30Hz组（n=20）、taVNS 300Hz组（n=20）、taVNS 3000Hz（n=20）组，4组均接受常规康复训练，同时增加不同频率的taVNS刺激，根据患者耐受情况调整ta-VNS治疗强度，每次30min，每日1次，连续治疗14d。在假刺激组中，只夹电极但不给与刺激。分别记录治疗前、治疗30d、治疗45d后简式Fugl-Meyer（FMA）运动功能评分。 结果治疗前4组FMA评分无显著差异（F=0.195，P=0.900）；重复测量方差分析结果显示，治疗30d及45d后，4组FMA评分均较治疗前显著提高（P＜0.001），同时taVNS 300Hz组治疗45d后的FMA评分最优（48.81±20.30）；不同治疗方案在治疗30d前后、治疗45d前后FMA指标的差值均具有差异（P＜0.001），其中taVNS 300Hz组治疗45d前后的FMA评分差值最大（9.81±1.69），具有临床意义。 结论taVNS结合康复运动能促进缺血性卒中患者的运动功能康复，taVNS 300Hz治疗组效果最优。

Abstract:

ObjectiveTo investigate the efficacy of transcutaneous auricular vagus nerve stimulation(taVNS) for motor function rehabilitation in patients with ischemic stroke. MethodsFrom June, 2023 to October, eighty ischemic stroke patients admitted in the Department of Neurology of Yangzhi Rehabilitation Hospital affiliated to Tongji University were randomly divided into 4 groups with 20 cases in each group. All patients received routine rehabilitation exercise; in addition, patients in different groups received taVNS 0Hz(control group), 30Hz, 300Hz or 3000Hz, respectively. According to the patients tolerance, the treatment intensity of ta-VNS was 30min/d for 14d. The scores of simplified Fugl-Meyer Assessment Extremities(FMA) were evaluated before treatment, 30d and 45d after treatments. ResultsThere was no significant difference in FMA score among 4 groups before treatment(F=0.195, P =0.900), while the FMA scores 30d or 45d after treatment were significantly higher than those before treatment in all groups(P<0.001). The FMA score of the taVNS 300Hz group was the best 45d after treatment(48.81±20.30, P<0.001). The differences of FMA scores before and 30d or 45d after treatment varied significantly among groups(P<0.001), while the difference of FMA score before and 45d after treatment in the taVNS 300Hz group was the largest(9.81±1.69, P<0.001), which was of clinical significance. ConclusionTranscutaneous auricular vagus nerve stimulation combined with rehabilitation exercise can effectively promote motor function rehabilitation in patients with ischemic stroke, and the effect of taVNS 300Hz treatment group is the best.