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目的探讨功能性电刺激(functional electrical stimulation,FES)对脑卒中偏瘫患者下肢功能的影响。方法 68例早期脑卒中患者以MINIMIZE分层后随机分为FES组23例,年龄(62.7±10.9)岁,病程(24.6±20.2)d、安慰组23例,年龄(61.6±9.7)岁,病程(23.7±16.9)d和对照组22例,年龄(64.2±8.8)岁,病程(25.2±19.4)d。3组常规治疗相同,FES组采用日本生产的低频电刺激治疗仪(KR7型)治疗,电极放在患侧胫前肌及腓骨长、短肌的运动点上;刺激参数为频率30 Hz,脉宽200μs,通电/断电比5 s/5 s,波升/波降1 s/1 s,电流以患者最大耐受强度为限;安慰组接受电刺激的部位时间和疗程与FES组相同,但每次治疗时没有电流输出,对照组不给任何电刺激,治疗1次/d,每次30 min,共3周(15次)。用综合痉挛量表(CSS)评定踝关节痉挛,Fugl-Meyer运动评定量表中下肢部分(FMA)评定下肢运动功能,脑卒中患者姿势评定量表(PASS)、Berg平衡量表(BBS)评定平衡功能。结果 3组患者一般资料及治疗前各项评定结果差异无统计学意义。治疗2周和3周后,FES组与安慰组及对照组(FES VS安慰VS对照)CSS、FMA评分差异有统计学意义(P<0.01),增加率分别为2周时CSS:(9.2±22.1)%VS(35.3±46.8)%VS(34.9±45.7)%,FMA:(106.5±76.8)%VS(52.5±46.1)%VS(53.6±47.4)%。3周时CSS:(10.5±18.2)%VS(49.6±54.7)%VS(50.3±51.6)%,FMA:(129.4±87.3)%VS(65.6±50.4)%VS(64.9±49.2)%。结论 FES能延缓早期脑卒中患者偏瘫下肢痉挛的发生、减轻痉挛程度,改善下肢运动能力。
Objective To investigate the effect of functional electrical stimulation (FES) on lower extremity function in stroke patients with hemiplegia. Methods Sixty-eight patients with early stroke were randomly divided into FES group, 23 patients (62.7 ± 10.9) years old, duration of disease (24.6 ± 20.2) d, comfort group of 23 patients (61.6 ± 9.7) years of age, duration (23.7 ± 16.9) days and control group (22 cases), with an average age of 64.2 ± 8.8 years and a duration of (25.2 ± 19.4) days. Three groups of conventional treatment the same, FES group using Japanese production of low-frequency electrical stimulation treatment (KR7 type) treatment, the electrode placed in the affected side of the anterior tibial and fibular long and short muscles of the exercise point; stimulation parameters for the frequency of 30 Hz, pulse The current was limited to the patient’s maximum tolerated intensity; the time and course of the site of stimulation in the placebo group were the same as those in the FES group, However, there was no current output during each treatment, and the control group did not receive any electrical stimulation for 1 time / d for 30 min each for 3 weeks (15 times). The ankle spasticity was assessed by CSS, the lower extremity (FMA) in the Fugl-Meyer motion rating scale was used to assess the motor function of the lower limbs, PASS, Berg Balance Scale (BBS) Balance function. Results The general information of 3 groups of patients and the results before treatment were not statistically different. CSS and FMA scores of FES group and control group (FES VS comfort VS control) were significantly different at 2 and 3 weeks after treatment (P <0.01) 22.1)% VS (35.3 ± 46.8)% VS (34.9 ± 45.7)%, FMA: (106.5 ± 76.8)% VS (52.5 ± 46.1)% VS (53.6 ± 47.4)%. CSS: (10.5 ± 18.2)% VS (49.6 ± 54.7)% VS (50.3 ± 51.6)%, FMA: (129.4 ± 87.3)% VS (65.6 ± 50.4)% VS (64.9 ± 49.2)% at 3 weeks. Conclusion FES can delay the occurrence of spasticity of lower extremities in patients with early stroke, reduce the degree of spasticity and improve the ability of lower extremity movement.