文章摘要
吴琼芳,夏楠,韩肖华.电针对脑卒中患者网状脊髓束激活和预期性姿势调整的影响[J].中国康复,2024,39(5):274-279
电针对脑卒中患者网状脊髓束激活和预期性姿势调整的影响
Effects of electroacupuncture on reticulospinal tract activation and anticipatory postural adjustment in stroke patients
  
DOI:
中文关键词: 电针  预期性姿势调整  网状脊髓束  脑卒中  表面肌电
英文关键词: electroacupuncture  anticipatory postural adjustment  reticulospinal trat  stroke  sEMG
基金项目:
作者单位
吴琼芳 华中科技大学同济医学院附属同济医院康复医学科武汉 430030 
夏楠 华中科技大学同济医学院附属同济医院康复医学科武汉 430030 
韩肖华 华中科技大学同济医学院附属同济医院康复医学科武汉 430030 
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中文摘要:
  目的:以惊吓启动上肢够取运动范式为手段探究电针对脑卒中患者网状脊髓束(RST)的易化及预期性姿势调整(APA)的影响。方法:13例脑卒中患者在进行20min电针(合谷和曲池)干预前后分别进行惊吓启动上肢够取测试。此测试任务要求患者在坐位下根据80分贝(普通)或114分贝(惊吓)启动声音使用患侧上肢完成30次够取任务,同时采集双侧胸锁乳突肌(SCM)、双侧下斜方肌和运动侧的三角肌、桡侧腕屈肌及桡侧腕伸肌的表面肌电数据。另外,根据SCM是否发生提前激活将114分贝声音启动任务划分为SCM+和SCM-启动状态。基于肌电数据处理输出电针干预前后惊吓反应阳性发生率和不同启动状态下的运动前反应时、各肌肉APA激活启动延时及幅值等进行统计分析。结果:电针干预后患者惊吓反应阳性发生率明显升高(P=0.048),且运动前反应时显著缩短(P=0.038)。另外,电针干预后桡侧腕伸肌在惊吓阳性测试中的启动延时显著缩短(P<0.001),且APA幅值明显提高(P=0.049)。同时,电针干预后运动对侧下斜方肌在惊吓阴性测试中的启动延时显著延迟(P<0.001),在普通声音启动(P=0.003)和惊吓阳性启动状态下(P=0.01)的APA幅值显著降低。结论:电针对脑卒中患者RST通路存在易化作用,表现为阳性反应增强和前臂肌肉预期性姿势调节的增强。
英文摘要:
  Objective: To explore the effects of electroacupuncture (EA) on the facilitation of the reticulospinal tract and anticipatory postural adjustment (APA) in stroke patients via startle-activating reaching tests. Methods: All 13 stroke patients received startle-activating reaching tests based on sEMG before and 20 min after EA (LI4 and LI11). The patients were asked to perform 30 reaching tests with hemiplegia upper limb in the seated position via 80dB (normal) or 114dB (startle) starting sound. The sEMG data of bilateral sternocleidomastoid (SCM) and lower trapezius and anterior deltoid, flexor and extensor carpi radialis (ECR) on the motor side were collected in these tests. In addition, the 114dB tasks were subdivided into SCM+ and SCM- onset states according to whether the SCM was activated ahead of time. The incidence of the positive StartReact effect (SE) and the premotor reaction time (PRT), the APA onset latency and the amplitude of the muscles at different onset states were used for statistical analysis based on sEMG data processing. Results: The incidence of positive SE was significantly increased (P=0.048), and the PRT was shortened (P=0.038) after EA. Moreover, the onset latency of extensor carpi radialis at the positive SE state was shortened (P<0.001) and its APA amplitude was increased (P=0.049) after EA. Meanwhile, the onset latency of the contralateral lower trapezius was extended at the negative SE state (P<0.001), and its APA amplitude was reduced at the normal sound (P=0.003) and positive SE state (P=0.01) after EA. Conclusion: The facilitation effects of EA on the reticulospinal tract in stroke patients were demonstrated by enhanced positive response and enhanced anticipatory postural adjustment of forearm muscles.
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