镜像疗法结合低频脉冲电刺激对脑卒中偏瘫患者手功能恢复的研究

刘斌; 王英歌; 肖亚茹; 许笑天; 唐铁钰

doi:10.16766/j.cnki.issn.1674-4152.004306

镜像疗法结合低频脉冲电刺激对脑卒中偏瘫患者手功能恢复的研究

doi: 10.16766/j.cnki.issn.1674-4152.004306

1.
扬州大学附属医院康复医学科，江苏扬州 225001
2.
扬州大学附属医院神经内科

基金项目:

国家自然科学基金项目 81901084

详细信息

通讯作者:
唐铁钰，E-mail：ydfytty@163.com

中图分类号: R743.3 R682.22
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- 文章访问数: 9
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出版历程
- 收稿日期: 2024-12-27
- 网络出版日期: 2026-03-13

A retrospective study on the effect of mirror therapy combined with low-frequency pulse electrical stimulation on hand function recovery in stroke patients with hemiplegia

1.
Department of Rehabilitation Medicine, the Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, Jiangsu 225001, China

摘要

摘要: 目的探讨镜像疗法结合低频脉冲电刺激对脑卒中偏瘫患者手功能恢复的临床效果，并比较不同类型脑卒中和Brunnstrom分期患者的疗效差异。方法回顾性分析2020年1月—2023年12月在扬州大学附属医院接受康复治疗的124例脑卒中偏瘫患者的临床资料。根据患者实际接受的治疗方案进行分组，联合治疗组(62例)在常规康复基础上接受镜像疗法和低频脉冲电刺激治疗，对照组(62例)仅接受常规康复治疗，疗程为6周。主要评估指标包括Fugl-Meyer上肢运动功能评分(FMA-UE)、手臂动作调查测试(ARAT)、握力测试和改良Barthel指数(MBI)，次要评估指标为改良Ashworth量表(MAS)和肌电图(EMG)。采用重复测量方差分析比较2组治疗效果。结果治疗6周后，联合治疗组FMA-UE评分从基线的(28.76±5.43)分提高到(48.95±5.63)分，显著高于对照组的(42.18±5.27)分(F=6.924，P < 0.001)。联合治疗组ARAT、握力和MBI评分改善幅度均显著大于对照组(P < 0.01)。EMG结果显示，联合治疗组峰值电压增幅[(33.33±7.86)μV]显著高于对照组[(16.89±6.73)μV，t=6.884，P < 0.001]。亚组分析显示，联合治疗对缺血性脑卒中和Brunnstrom Ⅲ~Ⅳ期患者的疗效更显著(P < 0.01)。结论镜像疗法结合低频脉冲电刺激能显著改善脑卒中偏瘫患者的手功能。该联合疗法对中重度手功能障碍的缺血性脑卒中患者可能更有效。
- 脑卒中 /
- 偏瘫 /
- 镜像疗法 /
- 低频脉冲电刺激 /
- 手功能
Abstract: Objective To investigate the clinical effect of mirror therapy combined with low-frequency pulse electrical stimulation on hand function recovery in stroke patients with hemiplegia and to compare the therapeutic effects between different types of stroke and Brunnstrom stages. Methods A retrospective analysis was conducted on the clinical data of 124 patients with hemiplegia after stroke who received rehabilitation treatment at the Affiliated Hospital of Yangzhou University from January 2020 to December 2023. Patients were grouped according to the treatment regimen they actually received. The combined treatment group (n=62) received mirror therapy and low-frequency pulse electrical stimulation treatment on the basis of conventional rehabilitation, while the control group (n=62) only received conventional rehabilitation treatment. The treatment course was 6 weeks. The main evaluation indicators included the Fugl-Meyer assessment of upper limb motor function (FMA-UE), action research arm test (ARAT), grip strength test and modified Barthel index (MBI). The secondary assessment indicators were the modified Ashworth scale (MAS) and electromyography (EMG). Repeated measures analysis of variance was used to compare the therapeutic effects of the two groups. Results After 6 weeks of treatment, the FMA-UE score of the combined treatment group increased from (28.76±5.43) points at baseline to (48.95±5.63) points, which was significantly higher than that of the control group [(42.18±5.27) points, F=6.924, P < 0.001]. The improvement amplitudes of ARAT, grip strength and MBI scores in the combined treatment group were significantly greater than those in the control group (P < 0.01). The EMG results showed that the increase in peak voltage in the combined treatment group [(33.33±7.86) μV] was significantly higher than that in the control group [(16.89±6.73) μV, t=6.884, P < 0.001]. Subgroup analysis showed that the combined treatment had a more significant therapeutic effect on patients with ischemic stroke and Brunnstrom stage Ⅲ-Ⅳ (P < 0.01). Conclusion Mirror therapy combined with low-frequency pulse electrical stimulation can significantly improve hand function in stroke patients with hemiplegia. This combined therapy may be more effective for patients with moderate to severe hand function impairment, particularly those with ischemic stroke.
- Stroke /
- Hemiplegia /
- Mirror therapy /
- Low-frequency pulse electrical stimulation /
- Hand function

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表 1 2组脑卒中偏瘫患者基线资料比较

Table 1. Comparison of baseline characteristics between the two groups of stroke patients with hemiplegia

组别	例数	年龄 (x±s，岁)	性别 (男性/女性，例)	病程 (x±s，周)	卒中类型 (缺血/出血，例)	患侧 (左/右，例)	基线FMA-UE 评分(x±s，分)	基线ARAT 评分(x±s，分)	基线握力 (x±s，kg)	基线MBI 评分(x±s，分)	基线MAS 评分(x±s，分)
联合治疗组	62	62.35±8.47	34/28	6.24±2.81	48/14	33/19	28.76±5.43	22.85±4.62	9.85±2.76	52.37±6.85	1.82±0.75
对照组	62	63.18±7.92	36/26	6.37±2.95	50/12	35/27	29.12±5.37	23.17±4.58	10.03±2.82	53.15±7.02	1.79±0.72
统计量		0.568^a	0.133^b	0.250^a	0.192^b	0.133^b	0.376^a	0.389^a	0.365^a	0.627^a	0.233^a
P值		0.572	0.715	0.803	0.661	0.715	0.708	0.698	0.716	0.532	0.816
注：^a为t值，^b为χ²值。

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表 2 2组患者治疗前后FMA-UE评分主要结局指标比较(x±s)

Table 2. Comparison of the main outcome indicator FMA-UE score before and after treatment between the two groups of patients (x±s)

组别	例数	FMA-UE评分(分)					ARAT评分(分)
组别	例数	治疗前	治疗3周	治疗6周	F值	P值	治疗前	治疗3周	治疗6周	F值	P值
联合治疗组	62	28.76±5.43	39.85±5.87^a	48.95±5.63^b	23.452	＜0.001	22.85±4.62	31.43±4.75^a	38.76±4.82^b	31.284	＜0.001
对照组	62	29.12±5.37	35.64±5.52^a	42.18±5.27^b	18.719	＜0.001	23.17±4.58	28.36±4.67^a	33.54±4.61b	25.638	＜0.001
F值		0.376	4.127	6.924			0.389	3.658	6.235
P值		0.708	＜0.001	＜0.001			0.698	＜0.001	＜0.001

组别	例数	握力(kg)					MBI评分(分)
组别	例数	治疗前	治疗3周	治疗6周	F值	P值	治疗前	治疗3周	治疗6周	F值	P值
联合治疗组	62	9.85±2.76	14.92±3.18^a	18.73±3.42^b	15.832	＜0.001	52.37±6.85	69.83±7.54^a	81.24±7.85^b	42.163	＜0.001
对照组	62	10.03±2.82	13.24±3.05^a	15.86±3.18^b	12.457	＜0.001	53.15±7.02	65.26±7.31^a	74.37±7.53^b	35.889	＜0.001
F值		0.365	3.127	4.856			0.627	3.528	5.237
P值		0.716	＜0.001	＜0.001			0.532	＜0.001	＜0.001

组别	例数	EMG峰值电压(μV)					EMG平均电压(μV)
组别	例数	治疗前	治疗3周	治疗6周	F值	P值	治疗前	治疗3周	治疗6周	F值	P值
联合治疗组	62	45.32±6.12	62.18±7.54^a	78.65±8.23^b	28.925	＜0.001	32.47±5.83	45.89±6.32^a	58.37±7.16^b	36.522	＜0.001
对照组	62	46.25±6.21	55.72±6.89^a	63.14±7.28^b	19.749	＜0.001	33.05±5.94	40.17±6.15^a	48.23±6.73^b	27.411	＜0.001
F值		0.843	5.124	11.235			0.547	4.982	8.346
P值		0.401	＜0.001	＜0.001			0.585	＜0.001	＜0.001
注：与同组治疗前比较，^aP < 0.05；与同组治疗3周后比较，^bP < 0.05。

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表 3 2组患者治疗前后MAS评分比较(x±s，分)

Table 3. Comparison of MAS scores before and after treatment between the two groups (x±s, points)

组别	例数	治疗前	治疗3周	治疗6周	F值	P值
联合治疗组	62	1.82±0.75	1.43±0.62^a	1.12±0.54^b	12.635	＜0.001
对照组	62	1.79±0.72	1.58±0.67^a	1.37±0.61^b	187.924	＜0.001
F值		0.233	1.325	2.452
P值		0.816	0.188	0.016
注：与同组治疗前比较，^aP < 0.05；与同组治疗3周后比较，^bP < 0.05。

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表 4 缺血性脑卒中患者FMA-UE评分比较(x±s，分)

Table 4. Comparison of FMA-UE scores in patients with ischemic stroke (x±s, points)

组别	例数	治疗前	治疗6周	t值	P值
联合治疗组	48	29.22±5.16	47.85±5.63	26.324	＜0.001
对照组	50	29.73±5.21	41.62±5.29	14.235	＜0.001
t值		0.265^a	24.871^b
P值		0.792	＜0.001
注：^a为t值，^b为F值。

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表 5 出血性脑卒中患者FMA-UE评分比较(x±s，分)

Table 5. Comparison of FMA-UE scores in patients with hemorrhagic stroke (x±s, points)

组别	例数	治疗前	治疗6周	t值	P值
联合治疗组	14	27.18±4.38	41.18±4.67	19.568	＜0.001
对照组	12	27.57±4.49	37.38±4.58	12.873	＜0.001
t值		0.283^a	7.419^b
P值		0.781	0.025
注：^a为t值，^b为F值。

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表 6 缺血性脑卒中不同Brunnstrom分期患者FMA-UE评分比较(x±s，分)

Table 6. Comparison of FMA-UE scores among patients with different brunnstrom stages of ischemic stroke (x±s, points)

组别	例数	治疗前	治疗6周	t值	P值
Ⅱ期联合组	12	18.56±3.27	28.83±4.62	21.842	＜0.001
Ⅱ期对照组	13	19.05±3.41	26.75±4.38	13.567	＜0.001
t值		0.366^a	8.743^b
P值		0.718	0.008
Ⅲ期联合组	20	29.38±3.85	50.62±4.73	35.211	＜0.001
Ⅲ期对照组	21	30.04±3.96	43.29±4.56	13.987	＜0.001
t值		0.541^a	32.672^b
P值		0.592	＜0.001
Ⅳ期联合组	16	39.72±4.13	62.61±5.18	28.324	＜0.001
Ⅳ期对照组	16	40.11±4.25	54.83±4.92	15.763	＜0.001
t值		0.263^a	19.348^b
P值		0.794	＜0.001
注：^a为t值，^b为F值。

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表 7 出血性脑卒中不同Brunnstrom分期患者FMA-UE评分比较(x±s，分)

Table 7. Comparison of FMA-UE scores among patients with different brunnstrom stages of hemorrhagic stroke (x±s, points)

组别	例数	治疗前	治疗6周	t值	P值
Ⅱ期联合组	4	18.43±3.12	26.78±4.25	17.792	＜0.001
Ⅱ期对照组	3	18.55±3.29	24.94±4.21	11.323	＜0.001
t值		0.049^a	3.921^b
P值		0.963	0.089
Ⅲ期联合组	6	27.21±3.88	44.35±4.69	18.441	＜0.001
Ⅲ期对照组	6	27.89±3.97	38.54±4.38	12.878	＜0.001
t值		0.300^a	9.147^b
P值		0.770	0.006
Ⅳ期联合组	4	35.89±4.14	52.42±5.07	16.542	＜0.001
Ⅳ期对照组	3	36.27±4.21	48.65±5.13	11.992	＜0.001
t值		0.119^a	4.158^b
P值		0.910	0.072
注：^a为t值，^b为F值。

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