血流限制联合低强度抗阻运动对脑卒中患者下肢功能及表面肌电的影响

关键词：脑卒中  抗阻运动  血流限制  表面肌电图  肌力

Keywords:stroke  resistance training  blood flow restriction  surface electromyography  muscle strength

摘要：

      摘要 目的：探讨血流限制联合低强度抗阻运动(blood flow restriction -low intensity， BFR-LI)对脑卒中患者下肢肌力、功能、表面肌电平均肌电值(average electromyographic， AEMG)、均方根值(root mean square，RMS)、积分肌电值(integrated electromyographic，IEMG)的影响。 方法：58例脑卒中患者随机分为试验组和对照组，两组均接受常规康复训练和20%一次重复最大力量(one repetition maximum， 1RM)下MOTOmed踏车运动，试验组在此基础上将压力袖带绑于大腿中上段(距髌骨上缘10cm)，加压到200mmHg，加压3min，停歇1min，共进行5组，2次/天，6天/周，共2周。于治疗前、治疗2周后采用1RM阻力变化、下肢Fugl-Meyer评分（lower Fugl-Meyer assessment，LFMA）、等速肌力测试进行下肢功能及膝关节伸展屈曲肌群的峰力矩(peak torque，PT)、峰力矩/体重比(peak torque/weight，PT/W)、总功(total work，TW)、屈肌/伸肌峰力矩比值(ham string/quadriceps，H/Q)变化，采用表面肌电测试健患侧股直肌、股二头肌、胫前肌、腓肠肌AEMG、RMS、IEMG的变化。 结果：①肌力评估：治疗后试验组伸展肌群PT、PT/W、TW、H/Q比值显著优于对照组(P<0.05)，屈曲肌群PT、PT/W、TW无明显变化(P>0.05)；②表面肌电变化：治疗后试验组患侧股直肌AEMG及股直肌、股二头肌长头、腓肠肌外侧头RMS、IEMG值高于对照组(P<0.05)，但患侧胫前肌RMS和IEMG值两组间差异无显著性意义(P>0.05)；③下肢功能变化：两组治疗后Fugl-Meyer评分和1RM阻力值均较治疗前显著增加(P<0.01)，但两组间比较无显著性意义(P>0.05)。 结论：BFR-LI能在短期内提高下肢肌群的肌纤维募集能力和肌力，从而改善脑卒中患者的下肢运动功能。

Abstract:

      Abstract Objective：To investigate the effects of blood flow restriction combined with low intensity resistance training (BFR-LI) on muscle strength， function and surface electromyography(sEMG) changes of lower extremity in stroke patients. Method：Fifty-eight patients with stroke were randomly divided into the experimental group and the control group. Both groups received routine rehabilitation training and 20% one repetition maximum (1RM) resistance training by MOTOmed device. Experimental group was subjected to blood flow restriction by 200mmHg pressure on the middle thigh(10cm from the upper edge of the patella) with pressure cuff for 20 minutes， five sessions with 3min restriction and 1min relaxation， once a day and six times per week， total two weeks. Before and after treatment， Fugl-Meyer score， 1RM resistance change， isokinetic muscle strength and surface electromyography were used to evaluate lower extremity function， muscle strength and electromyographic changes. Result：①Lower extremity function： After treatment， lower extremity Fugl-Meyer score and 1RM resistance value were significantly increased in both groups (P<0.01)， and there was no statistical significance between the two groups (P>0.05). ②Isokinetic muscle strength： After treatment， the improvements of PT， PT/W， TW and H/Q ratios in extension muscles of the experimental group were better than control group (P<0.05)， but there were no significant changes in PT， PT/W and TW of the flexion muscles between two groups； ③sEMG change： After treatment， the amplitude of AEMG of the affected rectus femoris muscle，RMS and IEMG of the affected rectus femoris muscle， biceps femoris muscle and gastrocnemius muscle in the experimental group increased obviously than control group (P<0.05)， but the RMS and IEMG of the affected tibialis anterior muscle had no differences between two groups (P>0.05). Conclusion：BFR-LI can improve the muscle fiber recruitment ability， muscle strength and the lower extremity function of stroke patients.