耳穴迷走神经电针刺激配合康复训练对痉挛型偏瘫脑性瘫痪儿童上肢功能的影响

关键词：迷走神经刺激  脑性瘫痪  痉挛型偏瘫  上肢运动功能

Keywords:vagus nerve stimulation  cerebral palsy  spastic hemiplegia  upper limb motor function

摘要：

      摘要 目的：探讨经皮耳穴迷走神经电针刺激（taVNS）配合康复训练对痉挛型偏瘫脑瘫（CP）儿童上肢功能的影响。 方法：选取符合标准的50例痉挛型偏瘫脑瘫儿童，随机分为治疗组（n=25）和对照组（n=25），治疗组采用常规康复功能训练联合taVNS治疗，对照组采用常规康复功能训练联合taVNS假刺激治疗。分别于治疗前和治疗12周后，采用改良Ashworth肌张力评定量表（MAS）、Carroll上肢功能评定量表（UEFT）、Peabody精细运动发育量表（PDMS-FM）以及儿童版功能独立性评定量表（WeeFIM）进行疗效评价。此外，治疗过程中密切观察并记录是否有不良反应发生。 结果：共脱落5例，其中治疗组3例，对照组2例。治疗后，两组儿童MAS评分与治疗前比较差异均无显著性意义（P＞0.05），且治疗组与对照组比较也无显著性差异（P=0.065）；两组儿童的UEFT评分、PDMS-FM评分和WeeFIM评分均较治疗前显著提高（P＜0.05），且治疗组各评分均优于对照组（P＜0.05）。 结论：在常规康复功能训练基础上辅以taVNS可以有效改善痉挛型偏瘫CP儿童患侧上肢运动功能并提高其功能独立性，并无明显副作用。

Abstract:

      Abstract Objective： To observe the effects of transcutaneous auricular vagus nerve stimulation（taVNS） matched with rehabilitation training on upper limb function in children with spastic hemiplegic cerebral palsy. Method： A total of 50 children with spastic hemiplegic cerebral palsy were randomly divided into treatment group （n=25） and control group （n=25）. The treatment group received conventional rehabilitation training combined with taVNS， while the control group received conventional rehabilitation training combined with sham-taVNS. The upper limb flexor muscle tension and upper limb function of the two groups were analyzed by the modified Ashworth scale （MAS）， Carroll Upper Extremities Functional Test （UEFT）, Peabody Developmental Motor Scales-Fine Motor (PDMS-FM) and Function Independence Measure for Children （WeeFIM） before and after 12 weeks of treatment respectively. In addition， any adverse reactions that occurred during the treatment process was closely monitored and recorded. Result： A total of 5 subjects dropped out， including 3 subjects in the treatment group and 2 subjects in the control group. After treatment， there was no significant difference in MAS classification of hemiplegic side in the two groups（P＞0.05）， and there was no significant difference between the treatment group and the control group（P=0.065）. However, both groups showed significant improvements in UEFT score, PDMS-FM and WeeFIM scores compared to before treatment（P＜0.05）， with the treatment group scoring better than the control group（P＜0.05）. Conclusion： Conventional rehabilitation training combined with taVNS can effectively improve the affected upper limb motor function in children with spastic hemiplegic cerebral palsy， without significant adverse effects.