经颅直流电刺激联合镜像疗法治疗脑卒中后肩手综合征的疗效观察

关键词：肩手综合征  疼痛  经颅直流电刺激  镜像疗法

Keywords:shoulder-hand syndrome  pain  transcranial direct current stimulation  mirror therapy

摘要：

      摘要 目的：观察经颅直流电刺激（transcranial direct current stimulation， tDCS）、tDCS联合镜像疗法治疗脑卒中后肩手综合征的临床疗效。 方法：选择45例脑卒中后肩手综合征患者，分为联合组、tDCS组和常规组，每组15例。联合组在常规康复基础上增加tDCS联合镜像疗法；tDCS组在常规康复治疗的基础上增加tDCS治疗；常规组进行常规康复治疗，共治疗10天。治疗前后采用肩数字评定量表（shoulder -numerical rating scale， S-RNS）、手数字评定量表（hand-numerical rating scale，H-RNS）、患手水肿程度、Fugl-Meyer评定量表上肢部分（Fugl-Meyer assessment of upper extremity， FMA-UE）、改良 Barthel 指数（modified Barthel index， MBI）、肩手综合征评估量表（shoulder-hand syndrome scale， SHSS）对三组患者进行评估。 结果：与治疗前相比，联合组和tDCS组治疗后S-NRS、H-NRS评分、患手水肿程度、FMA-UE、MBI及SHSS评分显著改善（P<0.05），常规组S-NRS评分显著改善（P<0.05）。治疗后，联合组H-NRS评分较tDCS组、常规组显著降低（P<0.05），SHSS评分和MBI评分也优于常规组（P<0.05），tDCS组MBI评分较常规组显著增加（P<0.05）。 结论：tDCS可以改善脑卒中后肩手综合征临床症状，联合镜像疗法应用效果更佳。

Abstract:

      Abstract Objective： To observe the clinical efficacy of transcranial direct current stimulation （tDCS） and tDCS combined with mirror therapy in the treatment of shoulder-hand syndrome after stroke. Method： Forty-five patients with post-stroke shoulder-hand syndrome were divided into the combined group，tDCS group and the conventional group，with 15 cases in each group. In the combined group，tDCS combined with mirror therapy was added on the basis of routine rehabilitation. The tDCS group added tDCS treatment on the basis of routine rehabilitation treatment. The conventional group received routine rehabilitation treatment. The treatment lasted for 10 days. Before and after treatment， shoulder-numerical rating scale（S-RNS），hand-numerical rating scale（H-RNS），edema degree of affected hand， Fugl-Meyer assessment of upper extremity（FMA-UE），modified barthel index（MBI） and shoulder-hand syndrome scale（SHSS） were used to evaluate patients in the three groups. Result： Compared with before treatment， the S-NRS， H-NRS score， hand edema degree， FMA-UE， MBI and SHSS score in the combined group and tDCS group were significantly improved （P<0.05） after treatment， while the H-NRS score in conventional group was significantly improved （P<0.05）. After the treatment， the shoulder-NRS score of the combined group was significantly decreased and the SHSS and MBI score were also significantly increased, compared with that of the tDCS and conventional group （P<0.05）. The MBI score of the tDCS group was significantly increased compared with the conventional group （P<0.05）. Conclusion： tDCS can improve the clinical symptoms of post-stroke SHS， the combination of mirror therapy is more effective.