经颅聚焦超声对脑卒中患者上肢运动功能的效应研究

关键词：脑卒中  神经康复  经颅聚焦超声  上肢功能

Keywords:stroke  neurorehabilitation  transcranial focused ultrasound  upper limb function

摘要：

      摘要 目的：探索经颅聚焦超声（transcranial focused ultrasound，tFUS） 对脑卒中患者上肢运动功能的效应。 方法：选取42例脑卒中患者，随机分为tFUS组和假刺激组，最终各20例完成治疗。两组均在常规康复基础上分别接受tFUS或假刺激，每周5次，共2周。记录治疗前后两组患者的Fugl-Meyer上肢运动功能（Fugl-Meyer assessment for upper extremity，FMA-UE）、上肢动作研究量表（action research arm test，ARAT）、美国国立卫生研究院卒中量表（National Institutes of Health Stroke scale of the United States，NIHSS）、改良Barthel指数（modified Barthel Index，MBI）的分值及双手握力，检测运动诱发电位（motor evoked potential，MEP）潜伏期，计算中枢运动传导时间（central motor conduction time，CMCT）。 结果：组内比较显示tFUS组在治疗后FMA-UE总分及手部得分、ARAT总分及各子项（抓、握、捏、粗大运动）、双手握力、NIHSS和MBI均显著改善；Sham组除ARAT抓、捏及健侧握力无明显变化（P＞0.05）外，其余指标均改善。tFUS组在FMA-UE、手部得分、患侧握力、ARAT总分及ARAT握、抓、捏部分治疗前后差值显著优于Sham组。进一步亚组分析ARAT≤47分患者，tFUS组在FMA-UE总分、手部运动得分、ARAT总分及抓、握、捏子项，以及患侧握力方面均优于Sham组（P<0.05）。此外，tFUS组治疗后的MEP潜伏期较Sham组显著缩短（P<0.05），CMCT在两组间无显著性差异（P＞0.05），但tFUS组MEP潜伏期、CMCT治疗前后差值均显著优于Sham组（P<0.001）。 结论：tFUS可改善脑卒中患者的上肢运动功能，尤其中度及以上上肢功能障碍患者，并促进皮质脊髓束恢复。

Abstract:

      Abstract Objective：To explore the effects of transcranial focused ultrasound （tFUS） on upper limb motor function in stroke patients. Method：A total of 42 stroke patients were enrolled and randomly assigned to the tFUS group or the sham stimulation group, with 20 patients in each group completing the study. Both groups received conventional rehabilitation combined with either tFUS or sham stimulation, five sessions per week for two weeks. Upper limb motor function, neurological impairment, and activities of daily living were assessed using the Fugl-Meyer assessment of the upper extremity(FMA-UE), action research arm test(ARAT), National Institutes of Health Stroke Scale (NIHSS), modified Barthel index (MBI), and bilateral handgrip strength. Motor evoked potential latency was recorded, and central motor conduction time (CMCT) was calculated. Result：Within-group analysis showed that the tFUS group exhibited significant improvements in FMA-UE total score, hand subscore, ARAT total score and ARAT subscores (grasp, grip, pinch, gross movement), affected and unaffected-side grip strength, NIHSS, and MBI after treatment. In the Sham group, ARAT grasp and pinch sub-scores, and unaffected-side grip strength did not improved(P>0.05). While other measures showed significant gains. Regarding pre-post differences, the tFUS group showed significantly greater improvements than the Sham group in FMA-UE total score, hand subscore, affected-side grip strength, ARAT total score, and ARAT grasp, grip, and pinch subscores (P<0.05). In the sub-group analysis of patients with baseline ARAT≤47, the tFUS group achieved greater improvements than the Sham group in FMA-UE total score, hand subscore, ARAT total score and subscores (grasp, grip, pinch), as well as affected-side grip strength (P<0. 05), and the pre-post differences showed similar results. Moreover, MEP latency was significantly shortened in the tFUS group compared with Sham group(P<0.05), whereas CMCT showed no difference between groups (P>0.05). However, the pre-post changes in both MEP latency and CMCT were significantly greater in the tFUS group than Sham group (P<0.001). Conclusion：tFUS can improve upper limb function and facilitate corticospinal tract recovery in stroke patients, especially in those with moderate to severe upper limb function impairment.