本文選題：腦梗死　切入點：雙側(cè)上肢訓練　出處：《成都體育學院》2017年碩士論文

【摘要】：研究目的:利用靜息態(tài)功能磁共振(Resting State Functional Magnetic Resonance Imaging,rs-fMRI)觀察腦梗死患者經(jīng)過雙側(cè)上肢訓練技術(shù)治療后上肢運動功能恢復情況,及觀察與其相匹配的臨床康復評定量表之間的關(guān)系,為腦梗死患者的康復提供理論及技術(shù)的支持。研究方法:對四川省人民醫(yī)院康復科的住院病人根據(jù)本實驗的篩選標準進行篩選,選出符合標準的20例患者,分為雙側(cè)上肢治療組10人(男6人,女4人),對照組10人(男5人,女5人)。所有患者都進行常規(guī)物理治療,作業(yè)治療,針灸等常規(guī)治療,單側(cè)和和雙側(cè)上肢訓練組在此基礎(chǔ)上再給予統(tǒng)一制定的上肢運動技術(shù)治療。訓練時長1個月,每天一次。所有患者于入院當日入院時進行上肢功能評分(Fugl-Meyer上肢運動功能評定)、常規(guī)T1WI(T1 weighted imaging,T1加權(quán)成像)、T2WI(T2 weighted imaging,T2加權(quán)成像)及靜息態(tài)功能磁共振掃描(rs-fMRI),在進行一個月的治療后,再次進行評定與掃描。將所收入的數(shù)據(jù)及圖像運用Matlab2012a軟件分析,測量所有患者治療前后患側(cè)初級運動皮層(primary motor cortex,M1)區(qū)的Reho值及Alff值,最后納入REST進行統(tǒng)計學分析。研究結(jié)果:1.經(jīng)過治療后,雙側(cè)上肢治療組和對照組所有患者在患側(cè)M1區(qū)的Reho激活都有所增加,雙側(cè)治療組增加更多(p0.05);2.雙側(cè)上肢治療組患側(cè)M1區(qū)的的Alff值較對照組更明顯的降低(p0.05);3.所有患者患者患側(cè)M1區(qū)的ReHo和Allf治療前后的變化值與臨床上肢功能評分(Fugl-Meyer)的治療前后變化都呈正相關(guān),與雙側(cè)上肢治療組的正相關(guān)性較明顯。雙側(cè)治療組的ΔReHo與ΔFugl-Meyer相關(guān)系數(shù)r=0.793(p=0.006),ΔAlff與ΔFugl-Meyer相關(guān)系數(shù)r=-0.837(p=0.003),對照組的ΔReHo與評分量表相關(guān)系數(shù)r=0.647(p=0.043),ΔAlff與ΔFugl-Meyer相關(guān)系數(shù)r=-0.764(p=0.01)。結(jié)論:雙側(cè)上肢訓練在對腦梗死患者上肢運動功能的康復比傳統(tǒng)的只針對單側(cè)上肢療法更有效;ReHo和Allf可以作為運用功能磁共振觀察腦梗死后上肢運動功能康復的指標。
[Abstract]:Objective: to observe the recovery of upper limb motor function after bilateral upper limb training in patients with cerebral infarction by resting State Functional Magnetic Resonance imagingrs-fMRI, and to observe the relationship between the corresponding clinical rehabilitation rating scales. To provide theoretical and technical support for the rehabilitation of patients with cerebral infarction. Methods: according to the screening criteria of this experiment, 20 patients with cerebral infarction were selected from the rehabilitation department of Sichuan Provincial people's Hospital. The patients were divided into bilateral upper limb treatment group (6 men, 4 women) and control group (5 men and 5 women). All patients were treated with routine physical therapy, occupational therapy, acupuncture and other routine treatment. On this basis, the unilateral and bilateral upper limb training groups were treated with unified upper limb motor techniques. The training time was 1 month. Once a day. All the patients were assessed with Fugl-Meyer upper limb motor function on admission day, and the routine T1WI(T1 weighted imagingT1-weighted imaging T _ 2WI _ I _ T _ 2 weighted imaging T _ 2 weighted imaging and resting functional magnetic resonance imaging were performed after one month's treatment. The data and images were analyzed by Matlab2012a software. The Reho and Alff values of primary motor cortexus M1 were measured in all patients before and after treatment. After treatment, the activation of Reho in the affected M1 region was increased in all the patients in the bilateral upper limb treatment group and the control group. The Alff value of M1 area in bilateral upper limb treatment group was significantly lower than that of control group. The changes of ReHo and Allf in the affected M1 area of all patients before and after treatment and the clinical upper limb function score were significantly lower than those in the control group. There was a positive correlation between the changes before and after treatment, The correlation coefficient between 螖 ReHo and 螖 Fugl-Meyer was 0.793p0.006, the correlation coefficient between 螖 Alff and 螖 Fugl-Meyer was r ~ (-0.837) p ~ (0.003), the correlation coefficient between 螖 ReHo and score scale was r 0.647 ~ (?) p 0.043, and the correlation coefficient between 螖 Alff and 螖 Fugl-Meyer was r ~ (-0.764) p ~ (0.01). Conclusion: bilateral upper limb training has a significant correlation with 螖 ReHo and 螖 Fugl-Meyer. Conclusion: bilateral upper extremity training is an important factor in bilateral upper extremity training, and the correlation coefficients of 螖 ReHo and 螖 Fugl-Meyer are 0. 647, p 0. 043, r = 0. 764, P = 0. 01, respectively. The rehabilitation of upper limb motor function in patients with cerebral infarction is more effective than traditional unilateral upper limb therapy. ReHo and Allf can be used as an index to observe the recovery of upper limb motor function after cerebral infarction with functional magnetic resonance imaging (fMRI).
【學位授予單位】：成都體育學院
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R743.33;R493

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