【摘要】：目的探討雙側(cè)肢體訓(xùn)練對(duì)腦卒中患者運(yùn)動(dòng)功能恢復(fù)的效果。方法按照入選標(biāo)準(zhǔn)和排除標(biāo)準(zhǔn)選取2015年10月至2016年9月華北理工大學(xué)附屬醫(yī)院康復(fù)醫(yī)學(xué)科收治的60例腦卒中偏癱患者,將入選病例按病變性質(zhì)分層,層內(nèi)按單純隨機(jī)法(隨機(jī)數(shù)字表法)進(jìn)行分組,每組30例,偶數(shù)為單側(cè)訓(xùn)練組,進(jìn)行傳統(tǒng)的患側(cè)肢體康復(fù)訓(xùn)練,奇數(shù)為雙側(cè)訓(xùn)練組,進(jìn)行雙側(cè)肢體訓(xùn)練。雙側(cè)訓(xùn)練組進(jìn)行常規(guī)康復(fù)訓(xùn)練和健側(cè)肢體的康復(fù)訓(xùn)練。兩組患者訓(xùn)練的時(shí)間頻率相同,每次訓(xùn)練45分鐘(單側(cè)訓(xùn)練組只訓(xùn)練患肢,雙側(cè)訓(xùn)練組進(jìn)行30分鐘的患側(cè)訓(xùn)練,再進(jìn)行15分鐘的健側(cè)肢體訓(xùn)練),每天訓(xùn)練1次,每周5天,連續(xù)4周。采用運(yùn)動(dòng)功能評(píng)定量表(MAS)、Fugl-Meyer運(yùn)動(dòng)功能評(píng)分量表(FMA)以及DELSYS表面肌電圖儀的最大自主收縮值(MVC)、隨意收縮狀態(tài)下的積分肌電(i EMG)以及均方根(RMS)在訓(xùn)練前和四周后進(jìn)行測(cè)量,來(lái)評(píng)估患者的康復(fù)效果。表面肌電測(cè)試腦卒中患者患側(cè)三角肌、肱二頭肌、肱三頭肌、股直肌、股二頭肌和脛前肌。結(jié)果1治療前MAS評(píng)分雙側(cè)訓(xùn)練組與單側(cè)訓(xùn)練組相比,無(wú)顯著性差異(P0.05),表明兩組在入組時(shí)MAS具有可比性。經(jīng)過(guò)四周的康復(fù)訓(xùn)練,兩組患者M(jìn)AS得分較治療前顯著提高(P0.05),且雙側(cè)訓(xùn)練組分?jǐn)?shù)提高幅度大于單側(cè)訓(xùn)練組(P0.05)。2治療前雙側(cè)訓(xùn)練組和單側(cè)訓(xùn)練組患者FMA評(píng)分比較無(wú)顯著性差異(P0.05),經(jīng)四周康復(fù)訓(xùn)練后,兩組患者FMA得分較治療前明顯提高(P0.05),雙側(cè)訓(xùn)練組提高值雖大于單側(cè)訓(xùn)練組,但兩組分?jǐn)?shù)提高值比較無(wú)明顯差異(P=0.185)。3治療前兩組患者患側(cè)三角肌、肱二頭肌、肱三頭肌、股直肌、股二頭肌和脛前肌的MVC比較無(wú)明顯差異(P0.05),四周的康復(fù)訓(xùn)練后,兩組患者的三角肌、肱二頭肌、肱三頭肌、股直肌、股二頭肌和脛前肌的MVC較治療前明顯提高(P0.05),雙側(cè)訓(xùn)練組這六塊肌肉MVC提高幅度優(yōu)于單側(cè)訓(xùn)練組(P0.05)。4治療前雙側(cè)訓(xùn)練組和單側(cè)訓(xùn)練組患者患側(cè)三角肌、肱二頭肌、肱三頭肌、股直肌、股二頭肌和脛前肌的i EMG比較無(wú)明顯差異(P0.05),四周的康復(fù)訓(xùn)練后,兩組患者患側(cè)三角肌、肱二頭肌、肱三頭肌、股直肌、股二頭肌和脛前肌的i EMG較治療前明顯升高(P0.05),雙側(cè)訓(xùn)練組這六塊肌肉i EMG的提高幅度大于單側(cè)訓(xùn)練組(P0.05)。5治療前雙側(cè)訓(xùn)練組和單側(cè)訓(xùn)練組患者患側(cè)三角肌、肱二頭肌、肱三頭肌、股直肌、股二頭肌和脛前肌的RMS比較無(wú)明顯差異(P0.05),四周的康復(fù)訓(xùn)練后,兩組患者患側(cè)三角肌、肱二頭肌、肱三頭肌、股直肌、股二頭肌和脛前肌的RMS值較治療前明顯提高(P0.05),雙側(cè)訓(xùn)練組這六塊肌肉RMS提高幅度大于單側(cè)訓(xùn)練組(P0.05)。結(jié)論腦卒中患者的雙側(cè)肢體訓(xùn)練可促進(jìn)其運(yùn)動(dòng)功能恢復(fù),且效果優(yōu)于傳統(tǒng)患側(cè)肢體訓(xùn)練,對(duì)腦卒中患者進(jìn)行健側(cè)肢體訓(xùn)練有助于患側(cè)肢體運(yùn)動(dòng)功能的恢復(fù)。
[Abstract]:Objective to investigate the effect of bilateral limb training on motor function recovery in stroke patients. Methods from October 2015 to September 2016, 60 patients with stroke hemiplegia treated in the Department of Rehabilitation Medicine, affiliated Hospital of Huabei Polytechnic University, were selected according to the selection criteria and exclusion criteria. The selected cases were stratified according to the nature of the lesion. There were 30 cases in each group, the even number was one side training group, the traditional rehabilitation training of the affected side limbs was carried out, the odd number was bilateral training group, and the bilateral limb training group was carried out. Bilateral training group received routine rehabilitation training and contralateral limb rehabilitation training. The two groups were trained for 45 minutes each time (the unilateral training group only trained the affected limbs, the bilateral training group carried out 30 minutes of diseased side training and 15 minutes of healthy limb training), and the patients were trained once a day, 5 days a week. 4 weeks in a row. Using the motor function rating scale (MAS), Fugl-Meyer motor function scale (FMA) and the DELSYS surface electromyography to measure the maximum spontaneous contraction value (MVC), The integral electromyoelectric (i EMG) and root mean square (RMS) (RMS) were measured before and four weeks after training to evaluate the rehabilitation effect of the patients. Surface electromyography was performed on the affected deltoid, biceps, triceps, rectus femoris, biceps femoris and anterior tibial muscles of stroke patients. Results 1 there was no significant difference in MAS score between the bilateral training group and the unilateral training group before treatment (P0.05), indicating that MAS was comparable between the two groups when entering the group. After four weeks of rehabilitation training, the MAS scores of the two groups were significantly higher than those before treatment (P0.05). The scores of bilateral training group were significantly higher than that of unilateral training group (P0.05). 2 there was no significant difference in FMA score between bilateral training group and unilateral training group before treatment (P0.05). The FMA score of the two groups was significantly higher than that of the control group (P0.05). Although the improvement value of bilateral training group was higher than that of the unilateral training group, there was no significant difference between the two groups (P < 0.185). There was no significant difference in MVC between biceps, triceps, rectus, biceps, biceps and anterior tibialis (P0.05). After four weeks of rehabilitation training, the deltoid, biceps, triceps, rectus femoris, and rectus femoris were found in the two groups. The MVC of biceps femoris and anterior tibialis muscle was significantly higher than that of pre-treatment (P0.05). The increase of MVC in bilateral training group was better than that in unilateral training group (P0.05). The I EMG of biceps, triceps, rectus, biceps, biceps and anterior tibial muscles were not significantly different (P0.05). After four weeks of rehabilitation training, the patients in the two groups suffered from bilateral deltoid muscle, biceps brachii muscle, triceps brachii muscle, rectus femoris muscle. I EMG of biceps femoris and anterior tibialis muscle was significantly higher than that before treatment (P0.05). The increase of I EMG in these six muscles in bilateral training group was higher than that in unilateral training group (P0.05). 5 patients in bilateral training group and unilateral training group had affected deltoid muscle, biceps brachii muscle, triceps muscle, rectus femoris muscle before treatment. There was no significant difference in RMS between biceps femoris muscle and anterior tibial muscle (P0.05). After four weeks of rehabilitation training, the patients in the two groups suffered from bilateral deltoid muscle, biceps brachii muscle, triceps brachii muscle, rectus femoris muscle. The RMS value of biceps femoris and anterior tibialis muscle was significantly higher than that before treatment (P0.05). The increase of RMS in bilateral training group was higher than that in unilateral training group (P0.05). Conclusion bilateral limb training can promote the recovery of motor function in stroke patients, and the effect is better than that of traditional limb training.
【學(xué)位授予單位】：華北理工大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R743.3

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