卒中后偏瘫患者桡侧腕屈肌H反射测定指标的信度分析
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上海市科学技术委员会科研计划项目(14401932000,16411965100)


Reliability analysis of H reflex measurement index of radial flexor carpi in hemiplegic patients after stroke
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    摘要:

    目的 研究脑卒中后偏瘫患者上肢H反射的3 个测定指标[H反射最大波幅和最大M 波 比值(Hmax/Mmax)、H反射回归线斜率和M 波回归线斜率比(Hslp/Mslp)及H反射激活后抑制(PAD)]信度,及 其与患者临床评定的相关性,选择可靠的H反射测定指标。方法 选择2016 年1— 8 月在首都医科大学 宣武医院康复医学科住院的符合纳入标准的脑卒中恢复期偏瘫患者15 例。对患者偏瘫侧正中神经所 支配桡侧腕屈肌(FCR)进行连续2 d的H反射检查,测定3个检测指标,使用组内相关系数检验指标信度。 同时使用改良Ashworth 痉挛量表(MAS)、Fugl-Meyer 量表(FMA)、Brunnstrom 分期进行临床评定,对H 反 射3 个测定结果和临床评定结果进行相关性分析。结果 Hmax/Mmax 测定信度最好,ICC=0.88;Hslp/Mslp 的 信度其次,ICC=0.85;而PAD的信度最低,ICC=0.2。Hmax/Mmax、Hslp/Mslp 和临床上MAS、FMA、Brunnstrom 分期均无相关性。结论 卒中后偏瘫患者患侧FCR 的Hmax/Mmax 和Hslp/Mslp 信度最好,可以作为H反射测 定的可靠指标。

    Abstract:

    Objective To study the reliability of 3 indexes of upper limb H reflex in hemiplegic patients after stroke, including the maximum amplitude of H reflex and the ratio of maximum M wave( Hmax/ Mmax), Slope of H reflex regression line and slope ratio of M wave regression line( Hslp / Mslp) and post-activation depression( PAD). To explore the correlation between the indexes and paitent clinical assessment, so as to select a reliable H-reflex measurement. Methods A total of 15 stroke convalescent hemiplegic patients hospitalized in the Department of Rehabilitation Medicine, Capital Medical University from January to August 2016 were recruited in this study. The flexor carpi radialis( FCR) innervated by the median nerve of the hemiplegic side was examined by H-reflex for 2 consecutive days. The reliability of the three indexes was tested by intra-group correlation coefficient. At the same time, the clinical evaluation was carried out by using the modified Ashworth Spasm Scale( MAS), Fugl-Meyer Scale( FMA) and Brunnstrom Staging. The correlation between the results of three H reflex test results and clinical evaluation was analyzed. Results Of the three measurements, Hmax/Mmax was the best measurement in reliability, with ICC of 0.88. The next was Hslp/Mslp (ICC=0.85). The reliability of PAD was the lowest( ICC=0.2). There was no statistical correlation among Hmax/Mmax, Hslp/Mslp and clinical MAS, FMA, Brunnstrom staging. Conclusions The reliability of Hmax/Mmax and Hslp/Mslp on the affected side of FCR in post-stroke patients is the best, which can be used as a reliable index for H reflex measurements.

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刘秀贞,刘静,张艳明,等.卒中后偏瘫患者桡侧腕屈肌H反射测定指标的信度分析[J].神经疾病与精神卫生,2018,18(10):697-703. DOI:10.3969/j. issn.1009-6574.2018.10.004.

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  • 在线发布日期: 2018-04-19