作者：章金蓉，包凤岐，费惠慧，潘洁，陈兰，何俊

单位：

1.213000 江苏省常州市德安医院康复科 2.213000 江苏省常州市中医医院院感科 通信作者：包凤岐，E-mail：freedom315@126.com

Units：

1.Department of Rehabilitation, Changzhou Dean Hospital, Changzhou 213000, China 2.Department of Hospital Infection-control, Changzhou Hospital of Traditional Chinese Medicine, Changzhou 213000, China Corresponding author: BAO Fengqi, E-mail: freedom315@126.com

关键词：

卒中; 非特异性腰痛; 四肢联动训练; 心肺运动试验;

Keywords：

Stroke; Nonspecific low back pain; Limb linkage training; Cardiopulmonary exercise test

CLC：

DOI：

10.12114/j.issn.1008-5971.2022.00.013

Funds：

常州市卫计委青年人才科技项目（QN201827）

摘要：

背景脑卒中后非特异性腰背痛(NLBP)发病率较高,极大影响患者功能恢复和生活质量;当前脑卒中后NLBP的治疗手段单一,以口服镇痛类药物为主,长期服用不良反应明显。脑卒中后NLBP与肢体平衡和运动障碍密切相关,而心肺运动试验(CPET)指导下四肢联动训练正是改善肢体平衡和运动障碍的有效方法。目的探讨CPET指导下四肢联动训练治疗脑卒中后NLBP的效果。方法选取2019年10月至2020年12月在常州市德安医院康复中心就诊的脑卒中后NLBP患者60例,采用随机数字表法分为对照组30例、观察组30例。对照组有2例患者、观察组有1例患者中途自行退出本研究,最终纳入患者57例,其中对照组28例、观察组29例。对照组给予常规康复训练,观察组在常规康复训练基础上增加CPET指导下四肢联动训练,持续训练6周。比较两组患者训练前后视觉模拟评分法(VAS)评分、两侧腹直肌与腰段腰段竖脊肌平均功率频率(MPF)、Berg平衡量表(BBS)评分、FuglMeyer运动功能评定量表(FMAS)评分以及步态参数。结果训练后两组患者静息、步行状态下VAS评分分别低于本组训练前,且观察组患者静息、步行状态下VAS评分低于对照组(P <0.05)。训练后两组患者患侧及健侧腹直肌、腰段竖脊肌MPF分别高于本组训练前,且观察组患者患侧及健侧腹直肌、腰段竖脊肌MPF高于对照组(P <0.05)。训练后两组患者BBS及FMAS上肢部分、下肢部分评分分别高于本组训练前,且观察组患者FMAS上肢部分、下肢部分评分高于对照组(P <0.05)。训练后两组患者步幅、步频、步速、健侧摆动相/患侧摆动相分别高于本组训练前,步长偏差、健侧支撑相/患侧支撑相分别低于本组训练前,且观察组患者步幅、步频、步速、健侧摆动相/患侧摆动相高于对照组,步长偏差、健侧支撑相/患侧支撑相低于对照组(P <0.05)。结论在常规康复训练基础上增加CPET指导下四肢联动训练,能有效缓解脑卒中后NLBP患者的腰背痛,这可能与CPET指导下四肢联动训练更有助于改善患者上肢、下肢运动功能以及步态对称性,从而减少躯干代偿、减轻腰背部肌群疲劳有关。

Abstract：

【Abstract】　Background The incidence of nonspecific low back pain (NLBP) after stroke is high, which greatlyaffects patients' functional recovery and quality of life. Moreover, the current treatment of NLBP after stroke is single, mainly oralanalgesics, and long-term adverse reactions are obvious. After stroke, NLBP is closely related to limb balance and movementdisorder, and limb linkage training guided by cardiopulmonary exercise test (CPET) is an effective method to improve limb balanceand movement disorder.Objective To investigate the effect of limb linkage training guided by CPET on NLBP after stroke.MethodsA total of 60 patients with NLBP after stroke who were admitted to Rehabilitation Center of Changzhou Dean Hospitalfrom October 2019 to December 2020 were selected and divided into control group (n=30) and observation group (n=30) byrandom number table method. Two patients of control group and 1 patient of observation group exited during the study. Eventuallythere were 57 patients included in the study (28 patients in the control group, 29 patients in the observation group) . The controlgroup was given routine rehabilitation training, and the observation group was given limb linkage training guided by CPET onthe basis of routine rehabilitation training. The training lasted for 6 weeks. Visual Analogue Scale (VAS) scores, mean powerfrequency (MPF) of bilateral rectus abdominis and lumbar erector spine muscles, Berg Balance Scale (BBS) scores, Fugl-MeyerAssessment Scale (FMAS) scores and gait parameters were compared between the two groups before and after training. ResultsAfter training, VAS scores in resting and walking state in the two groups were lower than those before training, respectively,and VAS scores in resting and walking statee in the observation group were lower than those in the control group (P< 0.05) . Aftertraining, the MPF of bilateral rectus abdominis and lumbar erector spine muscles of patients in the two groups were higher thanthose before training, respectively, and the MPF of bilateral rectus abdominis and lumbar erector spine muscles of patients in theobservation group were higher than those in the control group (P< 0.05) . After training, the BBS, FMAS upper limb and lowerlimb scores of patients in the two groups were higher than before training, respectively, and FMAS upper limb and lower limbscores of patients in the observation group were higher than those in the control group (P< 0.05) . After training, stride length,stride frequency, step speed, healthy side swing phase/affected side swing phase in the two groups were higher than those beforetraining, step length deviation, healthy side stance phase/affected stance phase were lower than those before training, respectively,and stride length, stride frequency, step speed and healthy side swing phase/affected side swing phase of the observation groupwere higher than those of the control group, step length deviation, healthy side stance phase/affected side stance phase were lowerthan those of the control group (P< 0.05) . Conclusion The addition of limb linkage training guided by CPET on the basis ofroutine rehabilitation training can effectively relieve low back pain in patients with NLBP after stroke, which may be related to thefact that limb linkage training guided by CPET can improve the motor function of upper and lower limbs and gait symmetry, thusreduce trunk compensation and lumbar muscle group fatigue.

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