侵入性迷走神经电刺激联合康复训练治疗缺血性卒中后上肢运动功能障碍的可行性、疗效与安全性研究

doi:10.3969/j.issn.1673-5765.2025.09.004

中国卒中杂志 ›› 2025, Vol. 20 ›› Issue (9): 1097-1103.DOI: 10.3969/j.issn.1673-5765.2025.09.004

侵入性迷走神经电刺激联合康复训练治疗缺血性卒中后上肢运动功能障碍的可行性、疗效与安全性研究

栾伟*，魏达*，马超，张华伟，李铁民，彭玉涛，刘长青（*第一作者）

北京 100020 首都医科大学附属北京朝阳医院神经外科

收稿日期:2025-05-14 修回日期:2025-09-05 接受日期:2025-09-08 出版日期:2025-09-20 发布日期:2025-09-20
通讯作者: 刘长青 liuchangqing@ccmu.edu.cn
基金资助:
北京市自然科学基金-大兴创新联合基金（L256041）
北京慢性病防治与健康教育研究会、中关村人才协会医工领域“未来人才”培养计划（MBZX202502-0055）
北京朝阳医院2024年度金种子科研基金（CYJZ202427）

Study on the Feasibility, Efficacy, and Safety of Invasive Vagus Nerve Stimulation Combined with Rehabilitation Training for Upper Limb Motor Dysfunction after Ischemic Stroke

LUAN Wei*, WEI Da*, MA Chao, ZHANG Huawei, LI Tiemin, PENG Yutao, LIU Changqing (*contributed equally)

Department of Neurosurgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China

Received:2025-05-14 Revised:2025-09-05 Accepted:2025-09-08 Online:2025-09-20 Published:2025-09-20
Contact: LIU Changqing, E-mail: liuchangqing@ccmu.edu.cn

摘要/Abstract

摘要： 目的探讨侵入性迷走神经电刺激（invasive vagus nerve stimulation，iVNS）联合康复训练治疗缺血性卒中后上肢运动功能障碍的可行性、疗效与安全性。
方法回顾性分析2024年4—12月收治的缺血性卒中后上肢运动功能障碍患者资料，所有患者均接受左侧颈部iVNS植入并完成规范康复训练。刺激参数设定为频率30 Hz、脉冲宽度100 μs，每日累计刺激30 min，总疗程3个月。分别于术前、术后1个月及术后3个月采用Fugl-Meyer运动功能评定量表上肢部分（Fugl-Meyer motor assessment-upper extremity，FMA-UE）、改良Ashworth量表（modified Ashworth scale，MAS）进行患者上肢运动功能与肌张力的评估，并于术前和术后3个月采用汉密尔顿焦虑量表（Hamilton anxiety scale，HAMA）及汉密尔顿抑郁量表（Hamilton depression scale，HAMD）评估患者的焦虑和抑郁状态，同时记录治疗相关不良事件。采用描述性统计方法进行数据分析。
结果本研究共纳入5例男性患者，年龄41～73岁，均存在缺血性卒中后上肢运动功能障碍。术前FMA-UE评分为0～52分，MAS分级为0～3级，部分患者伴有轻中度焦虑和抑郁。随访结果显示，4例轻中度上肢运动功能障碍患者在术后1个月及术后3个月时，FMA-UE评分较术前升高，MAS分级较术前降低，HAMA和HAMD评分术后3个月呈降低趋势，提示患者上肢运动功能与肌张力改善，焦虑和抑郁状态也有所缓解，其中部分患者的手部精细功能出现改善。1例术前为完全瘫痪（术前FMA-UE评分为0分）的患者，随访期间上肢运动功能无明显改善。所有患者在治疗过程中均未发生感染、局部血肿、心律失常等严重不良事件。
结论 iVNS联合康复训练在本研究中展现出了可实施性与安全性；其疗效在轻中度患者中呈改善趋势，但重度患者的获益有限。

文章导读： 本研究探讨了侵入性迷走神经电刺激联合康复训练治疗缺血性卒中后上肢运动功能障碍的疗效，为轻中度上肢运动功能障碍患者的康复训练提供了新思路。

关键词: 侵入性迷走神经电刺激; 缺血性卒中; 上肢运动功能障碍; 康复训练

Abstract: Objective To explore the feasibility, efficacy, and safety of invasive vagus nerve stimulation (iVNS) combined with rehabilitation training for upper limb motor dysfunction after ischemic stroke.
Methods A retrospective analysis was conducted on the data from patients with upper limb motor dysfunction after ischemic stroke who were admitted between April and December 2024. All patients underwent left cervical iVNS implantation and completed standardized rehabilitation training. The stimulation parameters were set at a frequency of 30 Hz, a pulse width of 100 μs, with a daily cumulative stimulation duration of 30 minutes for a total treatment duration of 3 months. The upper limb motor function and muscle tone of patients were assessed using the Fugl-Meyer motor assessment-upper extremity (FMA-UE) and the modified Ashworth scale (MAS), respectively before surgery, 1 month after surgery, and 3 months after surgery. Additionally, the Hamilton anxiety scale (HAMA) and the Hamilton depression scale (HAMD) were used to assess patients’ anxiety and depression status before surgery and 3 months after surgery. Treatment-related adverse events were also recorded. Descriptive statistical methods were used for data analysis.
Results A total of five male patients aged 41-73 years were included in this study, all of whom had upper limb motor dysfunction after ischemic stroke. Preoperative FMA-UE scores ranged from 0 to 52, and MAS grades ranged from 0 to 3. Some patients presented with mild to moderate anxiety and depression. Follow-up results showed that four patients with mild to moderate upper limb motor dysfunction had increased FMA-UE scores and decreased MAS grades at 1 month and 3 months after surgery compared with preoperative values, and their HAMA and HAMD scores showed a decreasing trend at 3 months after surgery, suggesting improvements in upper limb motor function, muscle tone, anxiety and depression status. Some of these patients also exhibited improvements in hand fine motor function. One patient with complete paralysis at baseline (preoperative FMA-UE score=0) showed limited improvement in upper limb motor function during follow-up. No severe adverse events such as infection, hematoma, or arrhythmia were observed during treatment.
Conclusions In this study, iVNS combined with rehabilitation training showed feasibility and preliminary safety. Its efficacy showed a trend toward improvement in patients with mild to moderate symptoms, while those with severe symptoms had limited benefits.

Key words: Invasive vagus nerve stimulation; Ischemic stroke; Upper limb motor dysfunction; Rehabilitation training

中图分类号:

R74
R318

栾伟, 魏达, 马超, 张华伟, 李铁民, 彭玉涛, 刘长青. 侵入性迷走神经电刺激联合康复训练治疗缺血性卒中后上肢运动功能障碍的可行性、疗效与安全性研究[J]. 中国卒中杂志, 2025, 20(9): 1097-1103.

LUAN Wei, WEI Da, MA Chao, ZHANG Huawei, LI Tiemin, PENG Yutao, LIU Changqing. Study on the Feasibility, Efficacy, and Safety of Invasive Vagus Nerve Stimulation Combined with Rehabilitation Training for Upper Limb Motor Dysfunction after Ischemic Stroke[J]. Chinese Journal of Stroke, 2025, 20(9): 1097-1103.

参考文献

[1] CHENG F Q，CHENG P Y，XIE S D，et al. Epidemiological trends and age-period-cohort effects on ischemic stroke burden across the BRICS-plus from 1992 to 2021[J/OL]. BMC Public Health，2025，25：137[2025-08-30]. https://doi.org/10.1186/s12889-025-21310-9.
[2] CHEN L，GAO H X，WANG Z P，et al. Vagus nerve electrical stimulation in the recovery of upper limb motor functional impairment after ischemic stroke[J]. Cogn Neurodyn，2024，18（5）：3107-3124.
[3] THAYABARANATHAN T，KIM J，CADILHAC D A，et al. Global stroke statistics 2022[J]. Int J Stroke，2022，17（9）：946-956.
[4] ZHANG J，ZHOU F Y，ROBERTS N，et al. Invasive or non-invasive vagus nerve stimulation modulation of brain function and remodeling after stroke：a review[J]. Int J Surg，2025，111（2）：2148-2161.
[5] HAYAT H，REGEV N，MATOSEVICH N，et al. Locus coeruleus norepinephrine activity mediates sensory-evoked awakenings from sleep[J/OL]. Sci Adv，2020，6（15）：eaaz4232[2025-08-30]. https://doi.org/10.1126/sciadv.aaz4232.
[6] PORTER B A，KHODAPARAST N，FAYYAZ T，et al. Repeatedly pairing vagus nerve stimulation with a movement reorganizes primary motor cortex[J]. Cereb Cortex，2012，22（10）：2365-2374.
[7] DAWSON J，LIU C Y，FRANCISCO G E，et al. Vagus nerve stimulation paired with rehabilitation for upper limb motor function after ischaemic stroke（VNS-REHAB）：a randomised，blinded，pivotal，device trial[J]. Lancet，2021，397（10284）：1545-1553.
[8] POWERS W J，RABINSTEIN A A，ACKERSON T，et al. Guidelines for the early management of patients with acute ischemic stroke：2019 update to the 2018 guidelines for the early management of acute ischemic stroke：a guideline for healthcare professionals from the American Heart Association/American Stroke Association[J/OL]. Stroke，2019，50（12）：e344-e418[2025-08-30]. https://doi.org/10.1161/STR.0000000000000211.
[9] FUGL-MEYER A R，JAASKO L，LEYMAN I，et al. The post-stroke hemiplegic patient. 1. A method for evaluation of physical performance[J]. Scand J Rehabil Med，1975，7（1）：13-31.
[10] LIN S Y，RODRIGUEZ C O，WOLF S L. Vagus nerve stimulation paired with upper extremity rehabilitation for chronic ischemic stroke：contribution of dosage parameters[J]. Neurorehabil Neural Repair，2024，38（8）：607-615.
[11] MAIER W，BULLER R，PHILIPP M，et al. The Hamilton anxiety scale：reliability，validity and sensitivity to change in anxiety and depressive disorders[J]. J Affect Disord，1988，14（1）：61-68.
[12] HAMILTON M. A rating scale for depression[J]. J Neurol Neurosurg Psychiatry，1960，23（1）：56-62.
[13] MEYERS E C，KASLIWAL N，SOLORZANO B R，et al. Enhancing plasticity in central networks improves motor and sensory recovery after nerve damage[J/OL]. Nat Commun，2019，10：5782[2025-08-30]. https://doi.org/10.1038/s41467-019-13695-0.
[14] XIA X M，DUAN Y，WANG Y P，et al. Vagus nerve stimulation as a promising neuroprotection for ischemic stroke via α7nAchR-dependent inactivation of microglial NLRP3 inflammasome[J]. Acta Pharmacol Sin，2024，45（7）：1349-1365.
[15] HAYS S A，KHODAPARAST N，RUIZ A，et al. The timing and amount of vagus nerve stimulation during rehabilitative training affect poststroke recovery of forelimb strength[J]. Neuroreport，2014，25（9）：676-682.
[16] TSENG C T，GAULDING S J，DANCEL C L E，et al. Local activation of α2 adrenergic receptors is required for vagus nerve stimulation induced motor cortical plasticity[J/OL]. Sci Rep，2021，11（1）：21645[2025-08-30]. https://doi.org/10.1038/s41598-021-00976-2.
[17] FRANCISCO G E，ENGINEER N D，DAWSON J，et al. Vagus nerve stimulation paired with upper-limb rehabilitation after stroke：2- and 3-year follow-up from the pilot study[J]. Arch Phys Med Rehabil，2023，104（8）：1180-1187.
[18] VORA I，GOCHYYEV P，ENGINEER N，et al. Distal versus proximal arm improvement after paired vagus nerve stimulation therapy after chronic stroke[J]. Arch Phys Med Rehabil，2024，105（9）：1709-1717.
[19] WEE S K，HUGHES A M，WARNER M B，et al. Effect of trunk support on upper extremity function in people with chronic stroke and people who are healthy[J]. Phys Ther，2015，95（8）：1163-1171.
[20] WU C Y，CHEN Y A，LIN K C，et al. Constraint-induced therapy with trunk restraint for improving functional outcomes and trunk-arm control after stroke：a randomized controlled trial[J]. Phys Ther，2012，92（4）：483-492.

侵入性迷走神经电刺激联合康复训练治疗缺血性卒中后上肢运动功能障碍的可行性、疗效与安全性研究

Study on the Feasibility, Efficacy, and Safety of Invasive Vagus Nerve Stimulation Combined with Rehabilitation Training for Upper Limb Motor Dysfunction after Ischemic Stroke

PDF

可视化

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 15

编辑推荐

Metrics

[1]	解正绮, 宋晓微. ICAS所致急性缺血性卒中的斑块特征与发病机制关系研究[J]. 中国卒中杂志, 2025, 20(9): 1104-1112.
[2]	柴昌, 胡全忠. 红细胞压积与海拔梯度对中高海拔地区轻型缺血性卒中患者卒中后睡眠障碍的影响研究[J]. 中国卒中杂志, 2025, 20(9): 1113-1120.
[3]	苗连海, 陈继群, 宋诗涛, 杨志勇, 赵辉. 基于GDS-15评价老年卒中后抑郁状态的影响因素及其纵向分析[J]. 中国卒中杂志, 2025, 20(9): 1131-1136.
[4]	侯志凯, 何子骏, 于洮, 沈晨阳, 王嵘, 马宁. 经颈动脉血运重建术治疗颈动脉狭窄1例并文献分析[J]. 中国卒中杂志, 2025, 20(9): 1179-1185.
[5]	濮月华, 董培, 荆京, 董可辉, 李子孝, 龚浠平. 当急性缺血性卒中遇上“栓子雨”[J]. 中国卒中杂志, 2025, 20(9): 1193-1197.
[6]	李欢, 于向明. 急性缺血性卒中DWI-FLAIR不匹配影像学判读研究进展[J]. 中国卒中杂志, 2025, 20(9): 1198-1202.
[7]	卢肖, 张玉梅, 陈心雅. 卒中后感觉性失语症患者语言功能与非语言认知功能的相关性[J]. 中国卒中杂志, 2025, 20(8): 985-991.
[8]	刘安利, 薛茜, 杨金水, 苗瑞瑞, 王欢欢. 抽吸取栓与支架取栓治疗急性缺血性卒中有效性及安全性的meta分析[J]. 中国卒中杂志, 2025, 20(8): 992-1005.
[9]	李子恒, 刘毅. 急性缺血性卒中静脉溶栓后早期抗血小板治疗的研究现状与展望[J]. 中国卒中杂志, 2025, 20(8): 1042-1050.
[10]	朱霄宇, 周凡敬, 徐运, 张梅娟. 脑微出血分布模式与缺血性卒中的关联研究进展[J]. 中国卒中杂志, 2025, 20(8): 1051-1057.
[11]	熊俞婷, 程爱春, 尹金风, 李子孝, 王春娟, 张静. BMI与急性缺血性卒中静脉溶栓患者院内结局的关系——基于中国卒中中心联盟登记数据库的分析[J]. 中国卒中杂志, 2025, 20(8): 1066-1072.
[12]	杨志进, 谭荃丹, 毛凤凯, 李朝晖, 陈晨, 李刚, 杨杰, 林亚鹏. 急性缺血性卒中超早期血压管理研究进展[J]. 中国卒中杂志, 2025, 20(7): 829-839.
[13]	石艳萍, 罗颜, 朱龙海, 时代, 曹勇军, 石际俊. 茎突综合征与缺血性卒中：罕见但必须重视的病因[J]. 中国卒中杂志, 2025, 20(7): 917-922.
[14]	王赟, 米亚儒, 邓荷萍, 张博. 颈动脉脉搏波传导速度及血清Lp-PLA2、NRG-1与伴高血压的急性缺血性卒中的关系[J]. 中国卒中杂志, 2025, 20(6): 718-727.
[15]	郭莉, 宋欣同, 张冠一, 张倩, 鞠奕, 赵性泉. 颈动脉蹼的超声特征与缺血性卒中的关系[J]. 中国卒中杂志, 2025, 20(6): 728-733.