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

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。

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