摘要
经皮耳迷走神经刺激(taVNS)已被证明能激活中枢神经系统中与侵入性迷走神经刺激相似的迷走神经投射,降低因手术带来的不良反应,并产生相似的甚至更大的临床疗效。近年来,有关taVNS对脑卒中的研究日益增多,结果显示其对运动感觉、吞咽、言语及认知、意识等功能障碍均有一定的疗效,大部分的研究集中在taVNS对脑卒中后上肢运动功能的研究,另有一些研究针对意识障碍及吞咽功能障碍,而有关taVNS在脑卒中后言语认知功能障碍及卒中后抑郁方面的研究较少。无论是在其他康复治疗之前应用或是与其他康复治疗同时应用,taVNS均可产生较好的疗效,其最佳参数的确定仍需要进一步的研究。taVNS促进脑卒中后功能恢复的机制尚不明确,现有研究提示的机制包括改善皮质兴奋性,增加皮层的可塑性,通过增加神经营养因子的分泌、抑制神经炎症等途径减轻神经细胞和血脑屏障的损伤,促进神经的修复和血管的再生。目前的研究结果表明,taVNS用于卒中后康复的辅助治疗是安全可行的,仅有轻度不良反应,在迄今为止的研究中测试的剂量具有良好的耐受性。未来,我们还需进行更深入的高水平研究来证实其疗效及揭示其更确切的作用机制。
Transcutaneous auricular vagus nerve stimulation(taVNS)has been proved to activate the vagus nerve projections in the central nervous system,which is similar to the invasive vagus nerve stimulation method,and thereby reduces the adverse reactions caused by surgery and produces similar or even greater clinical efficacy compared to the invasive vagal nerve stimulation.In recent years,researches on taVNS for stroke has been increasing,which have indicated that taVNS has certain therapeutic effects on motor sensation,swallowing,speech,cognition,consciousness,and other functional disorders.Most research has focused on taVNS'impact on upper limb motor function after stroke,while some other studies targeting consciousness and swallowing impairments.However,there is limited research on taVNS for post-stroke speech and cognitive impairments,as well as post-stroke depression.taVNS has shown promising efficacy whether applied before or simultaneously with other rehabilitation treatments.Further research is needed to determine the optimal parameters.The mechanism by which taVNS promotes functional recovery after stroke is not yet fully understood.The mechanisms suggested by existing research include improving cortical excitability and increasing cortical plasticity,reducing damage to nerve cells and blood-brain barrier through increasing the secretion of neurotrophic factors and inhibiting neuroinflammation,and promoting nerve repair and vascular regeneration.Current researches indicate that taVNS as an adjuvant therapy for post-stroke rehabilitation is safe and feasible,with only mild adverse reactions.The dosages tested in studies conducted so far have demonstrated good tolerability.In the future,we need to conduct more in-depth high-level research to confirm its efficacy and reveal its more precise mechanism.
作者
张立新
ZHANG Lixin(Shengjing Hospital of China Medical University,Shenyang,Liaoning 110134,China;The Second School of Clinical Medicine,Shenyang,Liaoning 110134,China)
出处
《康复学报》
CSCD
2024年第5期417-425,共9页
Rehabilitation Medicine
基金
国家重点研发计划项目(2020YFC2005700,2020YFC2007600)
辽宁省自然基金计划项目(2019-KF-01-06)。
关键词
经皮耳迷走神经刺激
脑卒中
功能障碍
神经康复
transcutaneous auricular vagus nerve stimulation
stroke
dysfunction
neurological rehabilitation
