文章摘要
李莎,李欣怡,白一凡,等.基于功能性近红外光谱成像技术观察重复经颅磁刺激对缺血性脑卒中患者脑皮质血流动力学的影响[J].中华物理医学与康复杂志,2024,46(12):1085-1090
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基于功能性近红外光谱成像技术观察重复经颅磁刺激对缺血性脑卒中患者脑皮质血流动力学的影响
  
DOI:10.3760/cma.j.cn421666-20240422-00301
中文关键词: 脑卒中  重复经颅磁刺激  功能性近红外光谱成像技术  运动皮质
英文关键词: Stroke  Transcranial magnetic stimulation  Functional near-infrared spectroscopy  Motor cortex
基金项目:天津市医学重点学科(TJYXZDXK-060B);天津市卫生健康科技项目重点学科专项(TJWJ2022XK007);天津市应用基础研究多元投入基金面上项目(21JCYBJC01610)
作者单位
李莎 天津医科大学总医院康复医学科天津 300052 
李欣怡 天津医科大学总医院康复医学科天津 300052 
白一凡 天津医科大学总医院康复医学科天津 300052 
赵丽 天津医科大学总医院康复医学科天津 300052 
王春燕 天津医科大学总医院康复医学科天津 300052 
万春晓 天津医科大学总医院康复医学科天津 300052 
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中文摘要:
      目的 采用功能性近红外光谱成像技术(fNIRS)观察重复经颅磁刺激(rTMS)对缺血性脑卒中患者脑皮质血流动力学的影响。 方法 按照2∶1比例随机将26例缺血性脑卒中后上肢运动障碍患者分为观察组(17例)及对照组(9例)。2组患者均给予常规康复干预,在此基础上观察组患者采用10 Hz高频rTMS刺激病灶侧辅助运动区(SMA),每日治疗1次,每次20 min,每周治疗5 d,持续治疗3周;对照组患者则同期给予rTMS假刺激治疗。于干预前、干预3周后采用Fugl-Meyer上肢运动功能量表(FMA-UE)评估患者上肢运动功能恢复情况,采用fNIRS技术检测干预前、后2组患者初级感觉运动皮质(SM1)、辅助运动皮质及前运动皮质(SMA+PMC)的氧合血红蛋白(HbO)浓度,采用Pearson相关性检验分析FMA-UE评分与HbO浓度间的相关性。 结果 干预后2组患者FMA-UE评分均较干预前显著增加(P<0.05),并且观察组FMA-UE评分的改善幅度亦显著优于对照组水平(P<0.05)。干预后观察组患者准备期通道20及任务期通道31的HbO浓度均较干预前显著增加(P<0.05),观察组任务期病灶对侧SM1及SMA+PMC的HbO浓度均较干预前显著降低(P<0.05)。通过Pearson相关性分析发现,干预前观察组任务期通道31的HbO浓度与FMA-UE评分改善值具有正相关性(r=0.617,P=0.008)。 结论 采用高频rTMS刺激病灶侧SMA能更好地改善缺血性脑卒中患者上肢运动功能,在促进病灶侧局部运动皮质激活同时,还能抑制对侧运动皮质兴奋,且通道31(位于病灶侧SM1区)的HbO浓度可能对疗效结果具有预测价值。
英文摘要:
      Objective To observe any effect of repetitive transcranial magnetic stimulation (rTMS) on the hemodynamics of the cerebral cortex after an ischemic stroke using functional near-infrared spectroscopy (fNIRS). Methods Twenty-six ischemic stroke survivors with upper limb motor dysfunction were assigned at random to an experimental group (n=17) or a control group (n=9). Both groups received conventional rehabilitation training, but the experimental group additionally received 20 minutes of rTMS at 10Hz applied over the supplementary motor area (SMA) of the affected side. The treatment was applied 5 times a week for 3 weeks. The control group received sham rTMS stimulation on the same schedule. Before and after the intervention, the motor function of the hemiplegic upper limb was evaluated in both groups using the Fugl-Meyer upper extremity assessment (FMA-UE). The concentration of oxyhemoglobin (HbO) in the primary sensorimotor cortex (SM1), the SMA and the premotor cortex (PMC) was measured using fNIRS. The FMA-UE scores were then tested for any significant correlation with the HbO concentrations. Results After the intervention, the average FMA-UE scores had increased significantly in both groups, with significantly greater improvement in the experimental group. Among the experimental group a significant increase was also observed in the HbO concentration in channel 20 during the preparation period and in channel 31 during the task period, along with a significant decrease in it in the CL-SM1 and CL-(SMA+PMC) during the task period. HbO concentration in channel 31 during the task period before the intervention was found to be significantly correlated with the changes in the experimental group′s FMA-UE scores. Conclusions High-frequency rTMS of the SMA on the affected side can improve the motor functioning of a hemiplegic upper limb, promote activation of the local motor cortex on the lesioned side, and inhibit activation of the contralateral motor cortex. HbO concentration in channel 31 may predict these therapeutic effects.
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