崔汶轩,王春方,陈佳琪,等.高频经颅磁刺激对缺血性脑卒中患者上肢功能及其脑电功率谱密度的影响[J].中华物理医学与康复杂志,2025,47(11):978-983
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| 高频经颅磁刺激对缺血性脑卒中患者上肢功能及其脑电功率谱密度的影响 |
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| DOI：10.3760/cma.j.cn421666-20250425-00364 |
| 中文关键词: 经颅磁刺激 脑卒中 代偿模型 上肢功能 |
| 英文关键词: Transcranial magnetic stimulation Stroke Compensation models Upper limb function |
| 基金项目:国家自然科学基金(82102652)；天津市自然科学基金重点项目(23JCZDJC01230，22JCZDJC00060)；天津市中西医结合重点专科（ZDZKKF03） |
| 作者 | 单位 | | 崔汶轩 | 天津中医药大学研究生院,天津 301617 | | 王春方 | 天津市人民医院,南开大学第一附属医院康复科,天津 300121
天津市康复医学研究所,天津 300121 | | 陈佳琪 | 天津中医药大学研究生院,天津 301617 | | 韩倪 | 天津中医药大学研究生院,天津 301617 | | 郑羿婕 | 天津体育学院运动健康学院,天津 301617 | | 张颖 | 天津市人民医院,南开大学第一附属医院康复科,天津 300121
天津市康复医学研究所,天津 300121 |
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| 中文摘要: |
| 目的 基于半球代偿模型观察不同频率重复经颅磁刺激（rTMS）刺激健侧大脑对缺血性脑卒中后患者中重度上肢运动功能障碍及其脑电功率谱密度的影响。 方法 募集缺血性脑卒中患者30例，按随机数字表法随机分为假刺激组9例，高频组11例，低频组10例。3组患者均接受相同的物理治疗和同种类药物治疗，低频刺激组在常规康复治疗的基础上增加低频rTMS（1 Hz），高频刺激组在常规康复治疗的基础上增加高频rTMS（5 Hz），假刺激组则仅增加rTMS假刺激。3组患者均于健侧大脑施加rTMS，每日1次，每次20 min，连续治疗15 d。于治疗前、治疗7 d后和治疗15 d后采用Fugl-Meyer运动功能评定上肢部分（FMA-UE）和改良的Barthel指数（MBI）分别评估3组患者上肢运动功能和日常生活活动能力（ADL），同时采集所有患者闭眼静息态的脑电图（EEG）。评估和采集完成后，计算全脑范围内α波绝对功率值，并对FMA-UE评分、MBI评分、α波绝对功率值治疗前、后的差值（改善值）进行单因素方差分析和重复测量方差分析。 结果 治疗后，3组患者的FMA-UE评分、MBI评分、α波绝对功率值除低频刺激组和假刺激组的α波绝对功率值外，其余均显著优于组内治疗前，差异均有统计学意义（P<0.05）。重复测量方差分析显示，时间与组别间在FMA-UE评分（F=9.926，P<0.001）、MBI（F=8.789，P<0.001）和α波绝对功率值（F=4.511，P<0.05）方面均存在显著交互效应，提示不同干预方法对改善值的影响显著。经Bonferroni 校正后事后比较，高频刺激组FMA-UE评分、MBI评分、α波绝对功率值的改善值均显著优于假刺激组和低频刺激组，差异均有统计学意义（P<0.01）。 结论 5 Hz的rTMS刺激缺血性脑卒中后中重度上肢运动功能障碍的患者健侧大脑的疗效显著优于1 Hz的rTMS，因此针对FMA-UE评分<43分的脑卒中患者，建议采用代偿模型为指导方案。 |
| 英文摘要: |
| Objective To compare the effect of transcranial magnetic stimulation (rTMS) of the contralesional hemisphere at different frequencies on the recovery of upper limb motor function after a moderate-to-severe ischemic stroke. Methods The inter-hemisphere compensation model was applied along with electroencephalogram (EEG) power spectrum density measurements. Thirty stroke survivors were randomly assigned to a sham stimulation group (n=9), a high-frequency stimulation group (n=11) or a low-frequency stimulation group (n=10). In addition to physical and pharmacological therapy, the low-frequency and high-frequency groups received 1Hz or 5Hz rTMS, while the sham group received sham stimulation. The rTMS was delivered over the contralesional (unaffected) hemisphere once daily for 20 minutes over 15 consecutive days. Before, as well as 7 and 15 days after the treatment, all of the subjects′ motor functioning was assessed using the Fugl-Meyer Assessment for the upper extremity (FMA-UE) and their ability in the activities of daily living was assessed using the modified Barthel Index (MBI). Resting-state EEGs with the eyes closed were also recorded, and absolute alpha power across the whole brain was calculated. Changes from baseline FMA-UE and MBI scores and absolute alpha power were analyzed using one-way and repeated-measures analysis of variance. Results After the treatment, significant within-group improvements from baseline were observed in the FMA-UE scores, MBIs and absolute alpha power, except for absolute alpha power in the low-frequency and sham groups. The repeated-measures analysis of variance revealed significant time × group interactions for FMA-UE (F=9.926, P≤0.001), MBI (F=8.789, P≤0.001) and absolute alpha power (F=4.511, P≤0.05). So the treatment effects varied among the groups. Post hoc Bonferroni-corrected comparisons showed that the high-frequency group exhibited significantly greater improvements from baseline in terms of all three indicators compared with the other two groups. Conclusions High-frequency (5Hz) rTMS applied to the contralesional hemisphere produced greater improvement than low-frequency (1Hz) stimulation in the upper limb motor function of patients with moderate-to-severe stroke. These findings support the use of the interhemispheric compensation model to guide rTMS therapy, particularly for patients with FMA-UE scores below 43. |
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