曹月姣,陈伟观,黄志东,等.重复外周磁刺激联合健侧低频重复经颅磁刺激对亚急性脑卒中患者上肢运动功能的影响[J].中华物理医学与康复杂志,2025,47(11):984-990
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| 重复外周磁刺激联合健侧低频重复经颅磁刺激对亚急性脑卒中患者上肢运动功能的影响 |
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| DOI：10.3760/cma.j.cn421666-20240627-00527 |
| 中文关键词: 脑卒中 重复经颅磁刺激 外周磁刺激 上肢运动功能 |
| 英文关键词: Stroke Transcranial magnetic stimulation Peripheral magnetic stimulation Upper limb motor function |
| 基金项目:南通市卫生健康委科研项目（QNZ2023025）；南通市卫生健康委科研项目（QNZ2024027） |
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| 中文摘要: |
| 目的 观察重复外周磁刺激（rPMS）联合中枢重复经颅磁刺激（rTMS）对亚急性早期脑卒中患者上肢运动功能的影响。 方法 选取脑卒中患者78例，按照随机数字表法分为对照组26例、rTMS组26例、联合磁刺激组26例。3组患者均接受常规康复训练，rTMS组在此基础上接受健侧M1区的低频rTMS治疗，联合磁刺激组在此基础上接受患侧上肢Erb′s点rPMS结合健侧M1区的低频rTMS治疗。所有患者均每日干预1次，每周治疗5 d，连续治疗3周。治疗前和治疗3周后（治疗后），采用Fugl-Meyer运动功能量表上肢部分（FMA-UE）和Wolf运动功能评价量表（WMFT）评估2组患者的上肢运动功能，同时采用Barthel指数（BI）和Brunnstrom分期分别评估其日常生活活动能力，以及上肢和手部的运动功能恢复情况，并记录3组患者患侧拇短展肌运动诱发电位（MEP）潜伏期和波幅。采用Pearson相关系数分析3组患者治疗前、后FMA-UE评分变化与MEP波幅变化的相关性。 结果 治疗后，3组患者的FMA-UE评分、WMFT评分、BI评分、上肢和手的Brunnstrom分期、MEP潜伏期和波幅较组内治疗前明显改善（P＜0.05），且联合磁刺激组上述各项指标除上肢的Brunnstrom分期外，其余各项均显著优于对照组和rTMS组（P＜0.05）。经Pearson相关系数分析，rTMS组和联合磁刺激组MEP波幅的增加与其FMA-UE评分的增加呈正相关（P＜0.05）。 结论 rPMS联合健侧低频rTMS可更有效地改善亚急性早期脑卒中患者的上肢运动功能。 |
| 英文摘要: |
| Objective To explore the effect of combining repeated peripheral (rPMS) and central transcranial magnetic stimulation (rTMS) in treating upper limb motor dysfunction after a stroke. Methods Seventy-eight patients with upper limb motor dysfunction after a stroke were randomly divided into a control group, an rTMS group and a combined magnetic stimulation group, each of 26. All three groups underwent routine rehabilitation, while the rTMS group was repeatedly given low frequency transcranial magnetic stimulation of the M1 region on the unaffected side, and the combined group also received repeated peripheral magnetic stimulation at Erb′s point on the affected upper limb. There was one treatment session a day, 5 days a week for 3 weeks. Before and after the treatment, everyone′s upper limb motor function was quantified using the Fugl-Meyer upper extremity assessment (FMA-UE) and the Wolf motor function test (WMFT). Skill in the activities of daily living was quantified in terms of a Barthel index (BI). Motor recovery of the upper limbs and hands was assessed using Brunnstrom staging. The latency and amplitude of the motor evoked potentials (MEPs) in the subjects′ affected abductor pollicis brevis muscles were also recorded before and after the treatment. Pearson correlation coefficients quantified the correlation between the changes in FMA-UE scores and MEP amplitudes before and after the treatment in the three groups. Results There were no significant differences among the three groups before the treatment. Afterward, however, the average FMA-UE, WMFT and BI scores, as well as the upper limb and hand Brunnstrom stages and the average MEP latencies and amplitudes of all the three groups had improved significantly. The combined group′s average results were then significantly better than the other two groups′ averages, except for the upper limb Brunnstrom stages. The increases in MEP amplitude were positively correlated with the increases in FMA-UE scores among the rTMS and the combined group, but there was no significant correlation between them in the control group. Conclusions The combined application of rPMS and contralateral low frequency rTMS can effectively relieve motor dysfunction in the upper limbs in the early stages after a stroke. |
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