《中国康复理论与实践》

《中国康复理论与实践》

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不同强度低频重复经颅磁刺激对脑卒中后上肢运动功能障碍的疗效①

李冰洁，李芳，张通   

  1. 1. 中国康复研究中心北京博爱医院神经康复中心，北京市100068；2. 首都医科大学康复医学院，北京市100068。
  • 出版日期:2016-09-25 发布日期:2016-12-05

Effects of Various Intensity of Repetitive Transcranial Magnetic Stimulation on Upper Limbs Motor Function after Stroke

LI Bing-jie, LI Fang, ZHANG Tong   

  1. 1. Neurorehabilitation Center, Beijing Bo'ai Hospital, China Rehabilitation Research Centre, Beijing 100068, China; 2. Capital Medical University School of Rehabilitation Medicine, Beijing 100068, China
  • Published:2016-09-25 Online:2016-12-05

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摘要： 目的探讨不同强度低频(1 Hz)重复经颅磁刺激(rTMS)刺激健侧大脑半球M1 区对缺血性脑卒中偏瘫患者上肢运动功能康复的效果。方法2014 年12 月~2015 年12 月，60 例缺血性脑卒中后上肢偏瘫患者随机分为高强度组(n=20)、低强度组(n=20)和对照组(n=20)。三组均给予常规康复，高强度组rTMS每天2 次，低强度组每天1 次，对照组给予假刺激，每次10 min，共10 d。治疗前后采用运动诱发电位(MEPs)、Fugl-Meyer上肢运动功能评定(FMA)和改良Barthel 指数(MBI)进行评定。结果治疗后，高强度组患侧MEPs波幅，高强度组和低强度组FMA、MBI评分均明显优于对照组(P<0.01)，高强度组明显优于低强度组(P<0.01)。无严重不良反应发生。结论低频rTMS刺激健侧大脑半球M1 区可改善卒中后上肢功能障碍，多次治疗效果更佳。

关键词: 脑卒中, 重复经颅磁刺激, 运动, 上肢, 康复

Abstract: Objective To investigate the effects of various intensity of 1 Hz repetitive transcranial magnetic stimulation (rTMS) on upper limbs motor function after stroke. Methods From December, 2014 to December, 2015, sixty patients with ischemic stroke were randomly divided into high density group (HD, n=20), low density group (LD, n=20) and control group (n=20). They all received routine rehabilitation and medication. The HD group received rTMS over contralesional motor cortex twice a day, while the LD group received rTMS once a day, and the control group received sham stimulation, 10 minutes a time for 10 days. They were tested with motor- evoked potentials (MEPs), Fugl-Meyer Assessment (FMA) of upper limbs and modified Barthel Index (MBI) before and after treatment. Results The amplitude of MEPs of the affected cortex, the scores of FMA and MBI were more in HD and LD groups than in the control group after treatment (P<0.01), and were more in HD group than in LD group (P<0.01). No serious side-effect was found. Conclusion rTMS was feasible for patients with stroke to improve the upper limbs motor function. It is more effective as more times a day.

Key words: stroke, repetitive transcranial magnetic stimulation, motor, upper limbs, rehabilitation