运动前区高频重复经颅磁刺激对脑卒中上肢功能康复的疗效

doi:10.3969/j.issn.1006-9771.2020.06.014

《中国康复理论与实践》 ›› 2020, Vol. 26 ›› Issue (6): 697-702.doi: 10.3969/j.issn.1006-9771.2020.06.014

运动前区高频重复经颅磁刺激对脑卒中上肢功能康复的疗效

周哲^1a,沈夏锋^1b(),熊莉^1c,张雯^1c,黄鸿雁^1c,张萍^1c,吴毅²,荣积峰^1c

1.上海市第一康复医院, a.综合康复科; b.神经康复科; c.康复治疗中心, 上海市 200090
2.复旦大学附属华山医院康复医学科, 上海市 200040

收稿日期:2019-12-02 修回日期:2020-05-22 出版日期:2020-06-25 发布日期:2020-06-29
通讯作者: 沈夏锋 E-mail:shenxiafeng@aliyun.com
作者简介:周哲(1984-),女,汉族,陕西安康市人,硕士研究生,主治医师,主要研究方向：神经康复。
基金资助:
1.上海市卫生和计划生育委员会科研项目(201840237);2.上海市残疾人联合会科研项目(K2018012);3.上海市卫生健康委员会科研项目(201940392)

Effects of High-frequency Repetitive Transcranial Magnetic Stimulation to Premotor Areas on Upper Limb Motor Dysfunction after Stroke

ZHOU Zhe^1a,SHEN Xia-feng^1b(),XIONG Li^1c,ZHANG Wen^1c,HUANG Hong-yan^1c,ZHANG Ping^1c,WU Yi²,RONG Ji-feng^1c

1.a. Department of Rehabilitation Medicine; b. Department of Neurological Rehabilitation; c. Rehabilitation Treatment Center, The First Rehabilitation Hospital of Shanghai, Shanghai 200090, China
2. Department of Rehabilitation, Huashan Hospital, Fudan University, Shanghai 200040, China

Received:2019-12-02 Revised:2020-05-22 Published:2020-06-25 Online:2020-06-29
Contact: SHEN Xia-feng E-mail:shenxiafeng@aliyun.com
Supported by:
Shanghai Municipal Commission of Health and Family Planning Scientific Research Project(201840237);Shanghai Disabled Persons' Federation Scientific Research Project(K2018012);Shanghai Municipal Health Commission Scientific Research Project(201940392)

摘要/Abstract

摘要：

目的探讨运动前区高频重复经颅磁刺激(rTMS)对脑卒中偏瘫患者上肢运动功能恢复的影响。方法 2018年8月至2019年7月,60例脑卒中偏瘫患者随机分为对照组(n = 30)和观察组(n = 30)。两组均进行常规药物治疗及康复训练,观察组给予患侧大脑半球运动前区5 Hz rTMS,共3周。对照组给予伪刺激。治疗前后采用Fugl-Meyer评定量表上肢部分(FMA-UE)、Brunnstrom分期、改良Ashworth量表(MAS)、改良Barthel指数(MBI)和Wolf手功能量表进行评价。结果对照组脱落2例。治疗后,两组FMA-UE、MBI和Wolf手功能量表评分均明显改善(|t| > 3.686, P< 0.01),观察组治疗前后FMA-UE评分和Wolf手功能量表评分差值大于对照组(|t| > 2.119, P< 0.05)。结论患侧大脑半球运动前区高频rTMS能促进脑卒中偏瘫患者上肢和手的运动功能恢复。

关键词: 脑卒中, 重复经颅磁刺激, 运动前区, 上肢, 手功能, 康复

Abstract:

Objective To explore the effect of high-frequency repetitive transcranial magnetic stimulation (rTMS) on upper limb motor function in hemiplegic patients after stroke.Methods From August, 2018 to July, 2019, 60 patients with hemiplegia after stroke were randomly divided into control group (n = 30) and observation group (n = 30). Both groups received conventional treatment. The observation group accepted 5 Hz rTMS to ipsilesional hemisphere premotor areas for three weeks. The control group received sham stimulation. They were assessed with Fugl-Meyer Assessment-Upper Extremities (FMA-UE), Brunnstrom stages, modified Ashworth Scale (MAS), modified Barthel Index (MBI) and Wolf Motor Function Test before and after treatment.Results Two patients dropped in the control group. After treatment, the scores of FMA-UE, MBI and Wolf Motor Function Test improved in both groups (|t| > 3.686, P< 0.01), and the difference values of FMA-UE and Wolf Motor Function Test before and after treatment were more in the observation group than in the control group (|t| > 2.119, P< 0.05).Conclusion High-frequency rTMS to ipsilesional hemisphere premotor areas could improve the recovery of upper limb and hand motor function in hemiplegic patients after stroke.

Key words: stroke, repetitive transcranial magnetic stimulation, premotor areas, upper limb, hand function, rehabilitation

中图分类号:

R743.3

周哲,沈夏锋,熊莉,张雯,黄鸿雁,张萍,吴毅,荣积峰. 运动前区高频重复经颅磁刺激对脑卒中上肢功能康复的疗效[J]. 《中国康复理论与实践》, 2020, 26(6): 697-702.

ZHOU Zhe,SHEN Xia-feng,XIONG Li,ZHANG Wen,HUANG Hong-yan,ZHANG Ping,WU Yi,RONG Ji-feng. Effects of High-frequency Repetitive Transcranial Magnetic Stimulation to Premotor Areas on Upper Limb Motor Dysfunction after Stroke[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2020, 26(6): 697-702.

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组别	n	性别(n)		年龄(岁)	病程(月)	偏瘫侧(n)		病变性质(n)
组别	n	男	女	年龄(岁)	病程(月)	左	右	脑梗死	脑出血
对照组	28	19	9	61.75±11.43	10.50±7.38	12	16	16	12
观察组	30	22	8	59.73±10.41	10.70±7.57	16	14	20	10
χ²/t值		0.210		-0.703	0.102	0.637		0.558
P值		0.647		0.485	0.919	0.425		0.455

组别	n	治疗前	治疗后	差值	t值	P值
对照组	28	30.04±18.33	32.21±19.19	2.18±2.42	-4.764	< 0.001
观察组	30	26.73±15.48	32.20±16.66	5.47±8.12	-3.686	0.001
t值		-0.743	-0.003	2.119
P值		0.461	0.998	0.041

组别	n	治疗前						治疗后						Z值	P值
组别	n	Ⅰ	Ⅱ	Ⅲ	Ⅳ	Ⅴ	Ⅵ	Ⅰ	Ⅱ	Ⅲ	Ⅳ	Ⅴ	Ⅵ	Z值	P值
对照组	28	6	4	5	6	7	0	5	5	4	5	6	3	-0.067	0.946
观察组	30	6	8	5	6	5	0	2	8	9	2	8	1	-0.541	0.589
Z值		-1.617						-0.886
P值		0.106						0.376

组别	n	治疗前						治疗后						Z值	P值
组别	n	Ⅰ	Ⅱ	Ⅲ	Ⅳ	Ⅴ	Ⅵ	Ⅰ	Ⅱ	Ⅲ	Ⅳ	Ⅴ	Ⅵ	Z值	P值
对照组	28	1	9	5	6	7	0	0	9	4	6	7	2	-0.036	0.971
观察组	30	8	10	3	3	3	3	4	9	5	5	3	4	-0.588	0.556
Z值		-0.919						-1.761
P值		0.358						0.078

组别	n	治疗前	治疗后	Z值	P值
对照组	28	0.37±0.57	0.34±0.56	-0.577	0.564
观察组	30	0.57±0.60	0.33±0.48	-1.950	0.051
Z值		-1.249	-0.096
P值		0.212	0.923

运动前区高频重复经颅磁刺激对脑卒中上肢功能康复的疗效

Effects of High-frequency Repetitive Transcranial Magnetic Stimulation to Premotor Areas on Upper Limb Motor Dysfunction after Stroke

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组别	n	治疗前	治疗后	差值	t值	P值
对照组	28	49.96±20.75	56.07±20.58	6.11±5.38	-6.010	< 0.001
观察组	30	49.50±22.82	57.33±23.68	7.83±9.64	-4.455	< 0.001
t值		-0.081	0.216	0.834
P值		0.936	0.830	0.408

组别	n	治疗前	治疗后	差值	t值	P值
对照组	28	39.54±25.31	42.15±25.78	2.61±2.94	-4.699	< 0.001
观察组	30	31.40±24.66	36.27±26.96	4.87±4.59	-5.805	< 0.001
t值		-1.240	-0.847	2.248
P值		0.220	0.401	0.029

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