高频重复经颅磁刺激对缺血性脑卒中后中枢性面瘫的效果

doi:10.3969/j.issn.1006-9771.2022.02.010

《中国康复理论与实践》 ›› 2022, Vol. 28 ›› Issue (2): 199-203.doi: 10.3969/j.issn.1006-9771.2022.02.010

高频重复经颅磁刺激对缺血性脑卒中后中枢性面瘫的效果

朱慧¹,夏有兵¹(),巩尊科²,王世雁²,马柯²,闫金秋³

1.徐州医科大学第二临床医学院,江苏徐州市 221000
2.徐州市中心医院康复科,江苏徐州市 221000
3.蚌埠医学院研究生院,安徽蚌埠市 233030

收稿日期:2021-08-23 修回日期:2021-11-07 出版日期:2022-02-25 发布日期:2022-03-09
通讯作者: 夏有兵 E-mail:xyb1976@sina.com
作者简介:朱慧(1989-),女,汉族,江苏徐州市人,硕士研究生,中级康复治疗师,主要研究方向：神经系统疾病的康复。
基金资助:
国家重点研发计划项目(2020YFC2006600)

Effects of high-frequency repetitive transcranial magnetic stimulation on central facial paralysis after ischemic stroke

ZHU Hui¹,XIA Youbing¹(),GONG Zunke²,WANG Shiyan²,MA Ke²,YAN Jinqiu³

1. The Second Clinical Medical School, Xuzhou Medical University, Xuzhou, Jiangsu 221000, China
2. Department of Rehabilitation, Xuzhou Central Hospital, Xuzhou, Jiangsu 221000, China
3. Bengbu Medical College, Bengbu, Anhui 233030, China

Received:2021-08-23 Revised:2021-11-07 Published:2022-02-25 Online:2022-03-09
Contact: XIA Youbing E-mail:xyb1976@sina.com
Supported by:
National Key Research and Development Program of China(2020YFC2006600)

摘要/Abstract

摘要：

目的探讨高频重复经颅磁刺激(rTMS)在缺血性脑卒中后中枢性面瘫中的应用价值。方法 2020年6月至2021年6月,选取在徐州市中心医院康复科住院的脑卒中后中枢性面瘫患者54例,随机分为对照组(n = 27)和试验组(n = 27)。两组均给予常规康复治疗,包括药物治疗和面部肌群康复训练。试验组加患侧初级运动皮质5 Hz rTMS治疗,对照组在同一治疗部位予以相同参数的假刺激治疗。治疗前、治疗4周后分别采用修订版House-Brackmann分级系统(HBGS-2)、Sunnybrook面部分级量表、静息时双侧嘴角至人中下中心点的水平距离差、最大努力示齿时双侧嘴角至下颌中切牙交点的水平距离差和伸舌时舌中线偏离面部正中线的角度对患者进行面神经功能评价。结果两组各脱落1例。治疗前,两组HBGS-2评分、Sunnybrook面部分级量表评分、静息时双侧嘴角至人中下中心点的水平距离差、最大努力示齿时双侧嘴角至下颌中切牙交点的水平距离差和伸舌时舌中线偏离面部正中线的角度均无显著性差异(P > 0.05);治疗后两组各项评价指标均显著改善(|t| > 8.987, P < 0.001),且试验组均明显优于对照组(t > 2.939, P < 0.01)。结论患侧初级运动皮质5 Hz rTMS对改善缺血性脑卒中后中枢性面瘫患者面神经功能有积极作用。

关键词: 缺血性脑卒中, 中枢性面瘫, 重复经颅磁刺激

Abstract:

Objective To explore the effect of high-frequency repetitive transcranial magnetic stimulation (rTMS) on central facial paralysis after ischemic stroke. Methods From June, 2020 to June, 2021, 54 patients with central facial palsy after ischemic stroke who were hospitalized in the Rehabilitation Department of Xuzhou Central Hospital were randomly divided into control group (n = 27) and experimental group (n = 27). Both groups were given conventional rehabilitation treatment, including medication and facial muscle rehabilitation training. The experimental group was treated with 5 Hz rTMS on the affected primary motor cortex, and the control group was treated with the same parameters of sham stimulation at the same site. Before treatment and four weeks after treatment, the House-Brackmann Grading System 2.0 (HBGS-2), the Sunnybrook Facial Grading System, the horizontal distance difference between the bilateral mouth corners to the lower center of the philtrum at rest, the horizontal distance difference between the bilateral mouth corners to the intersection of the mandibular central incisor when showing the teeth at the best effort and the angle of the tongue midline deviating from the facial midline when the tongue was stretched out were used to evaluate the facial nerve function of the patient. Results One case dropped down in each group. Before treatment, there was no significant difference in the scores of HBGS-2 and Sunnybrook Facial Grading System, the horizontal distance difference between the bilateral mouth corners to the lower center of the philtrum at rest, the horizontal distance difference between the bilateral mouth corners to the intersection of the mandibular central incisor when showing the teeth at the best effort, and the angle of the tongue midline deviating from the facial midline when the tongue was stretched out between two groups (P > 0.05). After treatment, all the indexes significantly improved in both groups (|t| > 8.987, P < 0.001), and were better in the experimental group than in the control group (t > 2.939, P < 0.01). Conclusion 5 Hz rTMS on the affected primary motor cortex is effective on the facial nerve function of patients with central facial palsy after ischemic stroke.

Key words: ischemic stroke, central facial palsy, repetitive transcranial magnetic stimulation

中图分类号:

R743.3

朱慧,夏有兵,巩尊科,王世雁,马柯,闫金秋. 高频重复经颅磁刺激对缺血性脑卒中后中枢性面瘫的效果[J]. 《中国康复理论与实践》, 2022, 28(2): 199-203.

ZHU Hui,XIA Youbing,GONG Zunke,WANG Shiyan,MA Ke,YAN Jinqiu. Effects of high-frequency repetitive transcranial magnetic stimulation on central facial paralysis after ischemic stroke[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2022, 28(2): 199-203.

图/表 4

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组别	n	性别/n		年龄/岁	病程/d	患侧/n		危险因素/n
组别	n	男	女	年龄/岁	病程/d	左	右	高血压	糖尿病	高血脂
对照组	27	19	8	63.19±10.17	21.44±7.04	15	12	21	15	16
试验组	27	21	6	62.37±9.43	21.63±7.98	17	10	22	16	11
χ²/t值		0.386		-0.305	0.090	0.315		0.134	0.080	1.926
P值		0.535		0.761	0.928	0.575		0.714	0.777	0.165

组别	治疗前(n = 27)	治疗后(n = 26)	t值	P值
对照组	13.00±1.72	11.00±1.74	11.402	< 0.001
试验组	13.12±1.71	8.96±2.07	20.237	< 0.001
t值	0.243	-3.842
P值	0.809	< 0.001

组别	治疗前(n = 27)	治疗后(n = 26)	t值	P值
对照组	49.88±8.28	59.00±7.82	-8.987	< 0.001
试验组	49.65±7.79	76.65±4.53	-26.876	< 0.001
t值	-0.104	9.956
P值	0.918	< 0.001

组别	静息状态下双侧嘴角至人中下中心点的水平距离差/mm		最大努力示齿时双侧嘴角至下颌中切牙交点的水平距离差/mm		伸舌时舌中线偏离面部正中线的角度/°
组别	治疗前(n = 27)	治疗后(n = 26)	治疗前(n = 27)	治疗后(n = 26)	治疗前(n = 27)	治疗后(n = 26)
对照组	7.77±1.68	6.04±1.31^a	9.12±1.40	6.92±1.26^b	24.23±5.32	15.54±5.25^c
试验组	7.96±1.54	4.35±1.35^d	9.31±1.16	5.08±1.13^e	23.00±4.57	12.04±3.47^f
t值	0.431	-4.577	0.541	-5.559	0.984	2.939
P值	0.669	< 0.001	0.591	< 0.001	0.375	0.007

高频重复经颅磁刺激对缺血性脑卒中后中枢性面瘫的效果

Effects of high-frequency repetitive transcranial magnetic stimulation on central facial paralysis after ischemic stroke

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