重复经颅磁刺激对恢复期脑卒中患者步行的效果

doi:10.3969/j.issn.1006-9771.2023.02.005

《中国康复理论与实践》 ›› 2023, Vol. 29 ›› Issue (2): 167-173.doi: 10.3969/j.issn.1006-9771.2023.02.005

重复经颅磁刺激对恢复期脑卒中患者步行的效果

马启寿¹^,², 李中元¹^,², 符卫卫¹^,², 林茜¹^,²()

1.福建中医药大学附属康复医院，福建福州市 350003
2.福建省康复技术重点实验室，福建福州市 350003

收稿日期:2022-09-12 修回日期:2023-02-09 出版日期:2023-02-25 发布日期:2023-03-16
通讯作者: 林茜 E-mail:29738019@qq.com
作者简介:马启寿(1981-)，男，汉族，福建连城县人，硕士研究生，主管技师，主要研究方向：神经疾病的康复治疗。
基金资助:
福建省教育厅中青年课题(JAT190264)

Effect of repetitive transcranial magnetic stimulation on walking of stroke patients at recovery stage

MA Qishou¹^,², LI Zhongyuan¹^,², FU Weiwei¹^,², LIN Qian¹^,²()

1. Rehabilitation Hospital Affiliated to Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian 350003, China
2. Fujian Key Laboratory of Rehabilitation Technology, Fuzhou, Fujian 350003, China

Received:2022-09-12 Revised:2023-02-09 Published:2023-02-25 Online:2023-03-16
Contact: LIN Qian E-mail:29738019@qq.com
Supported by:
Supported by Fujian Young and Middle-aged Research Projects No(JAT190264)

摘要/Abstract

摘要：

目的探讨重复经颅磁刺激(rTMS)对恢复期脑卒中患者步行能力的效果。方法 2021年1月至2022年1月，福建中医药大学附属康复医院恢复期脑卒中住院患者60例，随机分为A组(n = 20)、B组(n = 20)和C组(n = 20)。3组均接受常规康复治疗和下肢机器人训练，B组接受患侧第一躯体皮质运动区伪rTMS，C组接受患侧第一躯体皮质运动区高频rTMS，共4周。治疗前后采用Fugl-Meyer评定量表下肢部分(FMA-LE)、计时起立-行走测试(TUGT)和步态分析进行评定。结果治疗后，3组FMA-LE评分、TUGT、步速、步宽、步幅、双支撑相时间、患侧支撑相时间、患侧摆动相时间、健侧支撑相时间和健侧摆动相时间均显著改善(|t| > 5.990, P < 0.001)；除双支撑相时间外，C组所有指标均最优(F > 3.210, P < 0.05)。结论高频rTMS有助于改善恢复期脑卒中患者下肢运动功能和步行功能。

关键词: 脑卒中, 步行, 重复经颅磁刺激, 下肢机器人

Abstract:

Objective To investigate the effect of repetitive transcranial magnetic stimulation (rTMS) on walking function of stroke patients at recovery stage. Methods From January, 2021 to January, 2022, 60 stroke inpatients at recovery stage from Rehabilitation Hospital Affiliated to Fujian University of Traditional Chinese Medicine were randomly divided into group A (n = 20), group B (n = 20) and group C (n = 20). All the groups accepted conventional rehabilitation therapy and lower limb robot-assisted training, while group B accepted pseudo-rTMS, and group C accepted high-frequency rTMS, for four weeks. They were assessed with Fugl-Meyer Assessment-Lower Extremities (FMA-LE), Timed 'Up and Go' Test (TUGT) and gait analysis before and after treatment. Results The score of FMA-LE, TUGT, pace, stride width, stride, double support phase time, affected side support phase time, affected side swing phase time, healthy side support phase time and healthy side swing phase time improved after treatment in all the groups (|t| > 5.990, P < 0.001), and all the indexes improved the most in group C (F > 3.210, P < 0.05), except double support phase time. Conclusion High-frequency rTMS could facilitate the recovery of lower limb function and walking of stroke patients at recovery stage.

Key words: stroke, walking, repetitive transcranial magnetic stimulation, lower limb robot

中图分类号:

R743.3

马启寿, 李中元, 符卫卫, 林茜. 重复经颅磁刺激对恢复期脑卒中患者步行的效果[J]. 《中国康复理论与实践》, 2023, 29(2): 167-173.

MA Qishou, LI Zhongyuan, FU Weiwei, LIN Qian. Effect of repetitive transcranial magnetic stimulation on walking of stroke patients at recovery stage[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(2): 167-173.

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组别	n	性别(男/女)/n	年龄/岁	偏瘫侧(左/右)/n	卒中类型(梗死/出血)/n	病程/d
A组	20	13/7	54.85±5.65	11/9	7/13	47.50±5.62
B组	20	10/10	56.10±5.92	9/11	10/10	49.65±6.14
C组	20	9/11	56.75±7.07	12/8	13/7	50.65±5.47
χ²/F值		1.741	0.478	0.938	3.600	1.566
P值		0.419	0.622	0.626	0.165	0.218

组别	n	治疗前	治疗后	t值	P值
A组	20	13.90±1.77	20.90±2.51	-13.927	< 0.001
B组	20	14.20±2.26	21.45±2.35	-15.826	< 0.001
C组	20	14.35±1.93	26.95±2.86^a,b	-24.043	< 0.001
F值		0.107	33.604
P值		0.899	< 0.001

组别	n	治疗前	治疗后	t值	P值
A组	20	30.66±3.14	23.15±2.90	21.597	< 0.001
B组	20	31.95±3.32	24.04±2.14	17.579	< 0.001
C组	20	29.98±4.01	19.68±3.04^a,b	16.683	< 0.001
F值		1.638	14.396
P值		0.203	< 0.001

组别	n	治疗前	治疗后	t值	P值
A组	20	35.71±5.82	49.47±6.41	-9.730	< 0.001
B组	20	34.07±6.46	48.21±6.04	-16.647	< 0.001
C组	20	34.86±6.23	54.60±5.91^a,b	-17.228	< 0.001
F值		0.353	6.109
P值		0.704	0.004

组别	n	治疗前	治疗后	t值	P值
A组	20	22.63±6.10	18.26±4.98	7.268	< 0.001
B组	20	21.81±5.89	17.07±4.19	9.296	< 0.001
C组	20	23.24±6.00	14.42±3.61^a	9.938	< 0.001
F值		0.288	4.186
P值		0.751	0.020

重复经颅磁刺激对恢复期脑卒中患者步行的效果

Effect of repetitive transcranial magnetic stimulation on walking of stroke patients at recovery stage

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组别	n	治疗前	治疗后	t值	P值
A组	20	46.88±5.31	53.50±8.69	-6.899	< 0.001
B组	20	47.43±5.28	54.26±8.76	-6.661	< 0.001
C组	20	49.65±5.40	60.05±9.36^a,b	-10.236	< 0.001
F值		1.516	3.210
P值		0.228	0.048

组别	n	治疗前	治疗后	t值	P值
A组	20	44.19±9.09	39.48±6.67	7.119	< 0.001
B组	20	45.13±8.56	38.67±4.86	5.990	< 0.001
C组	20	47.85±8.07	35.64±7.20	10.991	< 0.001
F值		0.981	2.047
P值		0.381	0.139

组别	n	治疗前	治疗后	t值	P值
A组	20	71.07±6.59	67.49±5.13	6.258	< 0.001
B组	20	73.09±7.34	68.04±5.42	9.844	< 0.001
C组	20	71.41±5.05	63.78±5.71^a,b	16.536	< 0.001
F值		0.570	3.643
P值		0.569	0.032

组别	n	治疗前	治疗后	t值	P值
A组	20	28.93±6.59	32.51±5.13	-6.258	< 0.001
B组	20	26.92±7.34	31.97±5.42	-9.844	< 0.001
C组	20	28.60±5.05	36.22±5.71^a,b	-16.536	< 0.001
F值		0.570	3.643
P值		0.569	0.032

组别	n	治疗前	治疗后	t值	P值
A组	20	78.48±4.56	72.31±5.07	9.479	< 0.001
B组	20	79.43±4.99	73.13±4.29	11.966	< 0.001
C组	20	80.33±5.79	68.60±5.84^a,b	16.288	< 0.001
F值		0.649	4.474
P值		0.527	0.016

组别	n	治疗前	治疗后	t值	P值
A组	20	21.52±4.56	27.70±5.07	-9.479	< 0.001
B组	20	20.57±4.99	26.87±4.29	-11.966	< 0.001
C组	20	19.67±5.79	31.41±5.84^a,b	-16.288	< 0.001
F值		0.649	4.474
P值		0.527	0.016

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