重复经颅磁刺激联合镜像疗法对脑卒中偏瘫患者上肢运动功能及神经电生理的效果

doi:10.3969/j.issn.1006-9771.2023.10.012

摘要/Abstract

摘要：

目的探讨1 Hz重复经颅磁刺激(rTMS)联合镜像疗法对脑卒中偏瘫患者上肢运动功能及患侧皮质神经电生理的效果。
方法选择2022年10月至2023年3月复旦大学附属金山医院收治的脑卒中患者60例，随机分为对照组(n = 15)、磁刺激组(n = 15)、镜像疗法组(n = 15)和联合组(n = 15)。各组均给予内科治疗和常规康复治疗，在此基础上，对照组给予空载磁刺激和假镜像疗法，磁刺激组给予1 Hz低频rTMS和假镜像疗法，镜像疗法组给予空载磁刺激和镜像疗法，联合组给予1 Hz低频rTMS联合镜像疗法，共4周。采用Fugl-Meyer评定量表上肢部分(FMA-UE)和上肢动作研究量表(ARAT)评估患侧上肢运动能力，经颅磁刺激仪测定患侧皮质的运动诱发电位(MEP)振幅及中枢传导时间(CMCT)。
结果治疗后，各组FMA-UE评分、ARAT评分、MEP振幅均显著提高(|t| > 3.854, P < 0.001)，CMCT均显著缩短(t > 5.967, P < 0.001)。与对照组比较，磁刺激组、镜像疗法组和联合组FMA-UE评分、ARAT评分和MEP振幅更高，CMCT更短(P < 0.05);与磁刺激组和镜像疗法组比较，治疗后联合组FMA-UE评分、ARAT评分和MEP振幅更高，CMCT更短(P < 0.05)。各组FMA-UE评分、ARAT评分与MEP振幅呈显著正相关，与CMCT呈显著负相关(R² > 0.804, P < 0.001)。
结论 1 Hz低频rTMS联合镜像疗法有助于脑卒中后脑功能重塑，促进偏瘫患者上肢运动功能恢复。

关键词: 脑卒中, 上肢, 运动功能, 神经电生理, 重复经颅磁刺激, 镜像疗法

Abstract:

Objective To investigate the effect of 1 Hz repetitive transcranial magnetic stimulation (rTMS) combined with mirror therapy on upper limb motor function and cortical neurophysiological indicators in stroke patients with hemiplegia.
Methods Sixty stroke patients who were admitted to Jinshan Hospital of Fudan University, from October, 2022 to March, 2023 were randomly assigned to control group (n = 15), rTMS group (n = 15), mirror therapy group (n = 15) and combined group (n = 15). All groups received routine medicine and rehabilitation. In addition, the control group received sham rTMS and sham mirror therapy, rTMS group received 1 Hz rTMS and sham mirror therapy, the mirror therapy group received sham rTMS and mirror therapy, and the combined group received 1Hz rTMS combined with mirror therapy, for four weeks. Fugl-Meyer Assessment-Upper Extremities (FMA-UE) and Action Research Arm Test (ARAT) were used to evaluate the motor function of the affected upper limb. The motor-evoked potential (MEP) amplitude and central motor conduction time (CMCT) of the affected cortex were measured using a transcranial magnetic stimulation device.
Results After treatment, the scores of FMA-UE and ARAT, and the amplitude of MEP significantly improved in all groups (|t| > 3.854, P < 0.001), while the CMCT significantly shortened (t > 5.967, P < 0.001). Compared to the control group, rTMS group, the mirror therapy group and the combined group showed more significant improvement in the scores of FMA-UE and ARAT, and the amplitude of MEP, and shorter CMCT (P < 0.05). When compared to rTMS group and the mirror therapy group, the combined group showed more significant improvement the scores of FMA-UE and ARAT, and the amplitude of MEP, and shorter CMCT (P < 0.05). There was significant positive correlation of the scores of FMA-UE and ARAT with the amplitude of MEP, and negative correlation with the CMCT in all groups (R² > 0.804, P < 0.001).
Conclusion The combination of 1 Hz rTMS and mirror therapy contributes to the post-stroke brain functional remodeling and facilitates upper limb motor recovery in stroke patients with hemiplegia.

Key words: stroke, upper limb, motor function, neuroelectrophysiology, repetitive transcranial magnetic stimulation, mirror therapy

中图分类号:

R743.3

陈本梅, 蒋理想, 仇慕磊, 王传杰, 陶峰. 重复经颅磁刺激联合镜像疗法对脑卒中偏瘫患者上肢运动功能及神经电生理的效果[J]. 《中国康复理论与实践》, 2023, 29(10): 1201-1207.

CHEN Benmei, JIANG Lixiang, QIU Mulei, WANG Chuanjie, TAO Feng. Effect of repetitive transcranial magnetic stimulation combined with mirror therapy on upper limb motor function and neuroelectrophysiology in stroke patients with hemiplegia[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(10): 1201-1207.

图/表 6

表1

表2

各组治疗前后FMA-UE评分比较"

组别	n	治疗前	治疗后	t值	P值
对照组	15	25.20 $±$ 9.06	29.80±10.15	-9.465	< 0.001
磁刺激组	15	23.73 $±$ 8.70	38.87±9.43^a,b	-11.627	< 0.001
镜像疗法组	15	24.53±8.42	37.60±10.92^a,b	-9.038	< 0.001
联合组	15	24.87±9.27	46.87±11.10^a	-9.973	< 0.001
F值		0.075	6.743
P值		0.973	0.010

表2

表3

各组治疗前后ARAT评分比较"

组别	n	治疗前	治疗后	t值	P值
对照组	15	18.63 $± 7.99$	22.80±9.04	-7.607	< 0.001
磁刺激组	15	17.63±7.79	30.30±8.01^a,b	-10.526	< 0.001
镜像疗法组	15	18.05±7.95	29.41±9.24^a,b	-8.457	< 0.001
联合组	15	18.21±8.28	37.14±9.13^a	-10.345	< 0.001
F值		0.040	6.561
P值		0.989	0.001

表3

表4

表5

图1

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组别	n	性别/n		年龄/岁	病程/d	卒中类型/n		病变侧/n
组别	n	男	女	年龄/岁	病程/d	脑梗死	脑出血	左侧	右侧
对照组	15	8	7	55.60±7.11	32.53±21.56	10	5	9	6
磁刺激组	15	9	6	59.80±8.29	29.87±20.59	12	3	8	7
镜像疗法组	15	10	5	60.67±8.85	27.20±15.39	9	6	7	8
联合组	15	7	8	57.67±9.83	35.27±20.70	11	4	9	6
χ²/F值		1.357		1.052	0.464	1.587		0.741
P值		0.716		0.377	0.708	0.662		0.864