基于大脑半球之间多靶区间歇性θ爆发式磁刺激对脑卒中患者上肢功能的影响

doi:10.3969/j.issn.1006-9771.2022.05.002

摘要/Abstract

摘要：

目的探讨脑卒中后多靶区大脑皮质间歇性θ爆发式磁刺激(iTBS)对偏瘫侧上肢功能恢复的影响。方法 2019年11月至2020年8月,甘肃省康复中心医院40例脑卒中患者随机分为单靶区刺激组(n = 20)和多靶区刺激组(n = 20)。两组均进行临床常规药物治疗和日常康复锻炼。在此基础上,两组均辅以重复经颅磁刺激(iTBS模式)。单靶区刺激组仅刺激患侧脑部初级运动皮质(M1区);多靶区刺激组先刺激健侧大脑同侧小脑半球皮质,5 s后再刺激患侧大脑M1区。每天1次,每周6 d,共4周。治疗前和治疗4周后比较两组Fugl-Meyer评定量表-上肢部分(FMA-UE)、上肢动作研究量表(ARAT)、改良Barthel指数(MBI)评分以及上肢体感诱发电位N20 (潜伏期、波幅)的变化。结果所有患者均无不良反应发生。治疗后,两组FMA-UE、MBI和ARAT评分,N20潜伏期和波幅均改善(|t| > 3.478, |Z| > 2.243, P < 0.05),且多靶区刺激组FMA-UE和ARAT评分,N20波幅均明显优于单靶区刺激组(t > 2.939, Z = -2.697, P < 0.01)。结论多靶区刺激比单靶区刺激更能改善脑卒中患者偏瘫侧上肢运动功能和患侧N20波幅。

关键词: 脑卒中, 多靶区, 间歇性θ爆发式磁刺激, 上肢

Abstract:

Objective To investigate the effect of intermittent theta burst stimulation (iTBS) of the multi-target cerebral cortex after stroke on functional recovery of the upper limb of the hemiplegic side. Methods From November, 2019 to August, 2020, 40 stroke patients in Gansu Provine Hospital Rehabilitation Center were included and randomly divided into single-target stimulation group (n = 20) and multiple-target stimulation group (n = 20). Both groups underwent basic neurorehabilitation drug therapy and conventional rehabilitation exercises. The single-target stimulation group received repetitive transcranial magnetic stimulation (rTMS) (iTBS mode) only in the primary motor cortex (M1) of the affected side. The multi-target stimulation group received rTMS (iTBS mode) in the cerebellar cortex of the healthy brain and M1 of the affected side, once a day, six days a week, for four weeks. Before and after treatment, the scores of Fugl-Meyer Assessment-Upper Extremities (FMA-UE), Action Research Arm Test (ARAT) and modified Barthel Index (MBI), and the latency and amplitude of somatosensory-evoked potentials N20 were compared. Results No serious adverse reaction occurred during treatment. After treatment, the scores of FMA-UE, MBI and ARAT, and the amplitude and latency of N20 improved in both groups (|t| > 3.478, |Z| > 2.243, P < 0.05); and the scores of FMA-UE and ARAT, and the amplitude of N20 were better in the multiple-target stimulation group than in the single-target stimulation group (t > 2.939, Z = -2.697, P < 0.01). Conclusion Multi-target stimulation is superior to single-target stimulation for improving upper limb motor function and N20 amplitude in the hemiplegics after stroke.

Key words: stroke, multiple target, intermittent theta burst stimulation, upper extremity

中图分类号:

R743.3

曹志刚,冯海霞,李亚斌,杨佳丽,李姣,王红霞,曲博轩,张亚云. 基于大脑半球之间多靶区间歇性θ爆发式磁刺激对脑卒中患者上肢功能的影响[J]. 《中国康复理论与实践》, 2022, 28(5): 502-507.

CAO Zhigang,FENG Haixia,LI Yabin,YANG Jiali,LI Jiao,WANG Hongxia,QU Boxuan,ZHANG Yayun. Effects of interhemispheric multi-target intermittent theta burst stimulation on upper limb function in patients with stroke[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2022, 28(5): 502-507.

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组别	n	性别(男/女)/n	年龄/岁	病程/d	受损半球(左/右)/n
单靶区刺激组	20	11/9	48.75±13.24	41.90±24.86	13/7
多靶区刺激组	20	12/8	51.80±15.45	45.85±20.56	8/12
χ²/t值			0.670	0.547
P值		1.000^a	0.507	0.587	1.000^a

组别	n	治疗前	治疗后	t值	P值
单靶区刺激组	20	14.90±5.80	28.05±8.26	10.566	< 0.001
多靶区刺激组	20	16.75±6.23	37.20±5.77	16.454	< 0.001
t值		0.972	4.060
P值		0.337	< 0.001

组别	n	治疗前	治疗后	t值	P值
单靶区刺激组	20	35.55±14.78	72.00±12.43	14.936	< 0.001
多靶区刺激组	20	36.20±19.78	76.80±12.14	10.901	< 0.001
t值		0.118	1.235
P值		0.907	0.225

组别	n	治疗前	治疗后	Z值	P值
单靶区刺激组	20	7.50 (5.00,15.50)	9.50 (7.25,15.00)	-2.243	0.025
多靶区刺激组	20	6.50 (4.00,16.75)	20.00 (10.25,25.00)	-3.727	< 0.001
Z值		0.748	-2.697
P值		0.455	0.007

组别	n	治疗前	治疗后	t值	P值
单靶区刺激组	20	27.77±2.31	27.33±2.31	3.478	0.003
多靶区刺激组	20	27.21±3.78	26.57±3.41	5.467	< 0.001
t值		-0.612	-0.831
P值		0.544	0.411