小脑间歇性θ短阵快速脉冲刺激对脑卒中患者下肢运动功能的影响

doi:10.3969/j.issn.1006-9771.2022.10.011

《中国康复理论与实践》 ›› 2022, Vol. 28 ›› Issue (10): 1205-1210.doi: 10.3969/j.issn.1006-9771.2022.10.011

小脑间歇性θ短阵快速脉冲刺激对脑卒中患者下肢运动功能的影响

王淑睿¹,李丽²()

1.山东中医药大学康复医学院,山东济南市 250014
2.山东中医药大学第二附属医院,山东济南市 250001

收稿日期:2022-07-14 修回日期:2022-09-27 出版日期:2022-10-25 发布日期:2022-11-08
通讯作者: 李丽 E-mail:lily.jinan@163.com
作者简介:王淑睿(1996-),女,汉族,山西长治市人,硕士研究生,主要研究方向：脑卒中患者的中西医结合康复、颈肩腰腿痛的防治。|李丽(1962-),女,汉族,山东济南市人,硕士,教授、主任医师,主要研究方向：脑卒中后运动障碍、颈肩腰腿痛的防治、中西医结合康复。
基金资助:
山东省重点研发计划项目(2017GSF19114)

Effects of cerebellar theta-burst stimulation on lower extremity motor function in stroke patients

WANG Shurui¹,LI Li²()

1. School of Rehabilitation Medicine, Shandong University of Traditional Chinese Medicine, Ji'nan, Shandong 250014, China
2. The Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Ji'nan, Shandong 250001, China

Received:2022-07-14 Revised:2022-09-27 Published:2022-10-25 Online:2022-11-08
Contact: LI Li E-mail:lily.jinan@163.com
Supported by:
Shandong Key R & D Program(2017GSF19114)

摘要/Abstract

摘要：

目的观察小脑间歇性θ短阵快速脉冲刺激(iTBS)对脑卒中患者下肢运动功能的影响。

方法 2021年3月至12月,选取山东中医药大学第二附属医院康复中心脑卒中患者42例,按随机数字表法分为对照组(n = 21)和观察组(n = 21)。两组均进行常规药物和康复治疗,并行悬吊运动训练,包括躯干控制训练、分离运动强化训练、双下肢交替训练。观察组在悬吊运动训练前,采用小脑iTBS模式进行重复经颅磁刺激,每丛3个脉冲,丛内频率50 Hz,丛间频率5 Hz,刺激2 s,间歇8 s,共600个脉冲。分别于治疗前和治疗4周后采用Fugl-Meyer评定量表下肢部分(FMA-LE)、Berg平衡量表(BBS)和改良Barthel指数(MBI)进行评估,并比较运动诱发电位(MEP)潜伏期。

结果所有患者均完成康复训练,依从性良好,无不良事件发生。治疗4周后,两组FMA-LE、BBS、MBI均较治疗前显著提高(|t| > 10.053, P < 0.001),观察组MEP潜伏期显著下降(t = 5.326, P < 0.001),且FMA-LE、BBS、MEP潜伏期均明显优于对照组(|t| > 3.029, P < 0.01)。

结论小脑iTBS可以促进脑卒中患者下肢运动功能的恢复。

关键词: 脑卒中, 悬吊运动训练, 小脑间歇性θ短阵快速脉冲刺激

Abstract:

Objective To observe the effect of cerebellar intermittent theta burst stimulation (iTBS) on lower extremity motor function in stroke patients.

Methods From March to December, 2021, 42 stroke patients in Rehabilitation Center of the Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine were selected and divided into control group (n = 21) and observation group (n = 21) according to the random number table method. Both groups received routine medicine and rehabilitation therapy, as well as suspension training, including trunk control training, separation exercise strengthening training and alternating lower limb training. Before the suspension training, the observation group was intervened by repeated transcranial magnetic stimulation using the cerebellar iTBS mode, three pulses per plexus, the intra-cluster frequency of 50 Hz, the inter-cluster frequency of 5 Hz, and stimulated two seconds, intermited eight seconds, for 600 pulses. They were assessed with Fugl-Meyer Assessment-Lower Extremities (FMA-LE), Berg Balance Scale (BBS) and modified Barthel Index (MBI) before and four weeks after treatment, and the motor evoked potential (MEP) latencies were compared.

Results All the patients completed rehabilitation training with good compliance, and no adverse events occurred. After treatment, the scores of FMA-LE, BBS and MBI increased in both groups after treatment (|t| > 10.053, P < 0.001), while the MEP latency decreased (t = 5.326, P < 0.001) in the observation group, and the scores of FMA-LE and BBS, and MEP latency were better in the observation group than in the control group (|t| > 3.029, P< 0.01).

Conclusion Cerebellar iTBS can promote the recovery of lower extremity motor function in stroke patients.

Key words: stroke, suspension training, cerebellar theta-burst stimulation

中图分类号:

R743.3

王淑睿,李丽. 小脑间歇性θ短阵快速脉冲刺激对脑卒中患者下肢运动功能的影响[J]. 《中国康复理论与实践》, 2022, 28(10): 1205-1210.

WANG Shurui,LI Li. Effects of cerebellar theta-burst stimulation on lower extremity motor function in stroke patients[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2022, 28(10): 1205-1210.

图/表 5

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组别	n	性别(男/女)/n	年龄/岁	病程/周	脑卒中性质(脑梗死/脑出血)/n	偏瘫侧(左/右)/n	Brunnstrom分期(Ⅱ期/Ⅲ期/Ⅳ期)/n
对照组	21	9/12	54.62±7.85	72.95±47.37	13/8	12/9	4/8/9
观察组	21	11/10	52.62±8.61	82.33±45.27	12/9	13/8	3/8/10
χ²/t值		0.382	0.787	-0.656	0.099	0.099	0.195
P值		0.537	0.436	0.516	0.753	0.753	0.907

组别	n	治疗前	治疗后	t值	P值
对照组	21	19.10±1.97	26.95±2.91	-10.053	< 0.001
观察组	21	18.86±2.69	29.76±2.19	-16.760	< 0.001
t值		0.327	-3.539
P值		0.745	< 0.001

组别	n	治疗前	治疗后	t值	P值
对照组	21	39.67±2.61	49.86±2.71	-11.475	< 0.001
观察组	21	40.24±2.05	52.14±2.15	-18.834	< 0.001
t值		-0.789	-3.029
P值		0.435	0.004

组别	n	治疗前	治疗后	t值	P值
对照组	21	44.33±8.85	73.90±10.92	-10.731	< 0.001
观察组	21	45.24±9.60	77.24±9.95	-13.185	< 0.001
t值		-0.318	-1.049
P值		0.753	0.301

组别	n	治疗前	治疗后	t值	P值
对照组	21	35.17±2.03	33.98±1.98	1.657	0.113
观察组	21	34.78±2.19	31.23±2.11	5.326	< 0.001
t值		0.583	4.365
P值		0.563	< 0.001

小脑间歇性θ短阵快速脉冲刺激对脑卒中患者下肢运动功能的影响

Effects of cerebellar theta-burst stimulation on lower extremity motor function in stroke patients

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