双侧序贯重复经颅磁刺激干预脑卒中患者上肢运动功能的效果

doi:10.3969/j.issn.1006-9771.2023.08.009

《中国康复理论与实践》 ›› 2023, Vol. 29 ›› Issue (8): 926-932.doi: 10.3969/j.issn.1006-9771.2023.08.009

双侧序贯重复经颅磁刺激干预脑卒中患者上肢运动功能的效果

陈怡婷¹, 王倩², 崔慎红², 李映彩¹, 张思鈺¹, 魏衍旭¹, 任慧¹, 冷军²(), 陈斌³

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康复医学科，山东济南市 250001
3.福建中医药大学附属人民医院康复科，福建福州市 350000

收稿日期:2023-03-27 修回日期:2023-05-29 出版日期:2023-08-25 发布日期:2023-10-09
通讯作者: 冷军 E-mail:2908860266@qq.com
作者简介:陈怡婷(1997-)，女，汉族，四川自贡市人，硕士研究生，主要研究方向：脑、脊髓损伤相关的中西医结合康复研究。
基金资助:
山东省医药卫生科技发展计划项目(202020011200);中风病中医康复结局评价研究项目(JDZX201915)

Effect of bilateral sequential repetitive transcranial magnetic stimulation on motor function of upper limbs in stroke patients

CHEN Yiting¹, WANG Qian², CUI Shenhong², LI Yingcai¹, ZHANG Siyu¹, WEI Yanxu¹, REN Hui¹, LENG Jun²(), CHEN Bin³

1. College of Rehabilitation, Shandong University of Traditional Chinese Medicine, Ji'nan, Shandong 250014, China
2. Department of Rehabilitation Medicine, the Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Ji'nan, Shandong 250001, China
3. Department of Rehabilitation, Affiliated People's Hospital of Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian 350000, China

Received:2023-03-27 Revised:2023-05-29 Published:2023-08-25 Online:2023-10-09
Contact: LENG Jun E-mail:2908860266@qq.com
Supported by:
Project of Medical and Health Technology Development Program in Shandong Province(202020011200);Evaluation on Outcome of TCM Rehabilitation of Apoplexy(JDZX201915)

摘要/Abstract

摘要：

目的观察双侧序贯重复经颅磁刺激对脑卒中患者上肢运动功能恢复的影响。
方法 2020年12月至2022年12月山东中医药大学第二附属医院脑卒中住院患者62例，随机分为对照组(n = 31)和观察组(n = 31)。两组均进行常规药物和康复治疗，并行电针拮抗肌治疗。观察组在电针治疗前采用低频重复经颅磁刺激刺激患者健侧大脑皮质初级运动区(M1区)，接着使用间歇性θ波脉冲刺激刺激患者患侧大脑皮质M1区，共4周。分别于治疗前后采用Fugl-Meyer评定量表上肢部分(FMA-UE)、改良Barthel指数(MBI)和改良Ashworth量表(MAS)进行评价，并比较运动诱发电位(MEP)潜伏期。
结果观察组1例脱落，无不良事件发生。治疗后，两组FMA-UE、MBI评分均显著提高(|t| > 9.953, P < 0.001)，MAS、MEP潜伏期均显著下降(|t| > 5.043, P < 0.001)，观察组均优于对照组(|t| > 2.237, P < 0.05)。
结论大脑双侧序贯重复经颅磁刺激可有效促进脑卒中患者上肢运动功能的恢复。

关键词: 脑卒中, 重复经颅磁刺激, 电针, 上肢, 运动功能

Abstract:

Objective To observe the effect of bilateral sequential repetitive transcranial magnetic stimulation on the motor function of upper limbs in stroke patients.
Methods From December, 2020 to December, 2022, 62 stroke inpatients in the Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine were included. They were randomly divided into control group (n = 31) and observation group (n = 31). Both groups accepted conventional medicine and rehabilitation, as well as electroacupuncture antagonistic muscle therapy. Before electroacupuncture, the observation group acceped low-frequency repetitive transcranial magnetic stimulation at primary motor cortex (M1) on the healthy side, followed by intermittent theta burst stimulation at M1 on the affected side, for four weeks. They were assessed with Fugl-Meyer Assessment-Upper Extremities (FMA-UE), modified Barthel Index (MBI) and modified Ashworth Scale (MAS), and motor evoked potential (MEP) latency was compared before and after treatment.
Results One patient dropped down in the observation group, and no adverse event happened. After treatment, the scores of FMA-UE and MBI significantly increased (|t| > 9.953, P < 0.001), and the score of MAS and the latency of MEP significantly decreased (|t| > 5.043, P < 0.001) in both groups; while all of them were better in the observation group than in the control group (|t| > 2.237, P < 0.05).
Conclusion Bilateral sequential repetitive transcranial magnetic stimulation can effectively promote the recovery of upper limb motor function in stroke patients.

Key words: stroke, repetitive transcranial magnetic stimulation, electroacupuncture, upper limbs, motor function

中图分类号:

R743.3

陈怡婷, 王倩, 崔慎红, 李映彩, 张思鈺, 魏衍旭, 任慧, 冷军, 陈斌. 双侧序贯重复经颅磁刺激干预脑卒中患者上肢运动功能的效果[J]. 《中国康复理论与实践》, 2023, 29(8): 926-932.

CHEN Yiting, WANG Qian, CUI Shenhong, LI Yingcai, ZHANG Siyu, WEI Yanxu, REN Hui, LENG Jun, CHEN Bin. Effect of bilateral sequential repetitive transcranial magnetic stimulation on motor function of upper limbs in stroke patients[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(8): 926-932.

图/表 5

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组别	n	性别/n		年龄/岁	病程/d	病灶性质/n		偏瘫侧/n
组别	n	男	女	年龄/岁	病程/d	脑梗死	脑出血	右	左
对照组	31	16	15	65.30±7.02	63.58±19.42	23	8	13	18
观察组	30	18	12	65.80±6.12	63.17±18.33	20	10	14	16
t/χ²值		0.435		0.183	0.086	0.415		0.138
P值		0.510		0.857	0.932	0.519		0.799

组别	n	治疗前	治疗后	t值	P值
对照组	31	26.450±3.686	35.320±4.614	-14.151	< 0.001
观察组	30	24.830±3.228	42.100±6.950	-16.220	< 0.001
t值		-1.822	4.499
P值		0.074	< 0.001

组别	n	治疗前	治疗后	t值	P值
对照组	31	43.548±4.515	51.032±3.341	-14.802	< 0.001
观察组	30	42.000±6.602	54.533±8.025	-9.953	< 0.001
t值		-1.022	2.237
P值		0.288	0.029

组别	n	治疗前	治疗后	t值	P值
对照组	31	1.903±1.165	1.387±0.955	5.043	< 0.001
观察组	30	1.833±0.950	0.800±0.610	8.464	< 0.001
t值		-0.256	-2.851
P值		0.799	0.006

组别	n	治疗前	治疗后	t值	P值
对照组	31	34.677±3.208	31.645±2.470	12.042	< 0.001
观察组	30	34.833±2.780	27.933±3.279	12.478	< 0.001
t值		1.502	-5.004
P值		0.139	< 0.001

双侧序贯重复经颅磁刺激干预脑卒中患者上肢运动功能的效果

Effect of bilateral sequential repetitive transcranial magnetic stimulation on motor function of upper limbs in stroke patients

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