重复经颅磁刺激对脑卒中后慢性意识障碍的效果

doi:10.3969/j.issn.1006-9771.2026.07.002

《中国康复理论与实践》 ›› 2026, Vol. 32 ›› Issue (7): 752-759.doi: 10.3969/j.issn.1006-9771.2026.07.002

• 专题脑卒中并发症康复 • 上一篇下一篇

重复经颅磁刺激对脑卒中后慢性意识障碍的效果

黄耀辉¹^,^2a, 叶祥明^2a, 刘勇^2a, 唐沛^2b, 卢逸舒^2a()

¹ 浙江中医药大学，浙江杭州市 310053
² 浙江省人民医院(杭州医学院附属人民医院)， a.康复医学科; b.神经电生理科，浙江杭州市 310014

收稿日期:2025-10-14 修回日期:2026-02-12 接受日期:2026-02-25 出版日期:2026-07-25 发布日期:2026-07-30
通讯作者: 卢逸舒，E-mail： noouise@163.com
作者简介:黄耀辉(1997-)，男，汉族，浙江温州市人，康复技师，主要研究方向：神经康复，肌骨康复。
卢逸舒(1997-)，女，汉族，浙江温州市人，硕士，康复主管技师，主要研究方向：神经康复，淋巴水肿康复。
基金资助:
浙江省中医药科技计划项目(2023ZL238);浙江省医药卫生科技项目(2023KY032);浙江省医药卫生科技项目(2024KY706)

Effect of repetitive transcranial magnetic stimulation on prolonged disorders of consciousness after stroke

Huang Yaohui¹^,^2a, Ye Xiangming^2a, Liu Yong^2a, Tang Pei^2b, Lu Yishu^2a()

¹ Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310053, China
² a. Department of Rehabilitation Medicine; b. Department of Neuroelectrophysiology, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang 310014, China

Received:2025-10-14 Revised:2026-02-12 Accepted:2026-02-25 Published:2026-07-25 Online:2026-07-30
Supported by:
Zhejiang Traditional Chinese Medicine Science and Technology Program(2023ZL238);Zhejiang Province Medical and Health Science and Technology Project(2023KY032);Zhejiang Province Medical and Health Science and Technology Project(2024KY706)

摘要/Abstract

摘要：

目的探讨重复经颅磁刺激(rTMS)对脑卒中后慢性意识障碍(pDoC)的疗效。

方法选取2024年1月至7月浙江省人民医院收治的60例pDoC患者，随机分为对照组(n = 30)和观察组(n = 30)。对照组接受常规康复治疗联合高压氧治疗，观察组在对照组治疗基础上增加rTMS治疗，共4周。治疗前后采用修订版昏迷恢复量表(CRS-R)、美国国立卫生研究院卒中量表(NIHSS)、体感诱发电位(SEP)中双侧N20振幅及潜伏期进行评定，并记录患者的意识状态分级和Judson分级。

结果对照组脱落1例，观察组脱落2例。CRS-R评分的时间主效应(F = 118.420, P < 0.001)和交互效应(F = 23.980, P < 0.001)均显著，NIHSS评分的时间主效应(F = 103.376, P < 0.001)和交互效应(F = 14.241, P < 0.001)均显著。N20振幅组别主效应、时间主效应和交互效应均显著(F > 4.303, P < 0.05)，N20潜伏期组别主效应、时间主效应和交互效应均显著(F >7.569, P < 0.05)。简单效应分析显示，干预后，观察组CRS-R评分和N20振幅高于对照组(P < 0.05)，NIHSS评分和N20潜伏期低于对照组(P < 0.05)；观察组意识状态分级和Judson分级亦优于对照组(|Z| > 2.160, P < 0.05)。

结论 rTMS联合HBOT可进一步促进脑卒中pDoC患者意识水平的恢复、改善神经功能和中枢传导通路完整性。

关键词: 脑卒中, 慢性意识障碍, 重复经颅磁刺激, 高压氧治疗

Abstract:

Objective To investigate the effect of repetitive transcranial magnetic stimulation (rTMS) on prolonged disorders of consciousness (pDoC) after stroke.

Methods Sixty patients with pDoC admitted to Zhejiang Provincial People's Hospital from January to July, 2024 were randomly assigned into control group (n = 30) and observation group (n = 30). Both groups received conventional rehabilitation therapy combined with hyperbaric oxygen therapy, while the observation group received rTMS in addition, for four weeks. Before and after treatment, they were assessed with Coma Recovery Scale-Revised (CRS-R), National Institutes of Health Stroke Scale (NIHSS), and bilateral N20 amplitude and latency of somatosensory-evoked potential (SEP), while consciousness status classification and Judson classification were recorded.

Results One case in the control group and two in the observation group dropped out. Significant time main effects and interaction effects were observed in CRS-R score (F = 118.420, P < 0.001; F = 23.980, P< 0.001, respectively) and NIHSS score (F = 103.376, P < 0.001; F = 14.241, P < 0.001, respectively). Significant group main effects, time main effects and interaction effects were observed in N20 amplitude (F > 4.303, P < 0.05) and N20 latency (F > 7.569, P < 0.05). Simple effects analysis showed CRS-R score, N20 amplitude, NIHSS score and N20 latency were better in the observation group than in the control group (P < 0.05) after the intervention, while the consciousness status classification and Judson classification were also better (|Z| > 2.160, P < 0.05).

Conclusion rTMS can further promote recovery of consciousness, improve neurological function, and enhance the integrity of central conduction pathways in patients with pDoC after stroke.

Key words: stroke, prolonged disorders of consciousness, repetitive transcranial magnetic stimulation, hyperbaric oxygen therapy

中图分类号:

R743.3

黄耀辉, 叶祥明, 刘勇, 唐沛, 卢逸舒. 重复经颅磁刺激对脑卒中后慢性意识障碍的效果[J]. 《中国康复理论与实践》, 2026, 32(7): 752-759.

Huang Yaohui, Ye Xiangming, Liu Yong, Tang Pei, Lu Yishu. Effect of repetitive transcranial magnetic stimulation on prolonged disorders of consciousness after stroke[J]. Chinese Journal of Rehabilitation Theory and Practice, 2026, 32(7): 752-759.

图/表 6

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参考文献 33

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组别	n	性别/n		年龄/岁	病程/d	卒中类型(出血/缺血)/n
组别	n	男	女	年龄/岁	病程/d	卒中类型(出血/缺血)/n
对照组	29	15	14	60.52±17.71	61.66±18.71	14/15
观察组	28	15	13	56.21±18.80	58.68±18.39	13/15
χ²/t值		0.019		0.890	0.605	0.019
P值		0.889		0.378	0.547	0.889

变量	组别	n	干预前		干预后
变量	组别	n	均值	标准差	均值	标准差
CRS-R	对照组	29	6.52	4.74	8.41	5.02
CRS-R	观察组	28	6.57	4.42	11.57	5.62
NIHSS	对照组	29	13.28	3.10	10.65	3.09
NIHSS	观察组	28	13.54	3.17	7.82	4.54
N20振幅/μV	对照组	29	1.00	0.31	1.29	0.39
N20振幅/μV	观察组	28	0.93	0.20	1.72	0.51
N20潜伏期/ms	对照组	29	28.83	2.32	26.50	2.81
N20潜伏期/ms	观察组	28	29.07	2.12	22.41	4.03

变量	效应	平方和	自由度	均方	F值	P值
CRS-R	组别	73.477	1	73.477	1.578	0.214
	时间	338.778	1	338.778	118.420	< 0.001
	组别×时间	68.603	1	68.603	23.980	< 0.001
NIHSS	组别	47.188	1	47.188	2.351	0.131
	时间	494.834	1	494.834	103.376	< 0.001
	组别×时间	68.168	1	68.168	14.241	< 0.001
N20振幅	组别	0.934	1	0.934	4.303	0.043
	时间	8.405	1	8.405	142.625	< 0.001
	组别×时间	1.776	1	1.776	30.144	< 0.001
N20潜伏期	组别	105.561	1	105.561	7.569	0.008
	时间	577.514	1	577.514	193.007	< 0.001
	组别×时间	133.669	1	133.669	44.672	< 0.001

变量	组别	组别	平均值差	P值	95%CI
变量	组别	组别	平均值差	P值	下限	上限
CRS-R	对照组干预前	对照组干预后	-1.897	< 0.001	-2.787	-1.006
	观察组干预前	观察组干预后	-5.000	< 0.001	-5.906	-4.094
	对照组干预前	观察组干预前	-0.054	0.965	-2.493	2.384
	对照组干预后	观察组干预后	-3.158	0.029	-5.984	-0.332
NIHSS	对照组干预前	对照组干预后	2.621	< 0.001	1.469	3.772
	观察组干预前	观察组干预后	5.714	< 0.001	4.542	6.886
	对照组干预前	观察组干预前	-0.260	0.756	-1.925	1.405
	对照组干预后	观察组干预后	2.834	0.008	0.775	4.892
N20振幅	对照组干预前	对照组干预后	-0.293	< 0.001	-0.421	-0.166
	观察组干预前	观察组干预后	-0.793	< 0.001	-0.923	-0.663
	对照组干预前	观察组干预前	0.069	0.327	-0.071	0.208
	对照组干预后	观察组干预后	-0.431	0.001	-0.672	-0.189
N20潜伏期	对照组干预前	对照组干预后	2.336	< 0.001	1.426	3.247
	观察组干预前	观察组干预后	6.668	< 0.001	5.742	7.595
	对照组干预前	观察组干预前	-0.241	0.684	-1.422	0.940
	对照组干预后	观察组干预后	4.091	< 0.001	2.252	5.930

组别	n	测试	分级			Z值	P值
组别	n	测试	VS	MCS^-	MCS⁺	Z值	P值
对照组	29	前测	19	8	2	-2.828	0.005
		后测	14	10	5
观察组	28	前测	17	8	3	-4.123	< 0.001
		后测	5	15	8
治疗前两组比较						-0.440	0.660
治疗后两组比较						-2.160	0.031

重复经颅磁刺激对脑卒中后慢性意识障碍的效果

Effect of repetitive transcranial magnetic stimulation on prolonged disorders of consciousness after stroke

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