低频重复经颅磁刺激对脑卒中偏瘫患者下肢痉挛及平衡步态的影响

Effect of low frequency repetitive transcranial magnetic stimulation on lower limb spasticity and balance gait in patients with hemiplegia after stroke

目的探讨低频重复经颅磁刺激对脑卒中偏瘫患者下肢痉挛及平衡步态的影响。方法选取2021年4月至2022年4月中国医科大学第一附属医院收治的176例脑卒中偏瘫患者,采用随机数字表法将其分为对照组、观察组,各88例。对照组以常规康复+核心肌力训练干预,观察组在对照组的基础上增加低频重复经颅磁刺激。2周为1个疗程,两组均连续治疗3个疗程。比较两组临床疗效及治疗前后的症状评分、平衡步态参数,评价治疗安全性。结果观察组临床疗效优于对照组(P<0.05)。治疗后,两组临床痉挛指数(CSI)均低于治疗前,Berg平衡量表(BBS)、Fugl-Meyer运动功能量表下肢评估(FMA-LE)评分均高于治疗前,且观察组CSI低于对照组,BBS、FMA-LE评分高于对照组(P<0.05)。治疗后,两组屈髋峰值、屈膝峰值、步幅、步频、步速均高于治疗前,且观察组高于对照组(P<0.05)。治疗期间两组不良反应总发生率比较,差异无统计学意义(P>0.05)。结论低频重复经颅磁刺激对脑卒中偏瘫下肢痉挛的治疗效果良好,能提高患者下肢功能、平衡功能和步行功能,且安全性较好。

Objective To investigate the effect of low frequency repetitive transcranial magnetic stimulation on lower limb spasticity and balanced gait in patients with hemiplegia after stroke.Methods A total of 176 patients with hemiplegia after stroke admitted to the First Affiliated Hospital of China Medical University from April 2021 to April 2022 were selected and divided into control group and observation group by random number table method,with 88 cases in each group.The control group was treated with routine rehabilitation+core strength training,and the observation group was additionally treated with low frequency repetitive transcranial magnetic stimulation.Two weeks was a course of treatment,and both groups were treated for three consecutive courses.The clinical efficacy were compared,and the symptom score and balance gait parameters before and after treatment were compared between the two groups,and the safety of treatment was evaluated.Results The clinical effect of observation group was better than control group(P<0.05).After treatment,clinical spasm index(CSI)scores of both groups were lower than those before treatment,Berg balance scale(BBS)and lower limb Fugl-Meyer motor function assessment-lower limb evaluation(FMA-LE)scores were higher than those before treatment,and CSI of observation group were lower than control group,BBS and FMA-LE scores were higher than control group(P<0.05).After treatment,the peak value of hip flexion,peak value of knee flexion,stride length,stride frequency,and stride speed in both groups were higher than before treatment,and the observation group was higher than the control group(P<0.05).There was no significant difference in the total incidence of adverse reactions between the two groups during treatment(P>0.05).Conclusion Low frequency repetitive transcranial magnetic stimulation is effective in the treatment of lower limb spasticity in patients with hemiplegia after stroke,and can improve lower limb function,balance function,and walking function,with good safety.