重复经颅磁刺激与功能性电刺激对脑梗死后上肢运动功能的影响比较

Comparison of the effects of repetitive transcranial magnetic stimulation and functional electrical stimulation on motor function of upper limb in cerebral infarction patients

目的观察重复经颅磁刺激(repetitive transcranial magnetic stimulation,rTMS)与功能性电刺激(functional electrical stimulation,FES)对脑梗死后上肢运动功能的影响。方法选择本院2015年1月至2016年5月收治的脑梗死患者27例为研究对象。采用随机数表法将入选患者分为rTMS组(14例)和FES组(13例)。两组患者均给予常规康复功能训练,每天120分钟,每周5天,共3周。FES组患者除接受常规康复训练外,增加FES治疗,频率为50 Hz,每天15分钟,共3周,治疗部位为上肢伸肌。rTMS组患者除接受常规康复训练外,增加rTMS治疗,频率为1 Hz,每天15分钟,共3周,治疗部位为第一躯体运动区(primary somatomotor area,M1)。治疗前和治疗3周后,采用Fugl-Meyer运动功能评价法(Fugl-Meyer assessment,FMA)上肢部分评价上肢运动功能,采用巴塞尔指数(Barthel index,BI)评价患者日常生活活动(activities of daily living,ADL)能力。结果治疗前两组患者FMA和BI评分比较均无显著差异(P>0.05)。治疗后两组患者FMA和BI评分较本组治疗前均显著提高(P<0.05);rTMS组患者治疗前后FMA和BI评分差异均显著大于FES组(P<0.05)。结论 rTMS和FES对脑梗死偏瘫患者上肢运动功能的恢复和ADL能力的提高均具有积极的促进作用,且rTMS优于FES。

Objective To investigate the different effects between repetitive transcranial magnetic stimulation （rTMS） and functional electrical stimulation （FES） on motor function of upper limb in cerebral infarction patients. Method 27 cases of cerebral infarction patients with hemiplegia admitted to our hospital from January 2015 to May 2016 were divided into rTMS group （n = 14） and FES group （n = 13） by random number table. All of the patients were treated with normal rehabilitation training for 120 minutes per day, 5 days per week and for 3 weeks. The FES group receieved 50 Hz FES therapy on the extensor muscles of hemiplegic upper limb for 15 minutes per day and 3 weeks in all. The rTMS group received 1 Hz rTMS at contralesional primary motor cortex （M1） for 15 minutes per day and 3 weeks in all. Before and 3 weeks after treatment, Fugl-Meyer assessment （FMA） was used to evaluate the motor function of upper limb, and modified Barthel index （BI） was used to evaluate the activities of daily living ability. Result Before treatment, the scores of FMA and BI were not significantly different between the two groups （P 〈0.05）. The scoers of FMA and BI improved in both groups 3 weeks after treatment compared with themselves before treatment （P 〈 0.05）. And the rTMS group improved more significantly than FES group （P 〈 0.05）. Conclusion Both rTMS and FES can promote motor function of upper limb in patients after cerebralinfraction in the research. Compared with FES, rTMS can provide more effective treatment.