重复经颅磁刺激对急性缺血性卒中患者运动功能恢复的影响

Effect of repetitive transcranial magnetic stimulation on motor function recovery in patients with acute ischemic stroke

目的探讨高频（10 Hz）、低频（1 Hz）以及θ短阵快速脉冲模式（theta burst stimulation, TBS）重复经颅磁刺激（repetitive transcranial magnetic stimulation, rTMS）对急性期缺血性卒中偏瘫患者运动功能恢复的影响。方法将72例急性缺血性卒中偏瘫患者采用随机数字表法随机分组，分别给予低频（18例）、高频（18例）、TBS（18例）rTMS或假刺激（对照组，18例），每天1次，连续治疗2周。所有入组患者在rTMS治疗前（第1次治疗之前当天）和治疗后（最后1次治疗之后当天）应用Fugl-Meyer运动功能评分（Fugl-Meyer Assessment, FMA）和美国国立卫生研究院卒中量表（National Institutes of Health Stroke Scale, NIHSS）进行神经功能评价。结果4组患者治疗后FMA和NIHSS评分均较治疗前出现显著改善（P均〈0.05）。高频组、低频组以及TBS组rTMS治疗后FMA和NIHSS评分均较对照组出现显著改善（P均〈0.05），各治疗组间无显著性差异。结论高频、低频和TBS rTMS均能改善急性缺血性卒中偏瘫患者的运动功能恢复，各治疗模式间无显著性差异。

Objective To investigate the effect of high frequency （10 Hz）, low frequency （1 Hz） and theta burst stimulation （TBS） mode of repetitive transcranial magnetic stimulation （rTMS） on the recovery of motor function in hemiplegic patients following acute ischemic stroke. Methods Seventy-two patients with hemiplegia after acute ischemic stroke were randomly grouped with the random number table. They were treated with low frequency （n = 18）, high frequency （n = 18）, and TBS （n = 18） rTMS or sham stimulation （control group, n = 18）, once a day, for 2 weeks. Fugl-Meyer Assessment （FMA） and National Institutes of Health Stroke Scale （NIHSS） were used to evaluate neurological function in all patients before rTMS treatment （on the day before the first treatment） and after treatment （on the day after the last treatment）. Results After treatment, the FMA and NIHSS scores in the 4 groups were significantly improved compared with before treatment （all P 〈 0.05）. After rTMS treatment, the FMA and NIHSS scores were improved significantly in the high frequency group, low frequency group and TBS group compare with the control group （all P 〈 0.05）. There were no significant differences among all the treatment groups. Conclusions High frequency, low frequency and TBS rTMS can improve the recovery of motor function in hemiplegic patients following acute ischemic stroke. There were no significant differences among all the treatment modes.