不同频率重复经颅磁刺激对脑梗死后患者上肢运动障碍和电生理检测数据的改善效果观察

The effects of dyskinesia of upper limb and electrophysiologic data of patients with cerebral infarction after transcranial magnetic stimulation at different frequencies

目的探讨不同频率重复经颅磁刺激(rTMS)对脑梗死(Cl)后上肢功能障碍患者的临床疗效及电生理检测数据的影响。方法选取本院在2014年1月至2017年4月收治的CI后上肢功能障碍患者160例,按照随机数字表法平均分为联合组、低频组、高频组和假刺激组;分别给予健侧低频联合患侧高频颅磁刺激,健侧低频经颅磁刺激,患侧高频经颅磁刺激,随机部位假刺激,14d为1疗程;治疗前、治疗2w、4w后,采用运动功能Fugl-Meyer评估量表(FMA)进行运动功能评定,采用改良Barthel量表(MBI)对患者日常生活能力进行评分,采用运动功能评估量表(MAS)对患者的精细动作进行评分,测定患侧脑区运动诱发电位(MEP)潜伏期和中枢运动传导时间(CMCT),对比4组患者的临床疗效及上述各指标检测结果。结果 (1)联合组临床总有效率为95.00%,低频组临床总有效率为77.50%,高频组临床总有效率为72.50%,假刺激组临床总有效率为47.50%,比较差异有统计学意义(P<0.05);(2)治疗后2w、4w联合组FMA、MBI、MAS评分明显高于其他3组,高频组和低频组上述指标评分均明显高于假刺激组,差异均有统计学意义(P<0.05);低频组和高频组组间比较,差异无统计学意义(P>0.05);(3)治疗2w、4w后联合组CMCT和MEP明显短于其他3组,高频组和低频组CMCT和MEP明显短于假刺激组,差异有统计学意义(P<0.05);低频组和高频组组间比较,差异无统计学意义(P>0.05)。结论高频刺激和低频刺激均可显著改善CI后患者上肢运动功能和精细功能,2者疗效相当,联合治疗效果优于单一高频或低频刺激,值得临床应用。

Objective To investigate the effects of dyskinesia of upper limb and electrophysiologic data of patients with cerebral infarction （ CI ） after repetitive transcranial magnetic stimulation （ rTMS ） at different frequencies. Method 160 patients with CI upper limb disorder treated in our hospital from January 2014 to April 2017 were selected and divided into combined group, low frequency group, high frequency group and sham stimulation group according to the random number table method; They were treated respectively with low frequency rTMS on the uninjured side combined with high frequency rTMS on the affected side, low frequency rTMS on the uninjured side, high frequency transcranial magnetic stimulation on the affected side, pseudo stimulation on random site, and 14 days was a course of treatment; Before treatment, 2 weeks and 4 weeks after treatment, the motor function Fugl- Meyer assessment scale （ FMA ） was used to assess the motor function, the modified Barthel scale （ MBI ） was used to score the daily living ability of the patients, and the motor function assessment scale （ MAS ） was used to score the fine movements of the patients, the motor evoked potential （ MEP ） latent period on the affected side and the central motor transit time （ CMCT ） were measured, and the clinical efficacy of the four groups and the results of the above indexes were compared. Results ①the clinical total effective rate of combined group was 95%, the clinical total effective rate of low frequency group was 77.50%, the clinical total effective rate of high frequency group was 72.50%, the clinical total effective rate of sham stimulation group was 47.50%, and the differences were statistically significant （ P〈0.05 ） ; ②2 weeks and 4 weeks after treatment, the FMA, MBI, MAS scores of combined group were significantly higher than those of the other three groups, the above index scores of high frequency group and low frequency group were significantly higher than those of sham stimulation group, and the differences were statistically significant （ P〈0.05 ） ; There was no significant difference between low frequency group and high frequency group （ P〉0.05 ） ; ③2 weeks and 4 weeks after treatment, the CMCT and MEP of combination group were significantly shorter than those of the other three groups, the CMCT and MEP of high frequency group and low frequency group were significantly shorter than those of the sham stimulation group, and the difference was statistically significant （ P〈0.05 ） ; The difference between the low frequency group and the high frequency group was not statistically significant （ P〉0.05 ） . Conclusion High frequency stimulation and low frequency stimulation can significantly improve the upper limb motor function and fine function in patients with CI, Both of them are effective, and the combination therapy is superior to single high frequency or low frequency stimulation. It is worthy to be popularized.