不同频率高频重复经颅磁刺激对缺血性脑卒中患者上肢功能的效果

Effects of High-frequency Repetitive Transcranial Magnetic Stimulation in Different Frequencies on Upper Limb Function after Ischemic Stroke

目的探讨3 Hz和10 Hz重复经颅磁刺激(rTMS)对缺血性脑卒中后患者上肢运动功能和日常生活活动能力的影响。方法 2016年6月至2017年9月,缺血性脑卒中住院患者60例随机分为伪rTMS组(n=19)、3 Hz-rTMS组(n=21)和10 Hz-rTMS组(n=20),分别给予伪rTMS刺激、3 Hz和10 HzrTMS刺激,同时行常规上肢康复训练,共2周。治疗前后检测损伤对侧半球静息运动阈值(RMT),治疗前后和随访6周时,采用改良Ashworth量表(MAS)、Fugl-Meyer评定量表上肢部分(FMA-UE)和改良Barthel指数(MBI)进行评定。结果共48例患者完成试验,其中3 Hz-rTMS组脱落5例,10 Hz-rTMS组脱落5例,伪rTMS组脱落2例。治疗后,3 Hz和10 Hz-rTMS组RMT提高(t> 2.390, P <0.05),三组间无显著性差异(F=0.164, P> 0.05)。3 Hz和10 Hz-rTMS组腕、肘MAS评分随时间延长逐渐下降(Z> 2.460, P <0.05);随访时,3 Hz和10 Hz-rTMS组肘MAS评分优于伪rTMS组(P <0.05)。时间与组别对FMA-UE评分存在显著交互作用(F=14.243, P <0.001),不同时间段,3 Hz和10 Hz-rTMS组的改善程度均明显高于伪rTMS组(P <0.01)。MBI评分时间与组别无交互作用(F=1.481, P> 0.05);不同时间段之间改善程度比较,三组间无显著性差异(F <2.925,P> 0.05)。结论 3 Hz和10 Hz rTMS均可以有效促进缺血性脑卒中患者上肢运动功能恢复,疗效相似,10 Hz rTMS治疗时间更短,推荐临床应用。

Objective To observe the effect of 3 Hz and 10 Hz repetitive transcranial magnetic stimulation(rTMS)on upper limb motor function and activities of daily living in patients with ischemic stroke.Methods From June,2016 to September,2017,60 inpatients with ischemic stroke were randomly divided into sham rT‐MS group(n=19),3 Hz-rTMS group(n=21)and 10 Hz-rTMS group(n=20).All the patients received routine training and their own rTMS for two weeks.Their rest motor threshold(RMT)was measured,and they were assessed with modified Ashworth Scale(MAS),Fugl-Meyer Assessment-Upper Extremities(FMA-UE)and modified Barthel Index(MBI)before and after treatment,and at six weeks follow-up.Results There were 48 patients completing the trial,while five in 3 Hz-rTMS group,five in 10 Hz-rTMS group and two in the sham rTMS group dropped.The RMT increased in 3 Hz and 10 Hz rTMS groups(t>2.390,P<0.05)after treatment,but there was no significantly difference among the three groups(F=0.164,P>0.05).The MAS scores of elbow and wrist decreased gradually over time in 3 Hz and 10 Hz rTMS groups(P<0.05),and the MAS scores of elbow was less in 3 Hz and 10 Hz rTMS groups than in the sham rTMS group at follow-up(P<0.05).The interaction of time and group was significant on the FMA-UE scores(F=14.243,P<0.001),and the FMA-UE scores improved more in 3 Hz and 10 Hz rTMS groups than in the sham rTMS group at different stages(P<0.01).The interaction of time and group was not significant in MBI score(F=1.481,P>0.05),and there was no significant difference among the three groups at any time(F<2.925,P>0.05).Conclusion Both 3 Hz and 10 Hz rTMS can promote the recovery of upper limb motor function in ischemic stroke patients safely and effectively,and 10 Hz rTMS is recommended as less time is needed.