头穴重复经颅磁刺激治疗脑卒中后上肢痉挛性偏瘫疗效观察

Effect Observation on Repetitive Transcranial Magnetic Stimulation at Scalp Acupoints on Spastic Hemiplegia of Upper Extremity after Stroke

目的:观察经头穴重复经颅磁刺激(rTMS)治疗脑卒中后上肢痉挛性偏瘫的临床疗效。方法:60例脑卒中后上肢痉挛性偏瘫患者按照随机数字表法分为对照组、中医头针组、rTMS头穴组,每组20例。对照组仅接受常规康复治疗;中医头针组在对照组基础上加用头针治疗,针刺病灶对侧顶颞前斜线、顶颞后斜线以及枕下旁线刺激区;rTMS头穴组在对照组基础上加用经头穴rTMS治疗,利用rTMS刺激病灶同侧正营穴和顶部百会穴。3组治疗均1次/d,5次/周,连续治疗8周。采用改良Ashworth量表(MAS)评定患者偏瘫侧肘关节痉挛程度;Fugl-Meyer上肢运动功能评分量表(FMA-UE)评价痉挛上肢运动功能恢复情况;改良Barthel指数(MBI)评价患者日常生活活动能力。结果:治疗8周后,3组MAS、FMA-UE和MBI评分均较治疗前明显改善,差异具有统计学意义(P<0.05);与对照组比较,中医头针组和rTMS头穴组MAS评分明显降低,FMA-UE、MBI评分均明显升高,差异具有统计学意义(P<0.05)。结论:头穴重复经颅磁刺激治疗可促进脑卒中痉挛性偏瘫患者神经功能恢复,提高上肢活动能力。

Objective: To observe the clinical effect of repetitive transcranial magnetic stimulation(r TMS) at scalp acupoints on spastic hemiplegia of upper extremity after stroke. Methods: A total of 60 patients with spastic hemiplegia of upper extremity after stroke were randomly divided into control group, scalp-acupuncture group and r TMS acupoint group, with 20 cases in each group. The control group was treated by routine rehabilitation treatment;the scalp-acupuncture group was treated with scalp acupuncture on the basis of the control group, needling the stimulation area of the contralateral anterior parietal-temporal oblique line, posterior parietal-temporal oblique line and suboccipital side line;the r TMS acupoint group was treated with r TMS via scalp acupoint on the basis treatment of the control group, using r TMS to stimulate the ipsilateral Zhengying acupoint and Baihui acupoint. The three groups were treated once a day, five times in a week, continuous treatment for eight weeks. Modified ashworth scale(MAS) was used to assess the degree of spasticity of elbow joint on hemiplegic side;Fugl-Meyer upper extremity motor function scale(FMA-UE) was used to evaluate the recovery of motor function of spastic upper extremity;and modified Barthel index(MBI) was used to evaluate the activity of daily living. Results: After treatment for eight weeks, the scores of MAS, FMA-UE and MBI in the three groups improved significantly than those of treatment before, with statistically significant differences(P<0.05);Compared with the control group, the scores of MAS in scalp acupuncture group and r TMS scalp acupoint group decreased significantly, while the scores of FMA-UE and MBI increased significantly, with statistically significant differences(P<0.05). Conclusion: Repeated transcranial stimulation at scalp acupoints can promote the recovery of neurological function and improve the activity of upper extremity of stroke patients with spastic hemiplegia.