重复经颅磁刺激联合运动治疗对脑卒中偏瘫患者运动功能的影响

Effect of Repetitive Transcranial Magnetic Stimulation Combined with Exercise Therapy on the Motor Function in Stroke Patients with Hemiplegia

目的:探讨重复经颅磁刺激(rTMS)联合运动治疗对脑卒中偏瘫患者运动功能的影响。方法:选取2016年9月—2018年9月脑卒中偏瘫患者100例,按照随机数字表法分为激动组和运动组,每组50例。运动组给予运动治疗,激动组在此基础上给予rTMS治疗,2组治疗前和治疗3个月后均经颅磁治疗仪检测运动诱发电位潜伏期(MEP)、中枢运动传导时间(CMCT),采用Fugl-Meyer运动功能评分(FMA)评估上肢及下肢运动功能,采用日常生活能力量表(ADL)评估生活质量,比较2组运动神经电生理指标、运动功能、生活质量。结果:治疗前激动组和运动组MEP[(26.58±3.01)ms和(26.34±2.97)ms]、CMCT[(12.80±1.58)ms和(12.75±1.56)ms]比较差异无统计学意义(P>0.05),治疗3个月后激动组和运动组MEP[(20.15±2.26)ms和(23.24±2.56)ms]、CMCT[(10.04±1.26)ms和(11.64±1.24)ms]明显低于治疗前,治疗3个月后激动组MEP、CMCT明显低于运动组,差异均有统计学意义(P<0.001);治疗前激动组和运动组上肢FMA评分[(22.24±2.66)分和(22.46±2.72)分]、下肢FMA评分[(10.31±1.66)分和(10.23±1.62)分]比较差异无统计学意义(P>0.05),治疗3个月后激动组和运动组上肢FMA评分[(40.25±4.23)分和(34.58±3.95)分]、下肢FMA评分[(19.36±2.21)分和(15.26±1.92)分]明显高于治疗前,治疗3个月后激动组上肢FMA评分、下肢FMA评分明显高于运动组,差异均有统计学意义(P<0.001);治疗前激动组和运动组ADL评分[(40.91±4.82)分和(40.56±4.62)分]比较差异无统计学意义(P>0.05),治疗3个月后激动组和运动组ADL评分[(67.56±7.02)分和(59.72±6.52)分]明显高于治疗前,激动组ADL评分明显高于运动组,差异均有统计学意义(P<0.001)。结论:rTMS联合运动治疗可有效改善脑卒中偏瘫患者运动神经电生理指标和运动功能,提高患者的生活质量,值得临床推广。

Objective:To discuss the effect of repetitive transcranial magnetic stimulation(rTMS)combined with exercise therapy on the motor function in stroke patients with hemiplegia.Methods:A total of 100 stroke patients with hemiplegia were selected from September 2016 to September 2018,according to the random number table,and they were divided into excitation group and exercise group,with 50 cases in each group.The exercise group was treated with exercise therapy,and the excitation group was treated with rTMS combined with exercise therapy.Before treatment and after 3 months'treatment in the two groups,the latency of motor evoked potential(MEP)and central motor conduction time(CMCT)were measured by magnetic transcranial therapy,the motor function of upper and lower limbs were detected by Fugl-Meyer assessment scale(FMA),the quality of life were detected by activity of daily living scale(ADL),and the electrophysiological indexes,motor function,quality of life of the two groups were compared.Results:There was no significant difference in MEP[(26.58±3.01)ms and(26.34±2.97)ms],CMCT[(12.80±1.58)ms and(12.75±1.56)ms]between the excitation group and the exercise group before treatment(P>0.05).The MEP[(20.15±2.26)ms and(23.24±2.56)ms]and CMCT[(10.04±1.26)ms and(11.64±1.24)ms]in the excitation group and the exercise group after three months'treatment were significantly lower than those before treatment,the MEP and CMCT in the excitation group after three months'treatment were significantly lower than those in the exercise group,the difference was statistically significant(P<0.001).There was no significant difference in FMA scores of upper limbs[(22.24±2.66)scores and(22.46±2.72)scores],FMA scores of lower limbs[(10.31±1.66)scores and(10.23±1.62)scores]between the excitation group and the exercise group before treatment(P>0.05).The FMA scores of upper limbs[(40.25±4.23)scores and(34.58±3.95)scores]and lower limbs[(19.36±2.21)scores and(15.26±1.92)scores]in the excitation group and the exercise group after three months'treatment were significantly higher than those before treatment.After three months'treatment,FMA scores of upper limbs and lower limbs in the excitation group were significantly higher than those in the exercise group,with statistically significant differences(P<0.001).There was no significant difference in ADL scores[(40.91±4.82)and(40.56±4.62)]between the exercise group and the exercise group before treatment(P>0.05).The ADL scores[(67.56±7.02)scores and(59.72±6.52)scores]in the exercise group and the exercise group after three months'treatment were significantly higher than those before treatment,and the ADL scores in the excitation group after three months'treatment were higher than those in the exercise group,with statistically significant difference(P<0.001).Conclusions:rTMS combined with exercise therapy can effectively improve the motor neuroelectrophysiological indexes and motor function of stroke patients with hemiplegia,which is conducive to improving the quality of patients'life and worthy of clinical promotion.