重复经颅磁刺激对老年脑梗死偏瘫患者平衡功能的影响

Effects of repeated transcranial magnetic stimulation on the balance function in elderly patients with hemiplegia after cerebral infarction

目的探讨重复经颅磁刺激(rTMS)对老年脑梗死偏瘫患者平衡功能的影响。方法选择2016年8月-2018年8月上海市第二康复医院神经内科收治的老年脑梗死偏瘫患者120例,随机分为2组,各60例。低频组采用1 Hz的低频rTMS治疗,高频组采用10 Hz的高频rTMS治疗。比较2组平衡功能、神经电生理学指标和生命质量的差异。结果治疗前,2组患者左右偏移度、矩形面积、轨迹长度、外周面积和单位面积轨迹长度等平衡功能参数比较差异无统计学意义(P>0.05);治疗后,2组患者左右偏移度、矩形面积、轨迹长度、外周面积和单位面积轨迹长度明显低于治疗前,且高频组上述指标明显优于低频组(P<0.05)。治疗前,2组患者最大运动诱发电位皮质潜伏期(MEPCL)、中枢运动传导时间(CMCT)比较差异无统计学意义(P>0.05);治疗后,2组患者MEPCL、CMCT明显低于治疗前,且高频组MEPCL、CMCT明显优于低频组(P<0.05)。治疗前,2组患者上肢运动功能(FMA)、改良Barthel指数(MBI)评分比较差异无统计学意义(P>0.05);治疗后,2组患者FMA、MBI评分明显高于治疗前,且高频组FMA、MBI评分明显高于低频组(P<0.05)。结论与低频rTMS治疗相比较,高频rTMS明显改善神经电生理学指标,有利于改善老年脑梗死偏瘫患者的平衡功能,进而提高生命质量,值得临床推广应用。

Objective To investigate the effect of repeated transcranial magnetic stimulation(rTMS)on balance function in elderly patients with hemiplegia after cerebral infarction.Methods 120 cases of hemiplegic patients with cerebral infarction admitted to the Inpatient Department of Neurology of Shanghai Second Rehabilitation Hospital from August 2016 to August 2018 were selected and randomly divided into two groups,60 cases in each.Low frequency group were given 1 Hz low frequency of rTMS,and high frequency group 10 Hz high frequency of rTMS.The differences of balance function,neuroelectrophysiological indicators and life quality between the two groups were compared.Results Before treatment,right-left displacement,rectangular areas,fragment length,peripheral area and trajectory length per unit area were compared between the two groups with no statistically significant differences(P>0.05).After treatment,right-left displacement,rectangular areas,fragment length,peripheral area of the two groups were significantly lower than pre-therapy while trajectory length per unit area were significantly higher,the above indexes of the high frequency group were significantly better than those of the low frequency group(P<0.05).Before treatment,there was no significant difference in motor evoked potential cortical latency(MEPCL)and central motor conduction time(CMCT)between the two groups(P>0.05),after treatment,MEPCL and CMCT in the two groups were significantly lower than that pre-therapy,MEPCL and CMCT in the high frequency group were significantly better than those of low frequency group(P<0.05).Before treatment,there was no significant difference in Fuel-Meyer assessment(FMA)and modified Barthel index(MBI)scores between the two groups(P>0.05),but after treatment,FMAand MBI scores of the two groups were significantly higher than pre-therapy,FMA and MBI scores of high frequency group were significantly higher than low frequency group(P<0.05).Conclusion Compared with patients treated with low-frequency rTMS,high-frequency rTMS can significantly improve neuroelectrophysiological indexes,thus helping to significantly improve the balance function of elderly patients with hemiplegia after cerebral infarction,and so significantly improving life quality,which is worthy of clinical promotion and application.