头针疗法联合重复经颅磁刺激对脑卒中后单侧空间忽略康复疗效研究

Rehabilitation Effect of Scalp Acupuncture Combined with Repetitive Transcranial Magnetic Stimulation on Unilateral Spatial Neglect After Stroke

目的研究头针疗法联合重复经颅磁刺激治疗脑卒中后单侧空间忽略患者的康复疗效。方法收集河北北方学院附属第一医院收治的脑卒中后单侧空间忽略患者80例,随机分为对照组(n=40)和观察组(n=40),两组患者均给予常规康复治疗,对照组在常规治疗基础上加以头针治疗,而观察组加以头针治疗联合重复经颅磁刺激,连续治疗2个月。评价两组患者的治疗总有效率,采用画钟试验、数字删除试验、线段划消试验3种忽略症纸笔试验评价治疗前后患者忽略程度;采用Fugl-Meyer量表(FMA)评分、日常生活能力量表(ADL)、简易精神状态检查评分表(MMSE)评定患者日常生活、活动能力及精神状态;采用全自动生化仪检测患者血液流变学指标、血红蛋白(Hb)和平均红细胞容积(MCV)变化。结果治疗后观察组总有效率显著优于对照组(P<0.05);与治疗前相比,两组患者治疗后画钟试验、数字删除试验、线段划消试验评分显著低于治疗前(P<0.05),且观察组上述3项试验评分均低于对照组(P<0.05);治疗后两组患者FMA、独立性评定法(FIM)、MMSE评分均显著高于治疗前(P<0.05),且观察组患者上述3项评分均显著高于对照组(P<0.05);治疗后两组患者全血黏度、血浆黏度、纤维蛋白原水平均明显降低,Hb明显升高(P<0.05),且观察组患者血液流变学指标降低幅度、Hb升高幅度均大于对照组(P<0.05)。结论头针疗法联合重复经颅磁刺激在治疗脑卒中后单侧空间忽略方面具有良好的临床疗效,提高患者患侧肢体运动能力及生活能力,改善患者的精神状态及血液流变学指标,值得临床推广应用。

Objective To study the rehabilitation effect of scalp acupuncture combined with repetitive transcranial magnetic stimulation(rTMS)in patients with unilateral spatial neglect after stroke. Methods 80 cases of unilateral spatial neglect after stroke in the first affiliated hospital of Hebei north university were collected,and patients were randomly divided into control group(n=40)and observation group(n=40). Both groups were given routine rehabilitation treatment,the control group was treated with scalp acupuncture on the basis of routine treatment,while the observation group was treated with scalp acupuncture combined with repetitive transcranial magnetic stimulation. Both groups were treated for 2 months. Three kinds of paper pen tests were used to evaluate the degree of patients’ neglect before and after treatment,including clock drawing test,digital deletion test and line segment erasing test;Fugl Meyer scale(FMA),activity of daily living scale(ADL)and simple mental state examination score(MMSE)were used to evaluate the patients’ daily life,activity and mental state;The hemorheology index,hemoglobin(Hb)and mean corpuscular volume(MCV)were measured by automatic biochemical instrument. Results The total effective rate of the observation group was significantly higher than that of the control group(P<0.05);Compared with before treatment,the scores of clock drawing test,digit deletion test and line segment elimination test in the two groups were significantly lower than before treatment(P<0.05),and the scores of the three tests in the observation group were lower than those in the control group(P<0.05);The scores of FMA,FIM and MMSE in the two groups after treatment were significantly higher than those before treatment(P<0.05),and those in the observation group were significantly higher than those in the control group(P<0.05);After treatment,the whole blood viscosity,plasma viscosity and fibrinogen of the two groups were significantly reduced,Hb was significantly increased(P<0.05),and the decrease of hemorheology index and the increase of Hb in the observation group were greater than those in the control group(P<0.05).Conclusion Scalp acupuncture combined with repetitive transcranial magnetic stimulation has a good clinical effect in the treatment of unilateral spatial neglect after stroke. It can improve the motor ability of the affected limb and living ability,improve the mental state and hemorheology index of the patients,and is worthy of clinical application.