行为学疗法联合重复经颅磁刺激对脑卒中后单侧空间忽略患者的影响研究

Impact of Behavioral Therapy Combined with Repetitive Transcranial Magnetic Stimulation on Patients with Unilateral Spatial Neglect after Stroke

背景约85%的脑卒中患者存在不同程度的单侧空间忽略(USN),严重影响其日常生活活动能力。目前临床对脑卒中后USN尚缺乏有效的治疗方法,且现有的治疗方法疗效并不明确。目的探究行为学疗法联合重复经颅磁刺激(r-TMS)对脑卒中后USN患者的影响。方法选取徐州医科大学附属淮安医院2017年2月—2019年2月收治的脑卒中后USN患者80例为研究对象,采用随机数字表法将其分为对照组与观察组,各40例。对照组给予行为学疗法,观察组除给予行为学疗法外还给予r-TMS。比较两组治疗前后简式Fugl-Meyer运动功能评定量表(FMA)、功能独立性评定量表(FIM)、简易智能状态检查表(MMSE)评分及删除试验、数字消去法、平分直线法、自由画图、字体试验评分。结果观察组治疗后FMA、FIM、MMSE评分高于对照组(P<0.05);对照组、观察组治疗后FMA、FIM、MMSE评分分别高于本组治疗前(P<0.05)。观察组治疗前删除试验评分高于对照组,治疗后删除试验、数字消去法、平分直线法、自由画图、字体试验评分低于对照组(P<0.05);对照组、观察组治疗后删除试验、数字消去法、平分直线法、自由画图、字体试验评分分别低于本组治疗前(P<0.05)。结论行为学疗法联合r-TMS可提高脑卒中后USN患者运动功能、日常生活活动能力、认知功能,进而改善患者USN症状。

Background About 85%of stroke patients have varying degrees of unilateral spatial neglect(USN),which seriously affects their activities of daily living.At present,there is no effective clinical treatment for USN after stroke,and the curative effect of existing treatment methods is not clear.Objective To explore the impact of behavioral therapy combined with repetitive transcranial magnetic stimulation(r-TMS)on patients with USN after stroke.Methods A total of 80 patients with USN after stroke admitted to the Affiliated Huaian Hospital of Xuzhou Medical University from February 2017 to February 2019 were selected as the research objects,and they were randomly divided into control group and observation group,40 cases in each group.The control group was given behavioral therapy,and the observation group was given r-TMS in addition to behavioral therapy.Fugl-Meyer Assessment(FMA),Function Independent Measure(FIM)and Mini-Mental State Examination(MMSE)scores as well as deletion test,digital elimination method,split line method,free drawing and font test scores were compared between the two groups.Results After treatment,FMA,FIM and MMSE scores in the observation group were significantly higher than those in the control group(P<0.05);the scores of FMA,FIM and MMSE in the control group and the observation group after treatment were higher than those before treatment,respectively(P<0.05).The score of deletion test before treatment in the observation group was higher than that in the control group,while the scores of deletion test,digital elimination method,split line method,free drawing and font test after treatment were lower than those in the control group(P<0.05);the scores of deletion test,digital elimination method,split line method,free drawing and font test of the control group and the observation group after treatment were lower than those before treatment,respectively(P<0.05).Conclusion Behavioral therapy combined with r-TMS can improve motor function,activities of daily living,cognitive function of patients with USN after stroke,and then improve the symptoms of USN.