重复经颅磁刺激对急性颈髓损伤神经调控的疗效观察

Effect of repetitive transcranial magnetic stimulation on nerve regulation in acute cervical spinal cord injury

目的探讨重复经颅磁刺激(rTMS)在急性颈髓损伤神经调控的治疗效果。方法320例美国脊髓损伤协会(ASIA)损伤分级A~D级颈髓损伤患者,根据入院科别分为对照组(215例)和治疗组(105例)。对照组接受常规治疗及康复治疗;治疗组在此基础上加用rTMS治疗。比较2组患者治疗前后的ASIA运动评分、呼吸机使用时间、尿管使用时间、麻痹性肠梗阻时间、病死率、30 d肺炎治愈率。结果治疗前,2组患者的性别、年龄、ASIA运动评分、损伤部位比较,差异均无统计学意义(P>0.05);治疗30 d后,治疗组的ASIA运动评分较对照组有所提高,差异有统计学意义(P<0.05)。治疗组佩带呼吸机时间、留置尿管时间、麻痹性肠梗阻时间均明显短于对照组,差异有统计学意义(P<0.05);治疗组的肺炎患病率较对照组明显降低,30 d治愈率较对照组明显增高,差异均有统计学意义(P<0.05)。结论rTMS联合传统治疗可明显改善急性颈髓损伤患者的运动、肺功能、大小便功能,效果优于传统治疗。

Objective To investigate the therapeutic effect of repetitive transcranial magnetic stimulation(rTMS)in patients with acute cervical spinal cord injury.Methods Three hundred and twenty patients with grade American Spinal Cord Injury Association(ASIA)A-D cervical spinal cord injury were divided into control group(n=215)and treatment group(n=105)according to the admission department.The control group received routine treatment and rehabilitation treatment,while the treatment group was treated with rTMS on the basis of routine treatment.The ASIA motor score,application time of suction machine,catheter use time,paralytic intestinal obstruction time,mortality and 30 d pneumonia cure rate of the two groups before and after treatment were compared.Results Before treatment,there was no significant difference in gender,age,ASIA motor score and injury site between the two groups(P>0.05).After 30 d of treatment,the ASIA motor score of the treatment group was higher than that of the control group(P<0.05).The time of wearing respiratory muscle,indwelling catheter and paralytic intestinal obstruction in the treatment group were significantly shorter than those in the control group(P<0.05);the incidence of pneumonia in the treatment group was significantly lower than that in the control group,and the 30 d cure rate was significantly higher than that in the control group(P<0.05).Conclusion rTMS combined with traditional therapy can significantly improve the movement,lung function,defecation and urine function of patients with acute cervical spinal cord injury,the effect is better than traditional therapy.