中枢联合外周重复磁刺激对卒中后运动功能障碍的疗效

Effect of transcranial combined with peripheral repetitive magnetic stimulation on motor function after stroke

目的探讨中枢联合外周重复磁刺激对卒中后运动功能障碍的有效性。方法选取2019年1月-12月于西安交通大学第二附属医院康复医学科住院的脑卒中患者40例,采用随机数字法分为试验组和对照组,每组各20例。两组均给予常规药物治疗和康复训练,在此基础上试验组给予重复经颅磁刺激和重复外周磁刺激,对照组给予重复经颅磁刺激和假重复外周磁刺激治疗,均连续治疗2周。所有患者均于治疗前和入组后2、4、12周时采用Fugl-Meyer运动功能评定法(Fugl-Meyer Assessment,FMA)[包括FMA上肢运动功能评分(FMAUpper Limb,FMA-UL)和FMA下肢运动功能评分(FMA-Lower Limb,FMA-LL)]、美国国立卫生研究院卒中量表(National Institute of Health Stroke Scale,NIHSS)和改良Barthel指数(Modified Barthel Index,MBI)进行疗效评定。对两组患者治疗前后的变化和两组之间进行重复测量分析。结果试验过程中脱落5例,最终纳入35例,其中试验组18例,对照组17例。在试验过程中无患者发生不良反应。治疗前各评分组间比较,差异均无统计学意义(P>0.05)。治疗后,FMA评分试验组由(36.44±28.59)分变为(75.56±19.94)分,对照组由(39.05±29.85)分变为(54.64±23.25)分,在入组后4、12周时组间比较差异有统计学意义(P<0.05)。FMA-UL评分试验组由(21.39±22.14)分变为(46.94±15.84)分,对照组由(20.82±20.47)分变为(31.29±16.98)分,在入组后4、12周时组间比较差异有统计学意义(P<0.05)。FMA-LL评分试验组由(15.06±9.10)分变为(28.61±5.69)分,对照组由(18.23±10.33)分变为(23.35±8.20)分,在入组后12周时组间比较差异有统计学意义(P<0.05)。NIHSS评分试验组由(6.83±4.54)分变为(2.78±2.05)分,对照组由(6.35±3.67)分变为(3.94±2.56)分,各时间点组间比较差异无统计学意义(P>0.05)。MBI评分试验组由(53.33±17.90)分变为(83.06±12.50)分,对照组由(60.88±25.45)分变为(78.82±15.67)分,各时间点组间比较差异无统计学意义(P>0.05)。除对照组的FMA-LL外,余结局指标两组治疗后较治疗前差异均有统计学意义(P<0.05)。结论中枢重复磁刺激和中枢联合外周重复磁刺激均能改善卒中患者肢体运动功能,提高患者日常生活活动能力。中枢联合外周重复磁刺激的治疗模式对卒中后运动功能障碍的疗效更佳。

Objective To investigate the efficacy of transcranial combined with peripheral repetitive magnetic stimulation on motor dysfunction after stroke. Methods A total of 40 patients after stroke who were hospitalized in the Department of Rehabilitation Medicine, the Second Affiliated Hospital of Xi’an Jiaotong University between January and December 2019 were selected. The patients were divided into the trial group and the control group by random number table method, with 20 cases in each group. Both groups received conventional rehabilitation and medicine treatment, on that basis, the trial group received repetitive transcranial magnetic stimulation(rTMS) combined with repetitive peripheral magnetic stimulation(rPMS), while the control group received rTMS combined with fake rPMS,both lasted for 2 weeks. Before treatment and 2, 4, 12 weeks after the initiation of treatment, the Fugl-Meyer Assessment(FMA) [including FMA-Upper Limb(FMA-UL), FMA-Lower Limb(FMA-LL)], National Institute of Health Stroke Scale(NIHSS), and Modified Barthel Index(MBI) were used to evaluate the efficacy of rTMS combined with rPMS.Results Five patients fell off, and 35 patients were finally included, including 18 in the trial group and 17 in the control group. No adverse reaction occurred during the study. Before treatment, there was no significant difference in FMA,FMA-UL, FMA-LL, NIHSS or MBI scores between the two groups(P>0.05). After treatment, the FMA score of the trial group changed from 36.44±28.59 to 75.56±19.94, and that of the control group changed from 39.05±29.85 to 54.64±23.25;the between-group difference was statistically significant at the end of the 4 th and 12 th weeks(P<0.05). The FMA-UL score of the trial group changed from 21.39±22.14 to 46.94±15.84, and that of the control group changed from20.82±20.47 to 31.29±16.98;the between-group difference was statistically significant at the end of the 4 th and 12 th weeks(P<0.05). The FMA-LL score of the trial group changed from 15.06±9.10 to 28.61±5.69, and that of the control group changed from 18.23±10.33 to 23.35±8.20;the between-group difference was statistically significant at the end of the 12 th week(P>0.05). The NIHSS score of the trial group changed from 6.83±4.54 to 2.78±2.05, and that of the control group changed from 6.35±3.67 to 3.94±2.56;the MBI score of the trial group changed from 53.33±17.90 to 83.06±12.50, and that of the control group changed from 60.88±25.45 to 78.82±15.67;there was no statistically significant difference in NIHSS or MBI between the two groups at any timepoint(P>0.05). Except for the FMA-LL of the control group, the other outcome indicators in each group were significantly different after treatment compared with those before treatment(P<0.05). Conclusions Both rTMS and rTMS combined with rPMS can improve the limb motor function and activities of daily living of stroke patients. The treatment mode of rTMS combined with rPMS has better effect on motor dysfunction after stroke, which is of great significance for improving the overall rehabilitation effect.