常规康复训练联合重复经颅磁刺激在不同亚型脑梗死偏瘫患者的应用价值

Application Value of Routine Rehabilitation Training Combined with Repetitive Transcranial Magnetic Stimulation in Patients with Hemiplegia of Different Subtypes of Cerebral Infarction

目的:探讨常规康复训练联合重复经颅磁刺激(rTMS)在不同亚型脑梗死偏瘫患者的应用价值。方法:选择本院2019年1月-2021年3月收治的180例符合入组标准的脑梗死偏瘫患者为研究对象,按随机数字表法将其分为rTMS组和常规组,每组90例。根据MRI/CT诊断结果将患者分为皮层分水岭梗死(CWSI)亚型和内分水岭梗死(IWSI)亚型,常规组中CWSI亚型33例、IWSI亚型57例;rTMS组中CWSI亚型37例、IWSI亚型53例。常规组仅单纯进行常规康复训练干预,rTMS组在常规组的基础上给予rTMS干预,两组均干预4周,干预前和干预2、4周后进行Fugl-Meyer(FMA)量表、改良Barthel指数(MBI)、Berg平衡量表(BBS)评估,采用徒手肌力检查(MMT)测定上肢前臂腕背伸肌群和拇外展肌群肌力水平,评判肌力恢复有效率。结果:与同组治疗前比较,rTMS组和常规组中CWSI、IWSI亚型患者治疗2、4周的FMA、MBI、BBS评分均显著升高(P<0.05);与常规组比较,rTMS组中CWSI、IWSI亚型患者治疗2、4周的FMA、MBI、BBS评分均明显升高(P<0.05);与同组IWSI亚型患者比较,rTMS组和常规组组内CWSI亚型患者治疗2、4周FMA、MBI、BBS评分明显升高(P<0.05)。与同组IWSI亚型患者比较,rTMS组和常规组中CWSI亚型患者治疗4周上肢肌力恢复有效率、手肌力恢复有效率、临床总有效率均明显升高(P<0.05);与常规组比较,rTMS组中CWSI、IWSI亚型患者治疗4周上肢肌力恢复有效率、手肌力恢复有效率均明显升高(P<0.05),rTMS组中IWSI亚型患者临床总有效率明显升高(P<0.05)。结论:常规康复训练联合rTMS治疗不同亚型脑梗死偏瘫均具有确切效果,能够有效改善肢体运动功能与平衡功能,促进肌力恢复及日常生活能力恢复,且对CWSI患者治疗效果优于IWSI患者。

Objective:To explore the application value of routine rehabilitation training combined with repeated transcranial magnetic stimulation (rTMS) in hemiplegia patients with different subtypes of cerebral infarction.Method:A total of 180 patients with cerebral infarction and hemiplegia who were admitted to our hospital from January 2019 to March 2021 and met the inclusion criteria were selected as the subjects,they were divided into rTMS group and conventional group according to random number table method,90 patients in each group.According to MRI/CT diagnosis results,patients were divided into cortical watershed infarction (CWSI) subtype and inner watershed infarction (IWSI) subtype,there were 33 cases of CWSI subtype and 57 cases of IWSI subtype in routine group;there were 37 cases of CWSI subtype and 53 cases of IWSI subtype in rTMS group.The routine group only received conventional rehabilitation training intervention,while the rTMS group received rTMS intervention on the basis of the routine group,both groups were treated for 4 weeks.Fugl-Meyer (FMA) scale,modified Barthel index (MBI) and Berg Balance Scale (BBS) were evaluated before intervention,2 and 4 weeks after intervention,manual muscle strength test (MMT) was used to measure muscle strength levels of carpal dorsiflexor group and abductor pollicis group in the forearm of upper limbs to evaluate the recovery efficiency of muscle strength.Result:Compared with the same group before treatment,the scores of FMA,MBI and BBS of CWSI and IWSI subtypes in rTMS group and routine group were significantly higher at 2 and 4 weeks of treatment (P<0.05);compared with the routine group,the scores of FMA,MBI and BBS of CWSI and IWSI subtypes in rTMS group were significantly higher after 2 and 4 weeks of treatment (P<0.05);compared with IWSI subtype patients in the same group,FMA,MBI and BBS scores of CWSI subtypes in rTMS group and routine group were significantly higher after 2 and 4 weeks of treatment (P<0.05).Compared with IWSI subtype patients in the same group,the effective rate of upper limb muscle strength recovery,hand muscle strength recovery and total clinical effective rate of CWSI subtype patients in rTMS group and routine group were significantly higher after 4 weeks of treatment (P<0.05);compared with the routine group,the effective rates of upper limb muscle strength recovery and hand muscle strength recovery in patients with CWSI and IWSI subtypes in rTMS group were significantly higher after 4 weeks of treatment (P<0.05),and the total clinical effective rate in patients with IWSI subtype in rTMS group was significantly higher (P<0.05).Conclusion:Routine rehabilitation training combined with rTMS has definite effects in the treatment of hemiplegia with different subtypes of cerebral infarction,it can effectively improve limb motor function and balance function,promote muscle strength recovery and daily living ability recovery,and the treatment effect of CWSI patients is better than that of IWSI patients.