高频重复经颅磁刺激联合任务导向性训练对脑卒中后偏瘫患者上肢运动功能康复效果的影响

Impact on Rehabilitation Effect of High-frequency Repetitive Transcranial Magnetic Stimulation Combined with Task-oriented Training on Upper Limb Motor Function in Patients with Hemiplegia after Stroke

背景30%的脑卒中患者遗留偏瘫,严重影响其正常生活,因此促进患者肢体功能康复十分重要。重复经颅磁刺激(rTMS)作为一种新型无创技术逐渐应用于各类神经系统疾病的治疗,目前临床针对高频rTMS联合任务导向性训练在脑卒中后偏瘫患者中应用效果的研究较少。目的探讨高频rTMS联合任务导向性训练对脑卒中后偏瘫患者上肢运动功能康复效果的影响。方法选取华东师范大学附属芜湖医院康复医学科2016年8月至2020年8月收治的脑卒中后偏瘫患者87例为研究对象,根据康复治疗方案不同分为对照组42例和研究组45例。患者入院后均予以脑卒中二级预防药物治疗及物理疗法,对照组患者采用任务导向性训练,研究组患者在对照组基础上联合高频rTMS治疗,均连续治疗6周,随访1年。比较两组患者治疗前、治疗后6周及出院后3、6、12个月简化Fugl-Meyer运动功能评分法-上肢部分(FMA-UE)、Wolf运动功能测试(WMFT)、改良Barthel指数(MBI)量表评分。结果时间与治疗方法在FMA-UE、WMFT、MBI量表评分上存在交互作用(P<0.05);时间、治疗方法在FMA-UE、WMFT、MBI量表评分上主效应均显著(P<0.05)。研究组患者治疗后6周及出院后3、6、12个月FMA-UE、WMFT、MBI量表评分高于对照组(P<0.05)。两组患者治疗后6周及出院后3、6、12个月FMA-UE、WMFT、MBI量表评分分别高于本组治疗前(P<0.05)。结论高频rTMS联合任务导向性训练能够有效提高脑卒中后偏瘫患者的功能性训练效果,促进上肢运动功能恢复,进而提高患者的日常生活能力。

Background Thirty percent of stroke patients have hemiplegia,which obviously affect the daily life of patients.Therefore,it is very important to promote the limb function rehabilitation.Repetitive transcranial magnetic stimulation(rTMS),as a new non-invasive technique,is gradually applied to the treatment of various nervous system diseases.At present,there is little clinical research on the application effect of high-frequency rTMS combined with task-oriented training in patients with hemiplegia after stroke.Objective To explore the impact on rehabilitation effect of high-frequency rTMS combined with task-oriented training on upper limb motor function in patients with hemiplegia after stroke.Methods A total of 87 patients with hemiplegia after stroke admitted to the Department of Rehabilitation Medicine in Wuhu Hospital Affiliated to East China Normal University from August 2016 to August 2020 were selected,and they were divided into control group(42 cases)and study group(45 cases)according to different rehabilitation program.After admission,patients were given drugs and physical therapy,and patients in control group were given task-oriented training,patients in study group were given high-frequency rTMS based on control group,both groups were continually treated for 6 weeks,and followed up for 1 year.Scores of Fugl-meyer Assessment of Upper Extremity(FMA-UE),Wolf Motor Function Test(WMFT),modified Barthel Index(MBI)Scale before treatment,at 6 weeks after treatment and at 3,6,12 months after discharge were compared between the two groups.Results There was an interaction between time and treatment methods on scores of FMA-UE,WMFT,MBI Scale(P<0.05);time and treatment methods had significant main effects on scores of FMA-UE,WMFT and MBI Scale(P<0.05).Scores of FMA-UE,WMFT and MBI Scale at 6 weeks after treatment and at 3,6,12 months after discharge of study group were higher than those of control group(P<0.05).In the two groups,scores of FMA-UE,WMFT and MBI Scale at 6 weeks after treatment and at 3,6,12 months after discharge were higher than those before treatment,respectively(P<0.05).Conclusion High-frequency rTMS combined with task-oriented training can significantly promote functional training effect of patients with hemiplegia after stroke,promote upper limb motor function recovery,and then improve the ability of daily living of patients.