不同频率重复经颅磁刺激对脑卒中患者认知和运动的影响

Effect of repetitive transcranial magnetic stimulation of different frequencies on the cognition and movement of stroke patients

目的比较不同强度的重复经颅磁刺激(rTMS)对脑卒中后认知障碍患者认知和运动的影响。方法纳入2018年10月—2020年3月于安徽医科大学第二附属医院康复医学科住院的脑卒中患者63例,采用随机数表法分为3组(对照组22例、低频组20例、高频组21例)。对照组采用常规康复训练,低频组增加1 Hz的rTMS治疗,高频组增加10 Hz的rTMS治疗。治疗时间为3周。治疗前后比较患者蒙特利尔认知评估量表(MoCA)、简易智力状态检查量表(MMSE)、Fugl-Meyer量表(FMA)、改良Barthel指数(MBI)等。结果3组患者治疗后MoCA、MMSE、FMA、MBI评分较治疗前明显增加(均P<0.05);治疗后高频组、低频组各项总分均优于对照组(均P<0.05),治疗前后高频组与低频组的MoCA差值[(6.71±1.76)分vs.(4.85±2.03)分],MMSE差值[(3.05±1.07)分vs.(2.10±1.02)分],FMA差值[(7.52±2.36)分vs.(5.30±3.25)分],MBI差值[(10.00±4.74)分vs.(6.25±3.58)分]比较差异均有统计学意义(均P<0.05)。治疗后,高频组与低频组MoCA量表中的视空间与执行功能、定向能力评分比较差异有统计学意义(均P<0.05)。治疗后MoCA的差值与FMA的差值呈正相关关系(高频组r=0.906、低频组r=0.902、对照组r=0.886,均P<0.01)。结论常规康复训练联合高频或低频rTMS治疗均能够改善患者认知水平、运动功能和生活自理能力,常规康复联合高频rTMS康复效果更优。

Objective To compare the effects of different intensities of repetitive transcranial magnetic stimulation(rTMS)on cognition and movement in patients with cognitive impairment after stroke.Methods A total of 63 stroke patients who were hospitalised in the Department of Rehabilitation Medicine of the Second Hospital of Anhui Medical University from October 2018 to March 2020 were included.They were randomly divided into three groups(22 cases in control group,20 cases in low-frequency group and 21 cases in high-frequency group).The control group was treated with routine rehabilitation training.One Hz rTMS treatment was added to the low frequency group.Ten Hz rTMS treatment was added to the high frequency group.The duration of the above treatment was three weeks.The patients were evaluated using the Montreal cognitive assessment(MoCA),mini-mental state examination(MMSE),Fuel-Meyer assessment(FMA)and modified barthel index(MBI)before and after treatment.Results The scores of MOCA,MMSE,FMA and MBI in the three groups were significantly higher than those before treatment(all P<0.05).After treatment,the total scores of the high-frequency and low-frequency groups were better than those of the control group(all P<0.05).Before and after treatment,there were significant differences in MOCA difference[(6.71±1.76)points vs.(4.85±2.03)points],MMSE difference[(3.05±1.07)points vs.(2.10±1.02)points],FMA difference[(7.52±2.36)points vs.(5.30±3.25)points]and MBI difference[(10.00±4.74)points vs.(6.25±3.58)points]between high frequency group and low frequency group(all P<0.05).The scores of visual space,executive function and orientation ability in the high-frequency and low-frequency groups before and after treatment were statistically significant(all P<0.05).There was a significant positive correlation between the difference of MOCA and FMA after treatment(high-frequency group r=0.906,low-frequency group r=0.902,control group r=0.886,all P<0.01).Conclusion Routine rehabilitation training combined with high-frequency or low-frequency rTMS can effectively improve patients'cognition,movement and self-care ability,amongst which routine rehabilitation combined with high-frequency rTMS has the best effect.The cognitive and movement functions of stroke patients promote each other.