对侧抑制性rTMS联合运动想象对脑卒中偏瘫患者肢体功能的康复效果

Short-term effects of contralateral inhibitory rTMS combined with motor imagery on limb rehabilitation in patients with hemiplegia after stroke

目的探讨对侧抑制性重复经颅磁刺激(rTMS)联合运动想象(MI)对脑卒中偏瘫患者肢体功能的康复效果。方法选取廊坊市第四人民医院神经内科自2017年1月至2019年10月收治的108例脑卒中偏瘫患者为研究对象,按照随机数字表法将其分为常规组、MI组和联合组,每组36例。常规组接受常规药物治疗及康复治疗,MI组在常规组治疗基础上进行MI训练,联合组在MI组基础上进行对侧抑制性rTMS治疗;3组疗程均为4周。比较3组患者的临床疗效、治疗前后患侧运动诱发电位潜伏期(MEP-CL)、中枢运动传导时间(CMCT)、平衡量表(BBS)评分、起立-行走计时测试(TUGT)时间、修订版跌倒效能量表(MFES)评分、简化Fugl-Meyer评测法(FMA)评分、手部精细动作评估量表(MAS)评分、改良Barthel量表(MBI)评分。结果常规组、MI组、联合组治疗4周后总有效率分别为50.0%、77.8%、94.1%,3组患者的临床疗效比较差异有统计学意义(P<0.05)。3组患者的治疗前MEP-CL、CMCT、TUGT时间及BBS、MFES、FMA、手部精细动作MAS、MBI评分比较,差异无统计学意义(P>0.05)。治疗4周后,3组患者的MEP-CL、CMCT、TUGT时间缩短,BBS、MFES、FMA、手部精细动作MAS、MBI评分增高(P<0.05);改善程度:联合组>MI组>常规组,差异具有统计学意义(P<0.05)。结论对侧抑制性rTMS联合MI有利于脑卒中偏瘫患者的肢体功能康复,且能明显提高患者的生命质量。

Objective To explore the short-term effects of contralateral inhibitory repetitive transcranial magnetic stimulation(rTMS)combined with motor imagery(MI)on limb rehabilitation in patients with hemiplegia after stroke.Methods One hundred and eight patients with hemiplegia after stroke,admitted to Neurology Department of Fourth People’s Hospital of Langfang City from January 2017 to October 2019,were randomly divided into the conventional group,the MI group and the combined group,with 36 patients in each group.The conventional group received conventional drug therapy and rehabilitation therapy.The MI group received MI training on the basis of conventional treatment.The combined group underwent contralateral inhibitory rTMS therapy on the basis of the MI group.The course of treatment in all 3 groups was 4 weeks.The clinical efficacy,latent period of motor evoked potential(MEP-CL)on the affected side,central motor conduction time(CMCT)on the affected side,Berg balance scale(BBS),time up and go test(TUGT),modified falls efficacy scale(MFES),Fugl-Meyer assessment(FMA),motor assessment scale(MAS)of fine hand movement,modified barthel index(MBI)before and after treatment were compared among the 3 groups.Results After 4 weeks of treatment,the total effective rates of the conventional group,the MI group,and the combination group were 50.0%,77.8%,and 94.1%,respectively.The clinical efficacy of the 3 groups was compared with statistically significant differences(P<0.05).There were no statistically significant differences in MEP-CL,CMCT,TUGT time,BBS scores,MFES score,FMA score,fine hand movement MAS score and MBI score before treatment among the 3 groups(P>0.05).After 4 weeks of treatment,MEP-CL,CMCT and TUGT time were shortened,BBS score,MFES score,FMA score,fine hand movement MAS score and MBI score were increased in the 3 groups(P<0.05),the improvement degree:the combined group>the MI group>the conventional group(P<0.05).Conclusion The contralateral inhibitory rTMS combined with motor imagination is beneficial to the limb rehabilitation of patients with hemiplegia after stroke,and can significantly improve the quality of life of patients.