等速肌力训练联合经颅磁刺激对脑卒中患者下肢肌力、生活质量及运动功能的影响

Effects of isokinetic muscle strength training combined with transcranial magnetic stimulation on lower limb muscle strength,quality of life and motor function in stroke patients

目的探讨等速肌力训练联合经颅磁刺激对脑卒中患者下肢肌力、生活质量及运动功能的影响。方法前瞻性选择2020年5月至2022年1月青岛市中医医院收治的160例脑卒中患者作为研究对象,按照随机数字表法分为对照组和观察组,每组各80例。两组均予以常规康复治疗,在此基础上,对照组采取等速肌力训练,观察组采取等速肌力训练联合经颅磁刺激,持续治疗8周。在治疗前1 d及治疗结束后1 d,进行下肢肌力检测和改良Barthel指数(MBI)评分、下肢Fugl-Meyer运动功能量表(FMA)、Berg平衡量表(BBS)、Holden步行功能分级(HFAC)、Tinetti步态评估量表(TGA)评分。比较两组治疗前后的大脑中动脉血流动力学参数[峰值流速(Vs)、平均流速(Vm)、血管阻力指数(RI)],根据下肢Brunnstrom分级提高情况,综合评价临床疗效。结果治疗后,观察组120°/s时膝关节伸肌和屈肌的峰力矩体重比分别为(72.73±6.89)%、(33.51±5.47)%,均大于对照组[(65.41±5.06)%、(30.17±3.85)%],比较差异均有统计学意义(P<0.05)。治疗后,观察组MBI评分、下肢FMA评分分别为(69.98±10.23)、(28.23±6.74)分,均高于对照组[(55.35±6.79)、(22.45±4.36)分],比较差异均有统计学意义(P<0.05)。治疗后,观察组BBS评分、HFAC评分、TGA评分分别为(46.91±7.27)、(3.99±0.71)、(10.25±3.99)分,均高于对照组[(35.71±5.56)、(2.91±0.54)、(7.81±1.78)分],比较差异均有统计学意义(P<0.05)。观察组治疗总有效率为96.25%,高于对照组(85.00%),差异有统计学意义(P<0.05)。治疗后,观察组大脑中动脉的Vs、Vm分别为(47.96±7.95)、(35.71±6.89)cm/s,均大于对照组[(41.23±6.12)、(31.59±4.35)cm/s],RI为(37.56±2.07),小于对照组(73.59±3.14),差异均有统计学意义(P<0.05)。结论等速肌力训练联合经颅磁刺激对脑卒中患者的疗效显著,能有效增强下肢肌力、提高生活质量和改善运动功能,值得临床予以重视应用。

Objective To investigate the effects of isokinetic muscle strength training combined with transcranial magnetic stimulation on lower limb muscle strength,quality of life and motor function in stroke patients.Methods A total of 160 patients with cerebral apoplexy admitted to Qingdao Hospital of Traditional Chinese Medicine from May 2020 to January 2022 were prospectively selected as research objects and randomly divided into control group and observation group according to the random number table method,with 80 cases in each group.Both groups were given routine rehabilitation treatment.On this basis,the control group received isokinetic muscle training,and the observation group received isokinetic muscle training combined with transcranial magnetic stimulation for 8 weeks.One day before treatment and one day after treatment,lower extremity muscle strength test and modified BarBI Index(MBI)score,lower extremity Fugl-Meyer Motor Function Scale(FMA),Berg Balance Scale(BBS),Holden Walking Function Scale(HFAC),Tinetti Gait Assessment Scale(TGA)score were performed.The mechanical parameters of middle cerebral artery blood flow[peak velocity(Vs),mean velocity(Vm)and vascular resistance index(RI)]before and after treatment were compared between the two groups,and the clinical efficacy was comprehensively evaluated according to the improvement of Brunnstrom grade of lower limbs.Results At 120°/s after treatment,the peak moment weight ratio of the extensor and flexor muscles of the knee in the observation group was(72.73±6.89)%,(33.51±5.47)%,which was higher than that in the control group[(65.41±5.06)%,(30.17±3.85)%],the difference was statistically significant(P<0.05).After treatment,the MBI score and lower limb FMA score of the observation group were(69.98±10.23),(28.23±6.74)points,which were higher than those of the control group[(55.35±6.79),(22.45±4.36)points],the differences were statistically significant(P<0.05).After treatment,the BBS score,HFAC score and TGA score of the observation group were(46.91±7.27),(3.99±0.71),(10.25±3.99)points,which were higher than those of the control group[(35.71±5.56),(2.91±0.54),(7.81±1.78)points],the differences were statistically significant(P<0.05).The total effective rate of observation group was 96.25%,which was higher than that of control group(85.00%),the difference was statistically significant(P<0.05).After treatment,the Vs and Vm of the middle cerebral artery in the observation group were(47.96±7.95)and(35.71±6.89)cm/s,which were higher than those in the control group[(41.23±6.12)and(31.59±4.35)cm/s],and the RI was(37.56±2.07),which was lower than that in the control group(73.59±3.14),the difference was statistically significant(P<0.05).Conclusion Isokinetic muscle strength training combined with transcranial magnetic stimulation has a significant effect on stroke patients,which can effectively enhance lower limb muscle strength,improve quality of life and improve motor function,and is worthy of clinical attention.