重复性外周磁刺激对脑卒中瘫痪上肢屈肘肌痉挛的影响

Effect of Repetitive Peripheral Magnetic Stimulation on the Spasm of Elbow Flexion in Upper Extremity of Stroke

目的观察重复性外周磁刺激(repetitive peripheral magnetic stimulation,rPMS)联合常规治疗对脑卒中患者瘫痪侧上肢屈肘肌痉挛的影响。方法选取2019年9月至2020年9月在泰州市人民医院康复医学科接受康复治疗的脑卒中瘫痪上肢屈肘肌痉挛患者60例,随机分为实验组及对照组各30例。两组患者均给予常规治疗,实验组患者在此基础上给予重复性外周磁刺激治疗,对照组则给予假磁刺激治疗。在治疗前和治疗4周后选用改良Ashworth量表(modified Ashworth scale,MAS)对肌张力分级进行评估,选用表面肌电仪检测肱二头肌肌电积分值(iEMG)对痉挛情况进行判断,选用Fugl-meyer量表上肢部分(Fugl-Meyer motor assessment scale of Upper Extremity,FMA-UE)对患者上肢运动功能情况进行评估,选用改良Barthel指数(MBI)对患者日常生活活动能力情况进行评估。结果治疗4周后,组内比较,实验组及对照组患者Ashworth分级均较治疗前下降(P<0.05);两组患者肱二头肌iEMG值均较治疗前降低(P<0.05);两组患者FMA-UE评分、MBI评分均较治疗前升高(P<0.05);组间比较,实验组治疗后的上述疗效指标改善情况均较对照组更为显著,组间差异均具有统计学意义(P<0.05)。结论重复性外周磁刺激联合常规治疗可以更有效地减轻脑卒中后瘫痪肢体上肢屈肘肌痉挛,并且提高患者上肢运动功能及日常生活活动能力。

Objective To investigate the effects of repetitive peripheral magnetic stimulation(rPMS)on upper limb flexor elbow spasm in patients with paralysis in stroke.Methods From September 2019 to September 2020,a total of 60 patients with elbow flexion spasm of paralyzed upper limb after stroke who received rehabilitation treatment in Rehabilitation Department of Taizhou People’s Hospital were selected and divided into experimental group and control group by random number table method,with a sample size of 30 in each group.The patients in the experimental group were given repetitive peripheral magnetic stimulation on the basis of conventional treatment,while patients in the control group were given sham magnetic stimulation.Before treatment and after treatment of 4 weeks,Ashworth scale(MAS)was chosen to evaluate the muscle tension,surface electromyography was chosen to detect the iEMG of biceps brachii to judge the spasm,Fugl-meyer scale upper part(FMAUE)was chosen to assess patients with upper limb movement function,and modified Barthel index(MBI)was chosen to evaluate patient's activities of daily living.Results Before the intervention,there was no difference between the two groups in terms of any of the assessments.After 4 weeks of treatment,within group comparison,Ashworth grade of the experimental group and the control group was lower than that before treatment(P<0.05).The iEMG of biceps brachii in the two groups were lower than those before treatment(P<0.05).The FMA-UE score and the MBI score of the two groups higher than those before treatment(P<0.05).The improvement of the above therapeutic indexes in the experimental group was more significant than that of the control group,and the difference between the groups was statistically significant(P<0.05).Conclusion Repetitive peripheral magnetic stimulation combined with conventional treatment can more effectively reduce the spasticity of elbow flexor muscle of paralyzed limbs after stroke,and improve the motor function and activities of daily living of patients with upper limbs.