双侧序贯重复经颅磁刺激干预脑卒中患者上肢运动功能的效果

Effect of bilateral sequential repetitive transcranial magnetic stimulation on motor function of upper limbs in stroke patients

目的观察双侧序贯重复经颅磁刺激对脑卒中患者上肢运动功能恢复的影响。方法2020年12月至2022年12月山东中医药大学第二附属医院脑卒中住院患者62例,随机分为对照组(n=31)和观察组(n=31)。两组均进行常规药物和康复治疗,并行电针拮抗肌治疗。观察组在电针治疗前采用低频重复经颅磁刺激刺激患者健侧大脑皮质初级运动区(M1区),接着使用间歇性θ波脉冲刺激刺激患者患侧大脑皮质M1区,共4周。分别于治疗前后采用Fugl-Meyer评定量表上肢部分(FMA-UE)、改良Barthel指数(MBI)和改良Ashworth量表(MAS)进行评价,并比较运动诱发电位(MEP)潜伏期。结果观察组1例脱落,无不良事件发生。治疗后,两组FMA-UE、MBI评分均显著提高(|t|>9.953,P<0.001),MAS、MEP潜伏期均显著下降(|t|>5.043,P<0.001),观察组均优于对照组(|t|>2.237,P<0.05)。结论大脑双侧序贯重复经颅磁刺激可有效促进脑卒中患者上肢运动功能的恢复。

Objective To observe the effect of bilateral sequential repetitive transcranial magnetic stimulation on the motor function of upper limbs in stroke patients.Methods From December,2020 to December,2022,62 stroke inpatients in the Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine were included.They were randomly divided into control group(n=31)and observation group(n=31).Both groups accepted conventional medicine and rehabilitation,as well as electroacupuncture antagonistic muscle therapy.Before electroacupuncture,the observation group acceped lowfrequency repetitive transcranial magnetic stimulation at primary motor cortex(M1)on the healthy side,followed by intermittent theta burst stimulation at M1 on the affected side,for four weeks.They were assessed with Fugl-Meyer Assessment-Upper Extremities(FMA-UE),modified Barthel Index(MBI)and modified Ashworth Scale(MAS),and motor evoked potential(MEP)latency was compared before and after treatment.Results One patient dropped down in the observation group,and no adverse event happened.After treatment,the scores of FMA-UE and MBI significantly increased(|t|>9.953,P<0.001),and the score of MAS and the latency of MEP significantly decreased(|t|>5.043,P<0.001)in both groups;while all of them were better in the observation group than in the control group(|t|>2.237,P<0.05).Conclusion Bilateral sequential repetitive transcranial magnetic stimulation can effectively promote the recovery of upper limb motor function in stroke patients.