重复经颅磁刺激对脑卒中后运动功能障碍的临床研究

Study on the treatment of non-fluent aphasia after acute cerebral infarction by transcranial magnetic stimulation combined with stellate ganglion block

目的 探讨重复经颅磁刺激对脑卒中后上肢运动功能障碍患者的临床疗效。方法 纳入郑州大学第二附属医院2018年6月—2020年12月收治的脑卒中上肢运动功能障碍患者42例,随机分为对照组和观察组各21例。对照组给予基础治疗,观察组在对照组基础上进行健侧初级运动皮质区1 Hz的重复经颅磁刺激(rTMS)治疗,20 min/次,5次/周,连续4周。比较两组患者治疗前后NIHSS评分,FMA-UE评分,MBI评分以及MEP潜伏期变化。结果 治疗前两组NIHSS、FMA-UE、MBI评分及MEP潜伏期差异无统计学意义(P>0.05)。治疗后NIHSS评分对照组(7.87±2.22)分,观察组(5.66±2.68)分,观察组NIHSS评分显著低于对照组(P<0.05);FMA-UE评分对照组(18.69±7.46)分;观察组(22.16±6.76)分,观察组FMA-UE评分显著高于对照组(P<0.05);MBI评分对照组(46.49±6.52)分,观察组(57.16±7.28)分,观察组MBI评分显著高于对照组(P<0.05);MEP潜伏期对照组(17.69±1.54)ms,观察组(20.22±1.27)ms,观察组MEP潜伏期显著优于对照组(P<0.05)。结论 重复经颅磁刺激可在一定程度上修复脑卒中后损伤的神经功能,减轻神经功能损伤程度,改善脑卒中后运动障碍患者的上肢活动能力,并提高患者日常生活质量,具有可观的应用及推广前景。

Objective To investigate the clinical effect of repeated transcranial magnetic stimulation on patients with upper limb motor dysfunction after stroke.Methods A total of 42 patients with stroke and upper limb motor dysfunction hospitalized between June 2018 and Dec.2020 were enrolled and randomly divided into 21 controls and 21 patients,respectively.The control group received basic treatment and the observation group received 1 Hz repeated transcranial magnetic stimulation(rTMS)treatment in the contralateral primary motor cortex based on the control group,20 minutes/time,5 times/week,4 weeks.Continuous.Changes in NIHSS score,FMA-UE score,MBI score,and MEP latency before and after treatment were compared between the two groups.Results There were no significant differences in NIHSS,FMA-UE,MBI scores and MEP latency between the two groups prior to treatment(P>0.05).After treatment,the NIHSS score in the control group was(7.87±2.22)points and that in the observation group was(5.66±2.68)points.The NIHSS score in the observation group was significantly lower than that in the control group(P<0.05).The UE score of the control group was(18.69±7.46)points,and that of the observation group was(22.16±6.76)points.The FMA-UE score of the observation group was significantly higher than that of the control group(P<0.05).The control group scored(46.49±6.52)points and the observation group scored(57.16±7.28)points.The MBI score of the observation group was significantly higher than that of the control group(P<0.05).The incubation period for the control group was(17.69±1.54)ms.and the observation group was(20.22±1.27)ms.The MEP incubation period in the observation group was significantly better than that in the control group(P<0.05).Conclusion Repetitive transcranial magnetic stimulation repairs damaged neural function to some extent after stroke,reduces the degree of neural dysfunction,improves upper limb mobility in patients with movement disorders after stroke,and patients'quality of live.It has considerable application and promotional prospects.