高频rTMS联合任务导向性训练在脑卒中后偏瘫患者中的效果

Effect of High-Frequency rTMS Combined With Task-Directed Training in Patients After Stroke With Hemiplegia

目的分析高频重复经颅磁刺激(repetitive transcranial magnetic stimulation,rTMS)联合任务导向性训练在脑卒中后偏瘫患者中的效果。方法选取佛山市第五人民医院2020年7月—2022年1月的52例脑卒中后偏瘫患者为研究对象,根据随机数字表法分为2组,各26例。导向训练组采用务导向性训练,联合组在导向训练组基础上联合高频rTMS治疗。比较2组患者治疗前后上肢运动功能、偏瘫侧肌力以及神经功能情况。结果治疗前,2组患者上肢Fugl-Meyer评估法(Fugl-Meyer assessment,FMA)评分比较,差异无统计意义(P>0.05)。治疗后1、2、4、8、12个月,联合组的FMA评分分别为(43.86±7.13)分、(48.45±8.38)分、(52.45±7.89)分、(54.48±9.22)分、(58.42±10.43)分,高于导向训练组的(38.13±6.87)分、(41.38±7.94)分、(43.25±8.63)分、(46.12±8.21)分、(50.25±9.12)分,组间差异有统计学意义(P<0.05)。治疗前,2组患者医学研究委员会量表(Medical Research Council,MRC)评分比较,差异无统计学意义(P>0.05);治疗后1、2、4、8、12个月,联合组的MRC评分分别为(2.39±0.40)分、(2.76±0.51)分、(3.06±0.52)分、(3.47±0.47)分、(3.94±0.79)分,均高于导向训练组的(2.08±0.34)分、(2.39±0.46)分、(2.67±0.53)分、(3.10±0.49)分、(3.40±0.85)分,组间差异有统计学意义(P<0.05)。治疗前,2组患者美国国立卫生研究院卒中量表(National Institutes of Health stroke scale,NIHSS)评分比较,差异无统计意义(P>0.05);治疗后1、2、4、8、12个月,联合组的NIHSS评分分别为(21.06±3.73)分、(19.08±2.41)分、(16.47±2.03)分、(14.24±2.46)分、(13.10±2.34)分,低于导向训练组的(23.45±3.15)分、(21.09±3.56)分、(18.34±2.12)分、(16.84±2.65)分、(15.36±2.05)分,组间差异有统计学意义(P<0.05)。结论高频rTMS联合任务导向性训练应用于脑卒中后偏瘫患者中能有效改善患者偏瘫侧上肢肌力及功能,促进患者神经功能恢复,可为后期高频rTMS联合任务导向性训练在脑卒中后偏瘫患者中的应用提供理论基础。

Objective To analyze the effect of high-frequency repetitive transcranial magnetic stimulation(repetitive transcranial magnetic stimulation,rTMS)combined with task-oriented training in patients with poststroke hemiplegia.Methods A total of 52 poststroke hemiplegia patients from July 2020 to January 2022 of the Fifth People's Hospital,Foshan City were included in the study,and were divided into 2 groups,with 26 cases each group.The guided training group adopts the service oriented training,and the combined group combined the high frequency rTMS on the basis of the guided training group.Upper limb motor function,hemiplegic side muscle strength and neurological function before and after treatment in two groups were compared.Results Before treatment,there was no statistically significant difference in the Fugl-Meyer assessment(FMA)scores of the upper limbs between the two groups of patients(P>0.05).At 1,2,4,8,and 12 months after treatment,the FMA scores of the combination group were(43.86±7.13)points,(48.45±8.38)points,(52.45±7.89)points,(54.48±9.22)points,and(58.42±10.43)points,respectively,which were higher than the guided training group's(38.13±6.87)points,(41.38±7.94)points,(43.25±8.63)points,(46.12±8.21)points,and(50.25±9.12)points,with statistical significance(P<0.05).Before treatment,there was no statistically significant difference in the Medical Research Council(MRC)scores between the two groups of patients(P>0.05).At 1,2,4,8,and 12 months after treatment,the MRC scores of the combination group were(2.39±0.40)points,(2.76±0.51)points,(3.06±0.52)points,(3.47±0.47)points,and(3.94±0.79)points,respectively,higher than those of the guidance training group(2.08±0.34)points,(2.39±0.46)points,(2.67±0.53)points,(3.10±0.49)points,and(3.40±0.85)points,with statistically significant differences between the groups(P<0.05).Before treatment,there was no statistically significant difference in the National Institutes of Health stroke scale(NIHSS)scores between the two groups of patients(P>0.05).At 1,2,4,8,and 12 months after treatment,the NIHSS scores of the combination group were(21.06±3.73)points,(19.08±2.41)points,(16.47±2.03)points,(14.24±2.46)points,and(13.10±2.34)points,respectively,lower than those of the guidance training group(23.45±3.15)points,(21.09±3.56)points,(18.34±2.12)points,(16.84±2.65)points,and(15.36±2.05)points,with statistically significant differences between the groups(P<0.05).Conclusion High-frequency rTMS combined with task-oriented training can effectively improve the muscle strength and function of hemiplegic upper limbs and promote the recovery of neurological function,which can provide a theoretical basis for the application of high-frequency rTMS combined with taskoriented training in hemiplegic patients after stroke.