针刺结合重复经颅磁刺激改善脑卒中患者单侧忽略的效果

Value of acupuncture combined with repetitive transcranial magnetic stimulation in improving unilateral neglect in stroke patients

目的探讨针刺结合重复经颅磁刺激(rTMS)改善脑卒中患者单侧忽略(USN)的效果。方法前瞻性选取2022年3月至12月在成都市金牛区人民医院康复医学科、神经内科就诊的90例脑卒中后USN患者作为研究对象,通过随机抽样方法将其分为3组,每组各30例,A组患者给予rTMS治疗,B组患者给予针刺治疗,联合组患者给予rTMS加针刺治疗。3组均连续治疗8周。对比不同组别患者治疗前后USN严重程度评分(画钟试验、数字删除试验、线段划消试验),Fugl-Meyer(FMA)量表,日常生活能力(ADL)评分,简易精神状态检查量表(MMSE)评分,血液流变学(全血黏度、血浆黏度、纤维蛋白原)差异。结果(1)组内比较:治疗后,3组画钟试验、数字删除试验、线段划消试验评分均较治疗前降低;组间比较:联合组3项评分均低于A、B组,且A组3项评分均低于B组,差异均有统计学意义(P<0.05)。(2)组内比较:治疗后,3组FMA、ADL、MMSE评分均较治疗前提升;组间比较:联合组3项评分均高于A、B组,且A组3项评分均高于B组,差异均有统计学意义(P<0.05)。(3)组内比较:治疗后,3组全血黏度、血浆黏度、纤维蛋白原水平均较治疗前降低;组间比较:联合组3项水平均低于A、B组,且A组血浆黏度水平低于B组,差异均有统计学意义(P<0.05)。结论针刺结合rTMS对于改善脑卒中患者USN效果理想,能够明显提升患者肢体功能、日常生活能力及精神状态,调节血液流变学。

Objective To explore the value of acupuncture combined with repetitive transcranial magnetic stimulation(rTMS)in improving unilateral spatial neglect(USN)in stroke patients.Methods A prospective study was conducted on 90 post-stroke USN patients who visited the Rehabilitation Medicine Department and the Neurology Department of Chengdu Jinniu District People's Hospital from March 2022 to December 2022.They were randomly divided into three groups,with 30 patients in each group.Group A received rTMS treatment;Group B received acupuncture treatment;and Group C(the combined group)received rTMS plus acupuncture treatment;All three groups were treated continuously for 8 weeks.The differences of USN severity scores(clock drawing test,digital deletion test,line segment elimination test),Fugl-Meyer Assessment(FMA)scale,ability of daily living(ADL)score,simple mental state examination scale(MMSE)score,and hemorheology(whole blood viscosity,plasma viscosity,fibrinogen)of patients in the three groups were compared before and after treatment.Results(1)After treatment,the scores of the three groups of clock drawing test,digital deletion test,and line segment elimination test were lower than those before treatment;the scores of the three items in the combined group were lower than those in Group A and Group B,and the scores of the three items in Group A were higher than those in Group B;the differences were statistically significant(P<0.05);(2)After treatment,the scores of FMA,ADL and MMSE in the three groups were improved compared with those before treatment,and the differences between the three groups were statistically significant.The scores of the three items in the combined group were higher than those in Group A and B,and the scores of the three items in Group A were higher than those in Group B;the differences were statistically significant(P<0.05);(3)After treatment,the whole blood viscosity,plasma viscosity,and fibrinogen raw water in the three groups were lower than those before treatment on average.The three levels in the combined group were lower than those in group A and B,and the plasma viscosity level in group A was lower than that in group B;the differences between the three groups were statistically significant(P<0.05).Conclusion Acupuncture combined with rTMS has an ideal effect on improving the USN of stroke patients,can significantly enhance the limb function,daily living ability,and mental state of patients,and regulate hemorheology.