低频重复经颅磁刺激联合分期针刺疗法在脑卒中后偏瘫患者中的应用研究

Clinical efficacy of low-frequency repetitive transcranial magnetic stimulation combined with staging acupuncture for patients with stroke-induced hemiplegia

目的观察低频重复经颅磁刺激(LF-rTMS)联合分期针刺疗法治疗脑卒中后偏瘫患者的临床疗效。方法将106例脑卒中后偏瘫患者按照随机数字表法分为3组,在均予西医常规康复治疗的基础上,LF-rTMS组37例予LF-rTMS治疗,分期针刺组35例根据Brunnstrom分期予相应针刺治疗,联合组34例予LF-rTMS联合分期针刺治疗。3组均治疗6个疗程,比较3组治疗前后表面肌电信号变化情况,包括偏瘫侧上肢肱二头肌与肱三头肌屈肘及伸肘时的均方根值(RMS),以及肱二头肌屈肘与肱三头肌伸肘时的协同收缩率(CR),比较3组治疗前后Brunnstrom分期为Ⅳ~Ⅴ期(恢复期)患者占比变化情况,比较3组治疗前后上肢运动功能测试量表(U-FMA)评分、改良Ashworth量表(MAS)评分及改良Barthel指数(MBI)评分变化情况。结果与本组治疗前比较,3组治疗后肱二头肌屈肘RMS、肱三头肌伸肘RMS水平均升高(P<0.05),肱二头肌屈肘CR及肱三头肌伸肘CR水平均降低(P<0.05),且联合组治疗后肱二头肌屈肘RMS、肱三头肌伸肘RMS水平均高于LF-rTMS组及分期针刺组(P<0.05),肱二头肌屈肘CR及肱三头肌伸肘CR水平均低于LF-rTMS组及分期针刺组(P<0.05)。与本组治疗前比较,3组治疗后Brunnstrom分期为Ⅳ~Ⅴ期(恢复期)患者占比水平均升高(P<0.05),且联合组治疗后Brunnstrom分期Ⅳ~Ⅴ期(恢复期)患者占比水平均高于LF-rTMS组及分期针刺组(P<0.05)。与本组治疗前比较,3组治疗后U-FMA评分及MBI评分均升高(P<0.05),MAS评分均降低(P<0.05),且联合组治疗后U-FMA评分及MBI评分均高于LF-rTMS组及分期针刺组(P<0.05),MAS评分均低于LF-rTMS组及分期针刺组(P<0.05)。结论LF-rTMS联合分期针刺疗法治疗脑卒中后偏瘫患者临床疗效确切,可有效调节患者表面肌电信号,促进肢体功能恢复,改善痉挛状态,提高日常生活能力。

Objective To observe the clinical efficacy of low-frequency repetitive transcranial magnetic stimulation(LF-rTMS)combined with staging acupuncture for patients with stroke-induced hemiplegia.Methods A total of 106 patients with stroke-induced hemiplegia were randomly divided into three groups.Based on routine Western medicine,they received LF-rTMS therapy(n=37),Brunnstrom stag-based staging acupuncture therapy(n=35),or combination therapy(n=34).The treatment continued for 6 courses,the aim was to compare surface electromyography(SEMG)including root mean square(RMS)and co-contraction ratio(CR)of biceps brachii during elbow flexion and triceps brachii during elbow extension in hemiplegic upper limb,the proportion of patients at recovery stages(Brunnstrom Stages Ⅳ-Ⅴ),the upper limb motor function test of Fugl-meyer assessment(U-FMA),Modified Ashworth Scale(MAS),Modified Barthel Index(MBI).Results After treatment,RMS of biceps brachii during elbow flexion and triceps brachii during elbow extension in the three groups was significantly increased than that before treatment,but CR was significantly decreased(all P<0.05),and the combination group was superior to the LF-rTMS and the staging acupuncture group for RMS and CR(all P<0.05).After treatment,the proportion of patients at recovery stages(Brunnstrom Stages Ⅳ-Ⅴ)in the three groups was significantly increased than that before treatment(P<0.05),which was significantly higher in the combination group than in the LF-rTMS and the staging acupuncture group(P<0.05).U-FMA and MBI scores in the three groups after treatment were significantly increased than those before treatment,but MAS scores were significantly decreased(all P<0.05),and the combination group was superior to the LF-rTMS and the staging acupuncture group for the scores of U-FMA,MBI,MAS(all P<0.05).Conclusion The combination of LF-rTMS and staging acupuncture in stroke-induced hemiplegia has definite clinical efficacy,which can effectively regulate SEMG,promote limb function recovery,improve spasticity and daily living ability.