高频重复经颅磁刺激联合康复训练对脑卒中后运动功能的改善作用

The effect of high-frequency repetitive transcranial magnetic stimulation combined with rehabilitation training on the improvement of motor function after stroke

目的探讨高频重复经颅磁刺激(HF-rTMS)联合康复训练对脑卒中患者运动功能及炎症因子水平的影响。方法选取2021年1—12月张家港市中医医院收治的93例脑卒中偏瘫患者作为研究对象,随机分为对照组(n=47)与观察组(n=46)。对照组给予常规康复治疗,观察组在对照组基础上联合HF-rTMS治疗。比较两组治疗前后美国国立卫生研究院卒中量表(NIHSS)评分、日常生活能力(ADL)评分、偏瘫肢体功能评定(Brunnstrom)分级、炎症因子[白细胞介素-1β(IL-1β)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)]水平及临床疗效。结果治疗后,观察组NIHSS评分低于对照组,差异有统计学意义(P<0.05)。治疗后,观察组ADL评分高于对照组,但差异无统计学意义。治疗后,两组患侧上肢和下肢Brunnstrom评定分级比较差异无统计学意义,观察组患手分级情况优于对照组,差异有统计学意义(P<0.05)。治疗后,观察组血清IL-1β、IL-6、TNF-α水平均低于对照组,差异有统计学意义(P<0.05)。观察组临床疗效优于对照组,差异有统计学意义(P<0.05)。结论HF-rTMS联合康复训练可有效减轻脑卒中患者的炎症反应,减轻炎症反应,改善偏瘫肢体功能、神经功能和日常生活能力,促进患者运动功能,尤其是手功能的恢复。

Objective To investigate the effects of high-frequency repetitive transcranial magnetic stimulation(HF-rTMS)combined with reha-bilitation training on motor function and inflammation actor levels in stroke patients.Methods 93 patients with stroke hemiplegia treated in Zhangji-agang Hospital of Traditional Chinese Medicine from January to December 2021 were selected as the research subjects,and they were randomly di-vided into the control group(n=47)and the observation group(n=46).The control group was given routine rehabilitation treatment,and the observa-tion group was combined with HF-rTMS treatment on the basis of the control group.The National Institutes of Health stroke scale(NHISS)score,ability of daily living(ADL)score,hemiplegic limb function rating(Brunnstrom)grade,inflammatory factor(interleukin-1β[IL-1β],interleukin-6[IL-6],tumor necrosis factor-α[TNF-α])levels before and after treatment and clinical efficacy were compared between the two groups.Results Af-ter treatment,the NIHSS score in the observation group was lower than that in the control group,and the difference was statistically significant(P<0.05).After treatment,the ADL score in the observation group was higher than that in the control group,but the difference was not statistically signif-icant.After treatment,there was no statistically significant difference in Brunnstrom rating of upper limb and lower limb on the affected side between the two groups,while the observation group was better than the control group,the difference was statistically significant(P<0.05).After treatment,the serum levels of IL-1β,IL-6 and TNF-αin the observation group were lower than those in the control group,and the differences were statistically significant(P<0.05).The clinical efficacy in the observation group was better than that in the control group,the difference was statistically signifi-cant(P<0.05).Conclusion HF-rTMS combined with rehabilitation training can effectively reduce the inflammatory response of stroke patients,im-prove the function of hemiplegic limbs,nerve function and daily living ability,and promote the recovery of motor function,especially hand function.