重复经颅磁刺激联合分级运动想象训练对脑梗死后偏瘫患者运动功能及神经功能的影响

Influence of repetitive transcranial magnetic stimulation combined with graded motor imagery training on motor function and neurological function in patients with hemiplegia after cerebral infarction

目的:探讨重复经颅磁刺激(rTMS)联合分级运动想象训练对脑梗死后偏瘫患者运动功能及神经功能的影响。方法:本研究为前瞻性随机对照研究,选取2023年2月至2024年2月徐州市第一人民医院神经内科收治后转入康复医学科的164例脑梗死后偏瘫患者,男79例,女85例,年龄(57.41±7.79)岁,年龄范围为48~73岁。采用随机信封法将患者随机分为对照组、rTMS组、分级运动想象组及联合组,每组41例。对照组行常规内科治疗与康复,rTMS组行rTMS治疗,分级运动想象组行分级运动想象训练,联合组行rTMS联合分级运动想象训练。评估四组患者的上下肢运动功能、步行功能、平衡能力、日常生活活动能力、神经功能、脑血流灌注情况及不良反应发生情况。结果:治疗后4周,联合组的上肢Fugl-Meyer运动功能评分(FMA)、下肢FMA、脑卒中患者姿势评定量表、Banhel指数评分及表观弥散系数值分别为(57.94±4.71)分、(28.02±2.33)分、(28.21±2.39)分、(73.92±7.16)分、(643.45±65.04)×10^(-6)mm^(2)/s,rTMS组分别为(55.23±4.77)分、(26.33±2.61)分、(26.14±2.61)分、(65.01±6.41)分、(614.01±61.33)×10^(-6)mm^(2)/s,分级运动想象组分别为(54.52±4.86)分、(25.45±2.01)分、(25.36±3.35)分、(63.68±6.33)分、(597.91±70.12)×10^(-6)mm^(2)/s,三组的上述指标均高于对照组[(52.41±4.03)分、(23.89±3.94)分、(23.15±3.24)分、(60.32±7.21)分、(562.36±55.02)×10^(-6)mm^(2)/s],差异有统计学意义( P<0.05)。联合组、rTMS组、分级运动想象组的计时起立-行走测试时间分别为(17.68±3.01)s、(20.06±3.61)s、(21.24±3.34)s,三组的上述指标均短于对照组[(23.14±3.15)s],差异有统计学意义( P<0.05)。联合组、rTMS组、分级运动想象组的6分钟步行实验距离分别为(206.54±20.61)m、(189.24±16.64)m、(182.35±17.99)m,三组的上述指标均长于对照组[(174.36±15.33)m],差异有统计学意义( P<0.05)。联合组、rTMS组、分级运动想象组的美国国立卫生院神经功能缺损评分分别为(8.27±1.79)分、(9.65±2.16)分、(10.05±2.25)分,三组的上述指标均低于对照组[(11.36±2.88)分],差异有统计学意义( P<0.05)。 结论:rTMS联合分级运动想象训练能改善患者运动功能及日常活动能力,还能改善脑组织血流灌注,促进患者的神经功能恢复。

ObjectiveTo explore the influence of repetitive transcranial magnetic stimulation(rTMS)combined with graded motor imagery training on motor function and neurological function in patients with hemiplegia after cerebral infarction.MethodsThis study was a prospective randomized controlled study,a total of 164 patients were admitted to the department of Neurology and transferred to the department of Rehabilitation Medicine of Xuzhou No.1 People′s Hospital from February 2023 to February 2024,including 79 males and 85 females,aged(57.41±7.79)years old,ranging from 48 to 73 years old.The patients were divided into control group,rTMS group,graded motor imagery group and combined group by random envelope method,with 41 cases in each group.The control group received routine medical treatment and rehabilitation,the rTMS group was given rTMS treatment,the graded motor imagery group adopted graded motor imagery training,and combined group underwent rTMS combined with graded motor imagery training.The motor function of upper and lower limbs,walking function,balance function,activities of daily living,neurological function,cerebral blood flow perfusion status and occurrence of adverse reactions were evaluated in the 4 groups.ResultsAt 4 weeks after treatment,the upper limb Fugl-Meyer motor assessment(FMA),lower limb FMA,performance-oriented assessment of sensorimotor skills score,Barthel index and apparent diffusion coeffcient value were(57.94±4.71)points,(28.02±2.33)points,(28.21±2.39)points,(73.92±7.16)points and(643.45±65.04)×10^(-6)mm^(2)/s in combined group;there were(55.23±4.77)points,(26.33±2.61)points,(26.14±2.61)points,(65.01±6.41)points and(614.01±61.33)×10^(-6)mm^(2)/s in rTMS group;there were(54.52±4.86)points,(25.45±2.01)points,(25.36±3.35)points,(63.68±6.33)points,(597.91±70.12)×10^(-6)mm^(2)/s in graded motor imagery group,and the above indicators in the 3 groups were higher than(52.41±4.03)points,(23.89±3.94)points,(23.15±3.24)points,(60.32±7.21)points and(562.36±55.02)×10^(-6)mm^(2)/s in control group,the differences were statistically significant(P<0.05).The time up and go test was(17.68±3.01)s in combined group,that in rTMS group was(20.06±3.61)s and that in graded motor imagery group was(21.24±3.34)s,the above indicators in the 3 groups were shorter than(23.14±3.15)s in control group,the difference were statistically significant(P<0.05).The 6-minute walk test in combined group was(206.54±20.61)m,that in rTMS group was(189.24±16.64)m and that in graded motor imagery group was(182.35±17.99)m,the above indicators in the 3 groups were longer than(174.36±15.33)m in control group,the differences were statistically significant(P<0.05).The National Institutes of Health stoke scale in combined group was(8.27±1.79)points,that in rTMS group was(9.65±2.16)points and that in graded motor imagery group was(10.05±2.25)points,the above indicators in the 3 groups were lower than(11.36±2.88)points in control group,the differences were statistically significant(P<0.05).ConclusionsrTMS combined with graded motor imagery training can not only improve the motor function and daily activity ability of patients,but also improve cerebral blood perfusion and promote the recovery of neurological function of patients.