不同强度的高频重复经颅磁刺激对脑梗死早期患者上肢功能的影响

Effects of different intensity of high frequency repetitive transcranial magnetic stimulation on upper limb function in patients with early post-stroke

目的:观察不同强度高频重复经颅磁刺激(high-frequency repetitive transcranial magnetic stimulation,HF-rTMS)对脑梗死恢复早期患者上肢功能障碍恢复的影响。方法:选取60例脑梗死恢复早期患者,采用随机数字表法分为HF-rTMS 80%RMT组、100%RMT组和假刺激组,每组各20例。三组患者均给予基础治疗(药物治疗及常规康复训练),在此基础上分别给予不同强度的HF-rTMS治疗。记录治疗前及治疗4周后3组患者的Fugl-Meyer上肢运动功能评定(Fugl-Meyer assement-upper extremity,FMA-UE)和改良Barthel指数(modified Barthel Index,MBI)分值,检测运动诱发电位(motor evoked potential,MEP)潜伏期,计算中枢运动传导时间(central motor conduction time,CMCT),测量患侧大脑中动脉(middle cerebral artery,MCA)血流速度。结果:治疗前,3组患者的FMA-UE评分、MBI评分、MEP潜伏期、CMCT及MCA血流速度均无显著性差异(P>0.05)。治疗4周后,3组患者的上述指标均较治疗前提高,具有显著性差异(P<0.05);其中80%RMT组、100%RMT组指标改善均较假刺激组显著(P<0.05);除MBI外,100%RMT组各项指标改善最为显著(P<0.05)。结论:HF-rTMS可以改善脑梗死恢复早期患者上肢功能和日常生活能力,100%RMT HF-rTMS在提高功能、运动神经兴奋性,改善脑血流等方面较80%RMT更有优势。

Objective:To evaluate the effects of high-frequency repetitive transcranial magnetic stimulation(HF-rTMS)of different intensities on the recovery of upper limb motor dysfunction in patients during the early recovery stage of cerebral infarction.Method:Sixty patients with cerebral infarction at early recovery stage were randomly divided into the HF-rTMS 80%RMT group,the HF-rTMS 100%RMT group and the sham stimulation group,with 20 patients in each group.All three groups were also given basic treatment(medication and routine rehabilitation training).Before and after 4 weeks treatment,the Fugl-Meyer Assessment-Upper extremity(FMA-UE)and Modified Barthel Index(MBI),the latency of motor evoked potential(MEP).central motor conduction time(CMCT)and blood flow velocity of the ipsilateral middle cerebral artery(MCA)were recorded.Result:Before treatment,there were no significant dfferences in FMA-UE score,MBI score,MEP latency,CMCT and the blood flow velocity of MCA among the three groups(P>0.05).After four weeks of treatment,the above indicators of the three groups were significantly higher than those before treatment(P<0.05).Moreover,the improvement of the indicators in the 80%RMT group and 100%RMT group were significantly higher than those in the sham stimulation group(P<0.05).Except for MBI score,the improvement in all indicators in the 100%RMT group were the most significant(P<0.05).Conclusion:HF-rTMS can improve upper limb function and activity of daily living during the early recovery stage of cerebral infarction.Compared with 80%RMT,100%RMT HF-rTMS has more advantages in improving function,motor nerve excitability and cerebral blood flow.