高频重复外周磁刺激对脑出血后偏瘫患者肢体运动功能恢复的影响

The effect of high-frequency peripheral magnetic stimulation on the limb motor functioning of hemiplegic survivors of a cerebral hemorrhage

目的观察高频重复外周磁刺激(rPMS)对脑出血后偏瘫患者运动功能恢复的影响,并对其治疗机制进行初步探讨。方法采用随机数字表法将62例脑出血后偏瘫患者分为观察组及对照组,每组31例。2组患者均给予常规药物治疗及早期康复干预,观察组患者在此基础上针对上、下肢辅以高频rPMS治疗,对照组患者则同期给予假磁刺激治疗。于治疗前、治疗2周后分别采用Fugl-Meyer运动功能量表(FMA)、步行能力分级(FAC)以及改良Barthel指数(MBI)量表对2组患者肢体运动功能、步行能力和日常生活活动(ADL)能力进行评定,并检测2组患者磁刺激运动诱发电位(MEP)的波幅及潜伏期。结果治疗后2组患者上、下肢FMA评分、MBI评分、FAC分级、MEP波幅及潜伏期均较治疗前明显改善(P<0.05),并且观察组上、下肢FMA评分[分别为(30.94±0.85)分和(23.71±0.90)分]、MBI评分[(63.84±1.27)分]、FAC分级、MEP波幅及潜伏期[分别为(1.74±0.51)mV和(21.55±0.53)ms]亦显著优于对照组水平(P<0.05)。治疗期间2组患者均未发生明显不良反应。结论早期介入rPMS干预对脑出血后偏瘫患者肢体运动功能恢复具有显著促进作用,且安全性较好,其作用机制可能与rPMS调控大脑皮质兴奋性有关。

Objective To observe any impact of the repeated application of high-frequency peripheral magnetic stimulation(rPMS)on the recovery of motor function among hemiplegic survivors of an intracerebral hemorrhage.Also to explore the therapeutic mechanism involved.Methods Sixty-two hemiplegic survivors of an intracerebral hemorrhage were randomly assigned to an observation group or a control group,each of 31.Both groups received standard medical treatment and early rehabilitation,but the observation group also received high-frequency rPMS applied to their upper and lower limbs.Before and after two weeks of the treatment,everyone′s motor functioning was assessed using the Fugl-Meyer Assessment(FMA).Walking ability was quantified using functional ambulation classification(FAC).And ability in the activities of daily living was rated using the modified Barthel Index(MBI).The amplitudes and latencies of motor evoked potentials(MEPs)induced by transcranial magnetic stimulation and recorded from the abductor pollicis brevis of the affected side were also analyzed..Results After the treatment,significant improvement was observed in both groups′upper and lower limb FMA scores,MBI scores,FAC grades,and in their MEP amplitudes and latencies.On average,however,the observation group′s results were significantly better than those of the control group.Moreover,no significant adverse reactions were found in either group during the treatment.Conclusions Early rPMS intervention significantly enhances the recovery of limb function after an intracerebral hemorrhage,possibly through its modulation of cortical excitability.