低频重复经颅磁刺激联合康复机器人治疗脑卒中手功能障碍的临床研究

目的:观察低频重复经颅磁刺激联合康复机器人对脑卒中患者手功能障碍的治疗效果。方法:选取在我院康复科治疗的脑卒中手功能障碍患者36例,随机分为试验组(n=18)和对照组(n=18)。两组患者均接受常规治疗。对照组采用健侧1Hz重复经颅磁刺激治疗,试验组在对照组的基础上增加手功能康复机器人治疗,共持续治疗4周。于治疗前、治疗2周、治疗4周后采用皮质运动诱发电位(motor evoked potential,MEP)、中枢运动传导时间(central motor conduction time,CMCT)、患侧上肢Fugl-Meyer评分(Fugl-Meyer assessment,FMA)、运动强度指数(motricity index,MI)评分进行评定。结果:治疗4周后两组患者MEP、CMCT、FMA、MI较治疗前均有明显改善,差异均有显著性意义(P<0.001)。治疗4周后试验组MEP、CMCT、FMA、MI较对照组明显改善,差异均有显著性意义(P<0.05)。结论:健侧低频重复经颅磁刺激联合康复机器人可以明显改善脑卒中患者的手功能障碍。

重复经颅磁刺激联合镜像疗法对脑卒中偏瘫患者上肢运动功能及神经电生理的效果

目的探讨1 Hz重复经颅磁刺激(rTMS)联合镜像疗法对脑卒中偏瘫患者上肢运动功能及患侧皮质神经电生理的效果。方法选择2022年10月至2023年3月复旦大学附属金山医院收治的脑卒中患者60例,随机分为对照组(n=15)、磁刺激组(n=15)、镜像疗法组(n=15)和联合组(n=15)。各组均给予内科治疗和常规康复治疗,在此基础上,对照组给予空载磁刺激和假镜像疗法,磁刺激组给予1 Hz低频rTMS和假镜像疗法,镜像疗法组给予空载磁刺激和镜像疗法,联合组给予1 Hz低频rTMS联合镜像疗法,共4周。采用Fugl-Meyer评定量表上肢部分(FMA-UE)和上肢动作研究量表(ARAT)评估患侧上肢运动能力,经颅磁刺激仪测定患侧皮质的运动诱发电位(MEP)振幅及中枢传导时间(CMCT)。结果治疗后,各组FMA-UE评分、ARAT评分、MEP振幅均显著提高(|t|>3.854,P<0.001),CMCT均显著缩短(t>5.967,P<0.001)。与对照组比较,磁刺激组、镜像疗法组和联合组FMA-UE评分、ARAT评分和MEP振幅更高,CMCT更短(P<0.05);与磁刺激组和镜像疗法组比较,治疗后联合组FMA-UE评分、ARAT评分和MEP振幅更高,CMCT更短(P<0.05)。各组FMA-UE评分、ARAT评分与MEP振幅呈显著正相关,与CMCT呈显著负相关(R2>0.804,P<0.001)。结论1 Hz低频rTMS联合镜像疗法有助于脑卒中后脑功能重塑,促进偏瘫患者上肢运动功能恢复。

Effect of electroacupuncture combined with repetitive transcranial magnetic stimulation on limb dysfunction in patients with ischemic stroke

(rTMS) on limb dysfunction in ischemic stroke patients. Methods: A total of 63 stroke patients were divided into an observation group and a control group using the random number table method. Thirty-one patients in the control group were treated with routine Western medicine combined with rTMS;32 patients in the observation group were treated with EA in addition to the intervention in the control group. The duration of treatment was 3 months. The National Institutes of Health stroke scale (NIHSS), the Fugl-Meyer assessment (FMA), the modified Barthel index (MBI), and the motor evoked potential (MEP) latency of transcranial magnetic stimulation were observed before and after treatment in both groups. Results: Two cases withdrew from the observation group and 1 case withdrew from the control group. After treatment, the NIHSS score in both groups was lower than that before treatment, the FMA and MBI scores were higher than those before treatment, and the latency period of MEP was shorter than that before treatment, and the differences were statistically significant (P<0.05). After treatment, the NIHSS, FMA, and MBI scores and MEP latency period of the observation group improved more than those of the control group, and the differences between the groups were statistically significant (P<0.05). Conclusion: EA combined with rTMS can improve the motor function of limbs in ischemic stroke patients and improve their self-care ability. The mechanism may be related to increasing the excitability of the motor cortex and improving the electrophysiological function of the central nervous system.