高频重复经颅磁刺激对脑梗死患者运动功能的影响  

Effects of High-frequency Repetitive Transcranial Magnetic Stimulation on Motor Function in Patients with Cerebral Infarction

作　　者：吴冰洁[1] 郭记宏[2] 岳崴[3] 曹慧芳[3] 刘敏[3] 

机构地区：[1]河北医科大学第二医院神经内科,河北省石家庄市050000 [2]河北医科大学第一医院神经内科 [3]河北医科大学第二医院康复科,河北省石家庄市050000

出　　处：《中国全科医学》2014年第23期2751-2753,2760,共4页Chinese General Practice

基　　金：河北医科大学第二医院院级资助课题

摘　　要：目的观察高频重复经颅磁刺激(rTMS)对脑梗死患者运动功能的改善作用。方法选择2008—2012年河北医科大学第二医院神经内科和康复科收治的首次发病的大脑中动脉脑梗死患者90例,并按随机数字表法将其分为综合康复组、单纯康复组和对照组,各30例。对照组仅接受常规药物治疗;单纯康复组在药物治疗基础上于每日上午行肢体功能康复;综合康复组在药物和康复治疗基础上于每日下午行高频rTMS治疗。观察3组临床疗效,治疗前和治疗20 d后运动功能(FMA)评分及日常生活能力(Barthel指数)评分和治疗后不良反应发生情况。结果 90例患者均完成治疗。综合康复组总有效率为93.3%(28/30);单纯康复组总有效率为86.7%(26/30);对照组总有效率为70.0%(21/30)。3组的总有效率比较,差异有统计学意义(χ2=6.241,P=0.044)。综合康复组总有效率高于对照组(χ2=5.460,P=0.020);单纯康复组总有效率与对照组比较,差异均无统计学意义(χ2=2.460,P=0.117);综合康复组总有效率与单纯康复组比较,差异无统计学意义(χ2=0.743,P=0.389)。治疗前3组患者的上下肢FMA评分及Barthel指数评分比较,差异无统计学意义(P>0.05)。治疗20 d后3组患者的上下肢FMA评分及Barthel指数评分比较,差异均有统计学意义(P<0.05)。组间比较,治疗20 d后综合康复组和单纯康复组上下肢FMA评分及Barthel指数评分均高于对照组(P<0.05)。治疗20 d后综合康复组与单纯康复组下肢FMA评分比较,差异无统计学意义(P>0.05);上肢FMA评分及Barthel指数评分比较,差异均有统计学意义(P<0.05)。组内比较,3组患者治疗20 d后的上下肢FMA评分及Barthel指数评分均高于治疗前(P<0.05)。综合康复组30例患者在高频rTMS治疗期间未出现明显不良反应,且患者均能耐受并完成治疗。结论高频rTMS结合康复治疗能够促进脑梗死患者运动功能的恢复,尤其是上肢运动功能,且安全性较高,值�Objective To explore the effects of high-frequency repetitive transcranial magnetic stimulation（ rTMS） on motor function in patients with cerebral infarction（ CI）. Methods Ninety CI patients in department of neurology and depart-ment of rehabilitation medicine,the Second Hospital of Hebei Medical University from 2008 to 2012 were divided randomly into groups comprehensive rehabilitation（ CR）,simple rehabilitation（ SR）,control,30 in each. Control group were given conven-tional drug therapy（ CDT）,SR group given limb function rehabilitation（ LFR）based on CDT every morning,CR group given rTMS besides CDT and LFR every afternoon. The clinical effects were assessed,motor function and activities of daily living scored by Fugl-Meyer（ FMA）and Barthel index before treatment and after 20 d of treatment,adverse reactions observed after treatment. ResUlts All of the 90 patients completed the entire treatment. The total effective rate was 93. 3% in CR group（28/30）,86. 7% in SR group（26/30）,70. 0% in control group（21/30）,the difference was significant among the 3 groups（χ2=6. 241,P=0. 044）. The total effective rate was higher in CR group than in control group（χ2 =5. 460,P=0. 020）;no significant difference was noted between groups SR,control（χ2 =2. 460,P=0. 117）,between groups CR,SR（χ2 =0. 743, P=0. 389）. There was no difference in scores of upper or lower extremity FMA and Barthel index among the 3 groups before treatment（P〉0. 05）,but there was after 20 d of treatment（P〈0. 05）. The scores of upper and lower extremity FMA and Barthel index were higher in groups CR,SR than in control group after 20 d of treatment（P〈0. 05）. There was no difference in lower limb FMA score between groups CR and SR after 20 d of treatment（P〉0. 05）,there was in upper limb FMA and Barthel index score（P〈0. 05）. The scores of upper,lower limb FMA and Barthel index were higher after 20 d of treatment than before in 3 groups（P〈0. 05）. All patients of CR group ha

关 键 词：经颅磁刺激 脑梗死 运动功能 

分 类 号：R743.33[医药卫生—神经病学与精神病学]