重复经颅磁刺激对脑梗死患者上肢运动功能的影响  

Effects of repetitive transcranial magnetic stimulation on motor function of upper limbs in patients after cerebral infarction

作　　者：孟祥民[1] 赵宇阳[1] 杨传美[1] 陈曦[2] 李江[1] 

机构地区：[1]青岛大学附属医院康复医学科,266003 [2]聊城市人民医院康复医学科

出　　处：《中国康复医学杂志》2016年第6期664-669,共6页Chinese Journal of Rehabilitation Medicine

摘　　要：目的:研究不同频率重复经颅磁刺激(r TMS)对脑梗死偏瘫患者上肢运动功能的影响。方法:符合入组条件完成研究的45例患者按随机数字表法分为低频刺激组(14例)、假rTMS组(14例)和高频刺激组(17例)。所有患者均给予常规药物治疗和康复训练,低频刺激组则在非受累侧初级运动皮质区(M1区)进行1Hz的rTMS治疗;高频刺激组及假rTMS组则在患侧M1区给予10Hz的rTMS治疗;所有患者接受2周治疗,每周5天。分别于治疗前、治疗2周后对患者进行评估,包括患侧脑区运动诱发电位(MEP)皮质潜伏期、中枢运动传导时间(CMCT)、患侧上肢Fugl-Meyer评分(FMA)、患侧上肢MAS量表,将各组所得数据进行统计学分析比较。结果:(1)治疗前,3组患者上述指标组间比较,差异均无显著性意义(P>0.05);(2)神经电生理学变化:治疗2周后,3组患者的MEP皮质潜伏期、CMCT均较组内治疗前缩短(P<0.05);1Hz组和10Hz组较前明显缩短且优于假r TMS组(P<0.05);1Hz组和10Hz组组间比较差异无显著性意义(P>0.05);(3)上肢功能改善:治疗2周后,3组患者上肢FMA评分均较组内治疗前提高(P<0.05),其中1Hz组和10Hz组与假rTMS组比较有显著性意义(P<0.05);但1Hz组和10Hz组组间比较差异无显著性意义(P>0.05);(4)3组患者患侧上肢MAS量表评分均较组内治疗前有明显增加,有显著性差异(P<0.05),但3组患者治疗后MAS评分组间比较,差异无显著性意义(P>0.05)。结论:高频及低频rTMS治疗均有利于脑梗死患者上肢运动功能的恢复且两者间疗效无明显差异。Objective： To investigate the different frequency of repetitive transcranial magnetic stimulation（rTMS） on motor function of upper limbs in patients with cerebral infarction. Method：Forty-five patients were randomly assigned to a low frequency rTMS group（14 cases）, a high frequen- cy rTMS group（17 cases） and a sham rTMS group（14 cases）. All of the patients were treated with both con- ventional medical treatment and rehabilitation training. The low frequency rTMS group received l Hz rTMS at contralesional primary motor cortex（M1） area. Both the high frequency rTMS group and the sham rTMS group received 10 Hz rTMS at ipsilesional M1 area. All patients were treated for 5 days per week and for 2 weeks. Motor evoked potential（MEP） cortical latency, central motor conduction time（CMCT）, Fugl-Meyer assess- ment scale （FMA）,and the motor assessment scale（MAS） were evaluated before and 2 weeks after treatment. Result： ①Before treatment, the scores of cortical latency of MEP, CMCT, MAS and FMA were not significantly different among the three groups（P〉 0.05）.②The cortical latency of MEP and CMCT of the three groups were shorter after 2 weeks treatment（P〈 0.05）, and the 1Hz group and 10Hz group were significantly shorter than those of the sham rTMS group（P〈 0.05）. But there were no statistically significant differences between the 1Hz group and 10Hz group （P〉0.05）.③Upper limb function was improved in all 3 groups after two weeks treatment in FMA （P〈0.05）. And the 1Hz group and 10Hz group were significant improved than the sham rT- MS group（P〈0.05）. But there were no statistically significant difference between the 1Hz group and 10Hz group （P 〉 0.05）.④ The MAS scale of the upper limb of the patients in the 3 groups were statistically in- creased after treatment （P 〈 0.05）, wih no statistically significant difference among the 3 groups （P 〉 0.05）. Conclusion： Both the high frequency rTMS and the low frequency rTMS can promo

关 键 词：重复经颅磁刺激 脑梗死 运动诱发电位皮质潜伏期 中枢运动传导时间 上肢功能影响 

分 类 号：R743.3[医药卫生—神经病学与精神病学] R49[医药卫生—临床医学]