低频rTMS联合FES治疗对亚急性期缺血性脑卒中患者下肢痉挛及运动功能的康复作用  

Rehabilitative effect of low-frequency rTMS combined FES on lower limb spasm and motor function in patients with subacute ischemic stroke

作　　者：黄华垚 杜厚伟[2] 陈超 张逸仙[1] 陈清法[1] 陈振强 江信宏 李菁[4] 威晋[5] 刘楠[2] HUANG Hua-yao;DU Hou-wei;CHEN Chao;ZHANG Yi-xian;CHEN Qing-fa;CHEN Zhen-qiang;JIANG Xin-hong;LI Jing;WEI Jin;LIU Nan(Department of Rehabilitation, Affiliated Union Hospital of Fujian Medical University, Fuzhou, Fujian, 350001, China)

机构地区：[1]福建医科大学附属协和医院康复科,福建福州350003 [2]福建医科大学附属协和医院神经科,福建福州350003 [3]福建医科大学协和临床医学院 [4]福建医科大学附属协和医院,福建福州350003 [5]福建医科大学附属协和医院影像科,福建福州350003

出　　处：《心血管康复医学杂志》2019年第2期134-138,共5页Chinese Journal of Cardiovascular Rehabilitation Medicine

摘　　要：目的:探讨低频(1Hz)重复经颅磁刺激(rTMS)联合功能性电刺激(FES)对亚急性期缺血性脑卒中患者下肢痉挛及运动功能的康复作用。方法:选择入住我院康复科的亚急性期缺血性脑卒中伴下肢痉挛及运动功能障碍的患者92例,随机分为伪刺激+FES组(伪刺激组,45例),低频rTMS联合FES治疗组(低频rTMS组,47例)。连续治疗3周,治疗前后对患者采用Fugl-Meyer (FMA)量表评估下肢运动功能;改良Ashworth量表(MAS)评估下肢痉挛严重程度,并进行运动诱发电位(MEP)检测。结果:治疗3周后,与治疗前比较,两组FMA评分均显著提高,MAS评分和MEP值显著降低(P均=0.001);且治疗后,与伪刺激组比较,低频rTMS组FMA评分[16.0(13.0, 23.5)分比19.0(16.0, 27.0)分]提高更显著,MAS评分[1.5(1.3, 1.5)分比1.0(0.5, 1.5)分]和MEP值[(24.64±0.39)ms比(24.43±0.31)ms]降低更显著(P<0.05或<0.01)。结论:低频rTMS联合FES治疗较伪刺激联合FES治疗能显著改善亚急性期缺血性脑卒中患者下肢痉挛及运动功能。Objective: To explore rehabilitative effect of low-frequency (1Hz, LF) repetitive transcranial magnetic stimulation (rTMS) combined functional electrical stimulation (FES) on lower limb spasm and motor function in patients with subacute ischemic stroke (SAIS). Methods: A total of 92 SAIS patients with lower limb spasm and motor dysfunction hospitalized in our department were randomly divided into sham stimulation + FES group (sham stimulation group, n=45) and low-frequency rTMS + FES group (LF-rTMS group, n=47), both groups were continuously treated for three weeks. Lower limb motor function and spasm severity were assessed by Fugl-Meyer motor assessment (FMA) and modified Ashworth scale (MAS) respectively before and after treatment, and motor evoked potential (MEP) was detected. Results: Compared with before treatment, there was significant rise in FMA score, and significant reductions in MAS score and MEP in two groups after three-week treatment, P =0.001 all;compared with sham stimulation group, there was significant rise in FMA score [16.0(13.0, 23.5) scores vs. 19.0(16.0, 27.0) scores], and significant reductions in MAS score[1.5(1.3, 1.5)scores vs. 1.0(0.5, 1.5)scores] and MEP[(24.64±0.39)ms vs.(24.43±0.31)ms]in LF-rTMS group after treatment, P <0.05 or <0.01. Conclusion: Compared with sham stimulation + FES, LF-rTMS + FES can more significantly improve lower limb spasm and motor function in patients with subacute ischemic stroke.

关 键 词：卒中 经颅磁刺激 电刺激疗法 

分 类 号：R743.309[医药卫生—神经病学与精神病学]