低频重复经颅磁刺激对脑卒中患者上肢运动功能及脑血流的影响  

Effect of low frequency repetitive transcranial magnetic stimulation(rTMS)on upper limb motor function and cerebral blood flow in stroke patients

作　　者：钱立锋[1] 金文杰 朱鑫鑫 杨帆 占道伟 徐颖梅 QIAN Lifeng;JIN Wenjie;ZHU Xinxin;YANG Fan;ZHAN Daowei;XU Yingmei(Department of Rehabilitation,Jiaxing Hospital of Traditional Chinese Medicine in Zhejiang Province,Jiaxing314001,China)

机构地区：[1]浙江省嘉兴市中医医院康复科,浙江嘉兴314001

出　　处：《中国现代医生》2022年第9期88-92,共5页China Modern Doctor

基　　金：浙江省中医药科技计划(2021ZB286)。

摘　　要：目的探讨低频重复经颅磁刺激(rTMS)对脑卒中患者上肢运动功能及脑血流的影响。方法选取2020年1-9月浙江省嘉兴市中医医院康复科收治的60例脑卒中患者作为研究对象,随机分为治疗组(28例)和对照组(32例)。两组患者均给予常规康复治疗,治疗组在此基础上采用健侧M1区1 Hz,90%MT,总刺激数1200次,每次刺激持续时间为20 min的rTMS治疗;对照组采用假刺激,以上治疗共进行4周,每周干预5次。于治疗前和治疗4周后比较两组患者患侧拇短展肌运动诱发电位(MEP)皮质潜伏期、上肢Fugl-Meyer评分(FMA)、上肢运动力指数(MI)及运用经颅多普勒超声(TCD)检测治疗前后大脑前、中、后动脉(ACA、MCA、PCA)和椎动脉(VA)、基底动脉(BA)的血流速度。结果治疗前两组患者MEP时间比较,差异无统计学意义(P>0.05),4周后治疗组MEP明显低于对照组(P<0.001);治疗前两组患者上肢FMA评分比较,差异无统计学意义(P>0.05),4周后治疗组上肢FMA评分明显高于对照组(P<0.05);治疗前两组患者MI评分比较,差异无统计学意义(P>0.05),4周后治疗组MI评分明显高于对照组(P<0.05);治疗前两组患者TCD各项血流峰速度指标比较,差异无统计学意义(P>0.05),4周后治疗组TCD各项血流峰速度指标评分明显高于对照组(P<0.05)。结论对脑卒中偏瘫患者开展r TMS配合康复治疗更有助于改善患者上肢运动功能与脑血流,操作简单,值得临床开展运用。Objective To investigate the effect of low frequency repetitive transcranial magnetic stimulation(rTMS)on upper limb motor function and cerebral blood flow in stroke patients.Methods Sixty stroke patients admitted to the Department of Rehabilitation,Jiaxing Hospital of Traditional Chinese Medicine from January to September 2020 were selected as the study subjects.They were divided into the treatment group(n=28)and the control group(n=32)according to the random number.Patients in the two groups were given conventional rehabilitation treatment.On this basis,the treatment group was treated with rTMS with 1 Hz,90%MT of the contralateral M1 area,1200 times of total stimulation,and each stimulation duration of 20 minutes.The control group were treated with sham stimulation,and the above treatment was performed once a day,5 days a week,for a total of 4 weeks.The cortical latency of abductor hallucis motor evoked potential(MEP),upper limb Fugl-Meyer score(FMA)and upper limb motor force index(MI)of the affected side were compared between the two groups before and after 4 weeks of treatment.The blood flow velocities of anterior,middle and posterior cerebral arteries(ACA,MCA,PCA),vertebral artery(VA)and basilar artery(BA)before and after treatment were measured using transcranial Doppler(TCD).Results Before treatment,there was no significant difference in MEP time between the two groups(P>0.05).After treatment,the MEP in the treatment group was significantly lower than that in the control group(P<0.001).There was no significant difference in upper limb FMA score between the two groups before treatment(P>0.05).After treatment,the upper limb FMA score in the treatment group was significantly higher than that in the control group(P<0.05).There was no significant difference in MI score between the two groups before treatment(P>0.05).After treatment,the MI score in the treatment group was significantly higher than that in the control group(P<0.05).Conclusion rTMS combined with rehabilitation is more helpful to improve upper limb

关 键 词：低频重复经颅磁刺激 脑卒中 脑血流 运动功能 

分 类 号：R743.3[医药卫生—神经病学与精神病学]