高频重复经颅磁刺激对脑卒中恢复期偏瘫性肩痛的影响  

Effect of high-frequency repetitive transcranial magnetic stimulation on hemiplegic shoulder pain during convalescence of stroke

作　　者：陶林花 任志彬 傅晓倩 李亮 王月丽 傅建明 TAO Linhua;REN Zhibin;FU Xiaoqian;LI Liang;WANG Yueli;FU Jianming(Rehabilitation Medicine Center,Jiaxing Second Hospital in Zhejiang Province,Jiaxing 314000,Zhejiang,China;Department of Acupuncture and Physiotherapy,Wangdian People's Hospital of Jiaxing in Zhejiang Province,Jiaxing 314000,Zhejiang,China)

机构地区：[1]浙江省嘉兴市第二医院康复医学中心,浙江嘉兴314000 [2]浙江省嘉兴市王店人民医院针灸理疗科,浙江嘉兴3140001

出　　处：《中国现代医生》2023年第35期37-41,共5页China Modern Doctor

基　　金：浙江省嘉兴市科技计划项目(2017BY18022)。

摘　　要：目的观察高频重复经颅磁刺激(repetitive transcranial magnetic stimulation,rTMS)对脑卒中恢复期偏瘫性肩痛(hemiplegic shoulder pain,HSP)的影响。方法选取于2021年1月至2022年6月在嘉兴市第二医院康复医学中心住院治疗的脑卒中恢复期偏瘫性肩痛的患者40例,随机分为治疗组(rTMS组)20例,对照组(假rTMS组)20例。两组患者均给予消炎镇痛药物及常规康复治疗,在此基础上,治疗组结合rTMS治疗(刺激频率10.0Hz,强度80%的静息运动阈值,刺激时间10s,间歇50s,总治疗时间20min,周一至周五每日1次,间隔2天继续治疗,20次为1个疗程,共治疗4周),而对照组则给予假rTMS治疗。分别于治疗前,治疗第2周和第4周,采用数字疼痛评分法(numerical pain rating scale,NPRS)评估肩痛程度,量角器测量被动肩关节活动度,Fugl-Meyer上肢运动功能(Fugl Meyer assessment upper extremity,FMA-UE)评估偏瘫侧上肢运动功能,改良Barthel指数(modified Barthel index,MBI)评估日常生活活动能力。结果治疗后,两组患者肩痛NPRS分值较治疗前明显下降(P<0.001),被动肩关节活动度及Fugl-Meyer上肢运动功能较治疗前明显改善(P均<0.001),且治疗组明显优于对照组,组间差异有统计学意义(P<0.05或<0.001);两组患者改良Barthel指数较治疗前明显改善(P<0.001),但两组组间差异无统计学意义(P>0.05)。结论10.0Hz的高频重复经颅磁刺激可明显缓解脑卒中恢复期偏瘫性肩痛,改善患侧肩部的被动关节活动度,提高患侧的上肢运动功能,但在提高日常生活活动能力方面,疗效不显著。Objective To observe the effect of high-frequency repetitive transcranial magnetic stimulation on hemiplegic shoulder pain during convalescence of stroke.Methods A total of 40 patients with hemiplegic shoulder pain during convalescing stroke who were hospitalized in Rehabilitation Medicine Department of Jiaxing Second Hospital from January 2021 to June 2022 were selected and randomly divided into treatment group(rTMS group)and control group(sham rTMS group),with 20 cases in each group.Both groups were given anti-inflammatory and analgesic drugs and conventional rehabilitation treatment.On this basis,the treatment group was combined with rTMS treatment(stimulation frequency was 10.0Hz,stimulation intensity was 80%resting motor threshold,stimulation time was 10s,interval was 50s,total treatment time was 20 minutes,once a day from Monday to Friday,continued treatment 2 days apart,20 times as a course of treatment,a total of 4 weeks),while the control group received sham rTMS.Before treatment,2 and 4 weeks after treatment,numerical pain rating scale(NPRS)was used to assess the degree of shoulder pain,passive shoulder range of motion was measured by protractor,upper limb motor function of hemiplegic side was assessed by Fugl Meyer assessment upper extremity(FMA-UE),and the ability of daily living activities was assessed by modified Barthel index(MBI).Results After treatment,NPRS score of shoulder pain in 2 groups was significantly decreased compared with before treatment(P<0.001),passive shoulder motion and Fugl-Meyer upper limb motor function were significantly improved compared with before treatment(P<0.001),and the treatment group was significantly better than the control group,the difference between groups was statistically significant(P<0.05).The modified Barthel index in 2 groups was significantly improved compared with before treatment(P<0.001),but there was no statistical significance between 2 groups(P>0.05).Conclusion 10.0Hz high-frequency repetitive transcranial magnetic stimulation can significantly reliev

关 键 词：重复经颅磁刺激 偏瘫性肩痛 脑卒中 上肢运动功能 日常生活能力 

分 类 号：R493[医药卫生—康复医学] R743[医药卫生—临床医学]