作业疗法联合rTMS对脊髓损伤伴胃肠功能失调的干预研究  

Occupational therapy combined with repetitive transcranial magnetic stimulation for treatment of spinal cord injury with gastrointestinal dysfunction

作　　者：韩作献 徐婷 汪加胜 Zuo-Xian Han;Ting Xu;Jia-Sheng Wang(Jinhua Hospital of Traditional Chinese Medicine Affiliated to Zhejiang University of Traditional Chinese Medicine,Jinhua 321000,Zhejiang Province,China)

机构地区：[1]浙江中医药大学附属金华中医院康复治疗部,浙江省金华市321000

出　　处：《世界华人消化杂志》2024年第1期50-57,共8页World Chinese Journal of Digestology

摘　　要：背景脊髓损伤伴胃肠功能紊乱的治疗方法对于神经功能的恢复并不十分理想.观察作业疗法联合重复经颅磁刺激有望相互弥补,发挥各自优势,提高患者的康复的质量.目的观察作业疗法联合重复经颅磁刺激(repetitive transcranial magnetic stimulation,rTMS)在脊髓损伤(spinal cord injury,SCI)伴胃肠功能失调患者中的应用效果.方法通过随机数字表法将2020-06/2023-03间符合选例标准的150例SCI伴胃肠功能失调患者分成3组,每组50例.对照1组采取作业疗法,对照2组采取rTMS治疗,观察组采取作业治疗联合rTMS治疗,治疗3个疗程.观察患者疗效、治疗前后神经电生理[胫神经体感诱发电位(SEP)、运动诱发电位(MEP)]、外周血细胞因子[白介素-1β(interleukin-1β,IL-1β)、白介素-6(interleukin-6,IL-6)、转化生长因子β1(transforming growth factor-β1,TGF-β1)]、下肢关键肌群肌力积分、肠道功能[神经源性肠道功能障碍(neurogenic bowel dysfunction,NBD)、Cleveland失禁评分系统、Wexner便秘评分、布里斯托尔(Bristol)大便分级]、肢体功能恢复指标[Barthel指数(Barthel Index,BI)、功能独立性测量(Functional Independence Measure,FIM)、Berg平衡量表(Berg Balance Scale,BBS)].结果观察组总有效率94.00%高于对照1、2组74.00%、80.00%(P<0.05);观察组治疗1、3个疗程后胫神经SEP、MEP潜伏期水平<对照2组<对照1组,胫神经SEP、MEP峰值水平>对照2组>对照1组(P<0.05);观察组治疗1、3个疗程后血清IL-1β、IL-6、TGF-β1水平<对照2组<对照1组(P<0.05);观察组治疗1、3个疗程后下肢关键肌群肌力积分>对照2组>对照1组(P<0.05);观察组治疗1、3个疗程后NBD、Cleveland失禁评分、Wexner便秘评分<对照1、2组,BI、FIM、BBS评分>对照1、2组(P<0.05).结论与单一康复疗法相比,rTMS联合作业疗法可降低免疫炎症反应,改善SCI伴胃肠功能失调患者受损的肢体运动及肠道功能,有助于其更好地回归家庭与社会.BACKGROUND In the treatment of spinal cord injury(SCI)with gastrointestinal dysfunction,the recovery of neurological function is not ideal.Occupational therapy combined with repetitive transcranial magnetic stimulation(rTMS)is expected to complement each other,exert their respective advantages,and improve the quality of patients’rehabilitation.AIM To observe the therapeutic effect of occupational therapy combined with rTMS in patients with SCI accompanied by gastrointestinal dysfunction.METHODS A total of 150 patients with SCI and gastrointestinal dysfunction who met the selection criteria from June 2020 to March 2023 were randomly divided into two control groups and one observation group,with 50 patients in each group,using the random number table method.The two control groups were treated with either occupational therapy or rTMS alone,and the observation group was treated with occupational therapy combined with rTMS for three courses.The therapeutic effect was observed,as well as neuroelectrophysiology[tibial somatosensory evoked potential(SEP)and motion-evoked potential(MEP)],peripheral blood cytokines[interleukin-1β(IL-1β),interleukin-6(IL-6),and transforming growth factor-β1(TGF-β1)],muscle strength scores of key muscles of lower limbs,intestinal function[neurologic bowel dysfunction(NBD),Cleveland Incontinence Score,Wexner Constipation Score,and Bristol stool grading],limb function recovery indicators[Barthel Index(BI),Functional Independence Measurement(FIM)Scale,and Berg Balance Scale(BBS)]before and after treatment.RESULTS The total effective rate in the observation group was 94.00%,which was higher than that of the occupational therapy group(74.00%)and the rTMS group(80.00%)(P<0.05).After 1 and 3 treatment courses,the latent levels of SEP and MEP of the tibial nerve in ascending order were the observation group,rTMS group,and occupational therapy group,and the peak levels of SEP and MEP of the tibial nerve in descending order were the observation group,rTMS group,and occupational therapy group(P<0

关 键 词：脊髓损伤 重复经颅磁刺激 疗效 功能恢复 

分 类 号：R573[医药卫生—消化系统]