rTMS联合Bobath疗法治疗中风后痉挛性瘫痪患者的疗效及对运动功能、生活自理能力的影响  

Efficacy of rTMS combined with Bobath therapy in the treatment of patients with post-stroke spastic paralysis and its effect on motor function and self-care ability

作　　者：代美玲 胡雪艳[2] 张胜利 DAI Mei-ling;HU Xue-yan;ZHANG Sheng-li(Department of Rehabilitation Medicine,Electric Power Teaching Hospital,Capital Medical University,Beijing 100073,China;Department of Neurorehabilitation,Beijing Boai Hospital,China Rehabilitation Research Center,School of Rehabilitation,Capital Medical University,Beijing 100068,China)

机构地区：[1]首都医科大学电力教学医院康复医学科,北京100073 [2]中国康复研究中心北京博爱医院(首都医科大学康复医学院)神经康复科,北京1100068

出　　处：《临床和实验医学杂志》2025年第1期69-74,共6页Journal of Clinical and Experimental Medicine

基　　金：北京市自然科学基金面上项目(编号:7354238)。

摘　　要：目的 探讨重复经颅磁刺激(rTMS)联合Bobath疗法治疗中风后痉挛性瘫痪患者的疗效及对运动功能、生活自理能力的影响。方法 回顾性分析2021年5月至2024年5月首都医科大学电力教学医院收治的142例中风后痉挛性瘫痪患者,根据不同的治疗方案分为联合组(n=69)和对照组(n=73)。对照组采用Bobath疗法的康复治疗,联合组采用rTMS联合Bobath疗法的康复治疗,疗程均为3个月。比较两组的疗效,治疗前、治疗1、2、3个月后的运动功能评估量表(MAS)、Fugl-Meyer量表(FMA)及改良Barthel指数(MBI)评分,治疗前、治疗3个月后的肌张力、运动诱发电位的波幅和潜伏期。结果 治疗3个月后,联合组总有效率为91.30%,高于对照组(72.60%),差异有统计学意义(P<0.05)。治疗1、2、3个月后,两组患者MBI评分、FMA评分、MBI评分均较治疗前逐渐升高,差异均有统计学意义(P<0.05)。联合组治疗1、2、3个月后MAS评分分别为(28.94±5.13)、(35.26±5.42)、(39.45±5.68)分,均高于对照组[(26.42±4.69)、(32.47±6.25)、(37.24±5.32)分],差异均有统计学意义(P<0.05)。联合组治疗1、2、3个月后FMA评分分别为(76.24±8.35)、(84.33±6.20)、(92.76±5.15)分,均高于对照组[(72.59±7.14)、(80.65±6.64)、(89.64±6.23)分],差异均有统计学意义(P<0.05)。联合组治疗1、2、3个月后MBI评分分别为(50.16±10.24)、(62.88±10.73)、(73.48±9.65)分,均高于对照组[(45.69±11.48)、(56.57±12.26)、(67.86±12.14)分],差异均有统计学意义(P<0.05)。治疗3个月后,两组患者的肌张力分级均较治疗前改善,且联合组的肌张力分级优于对照组,差异有统计学意义(P<0.05)。联合组治疗3个月后运动诱发电位的波幅为(1.58±0.32)mV,高于对照组[(1.44±0.28)mV],潜伏期为(19.74±4.28)ms,低于对照组[(22.23±4.76)ms],差异均有统计学意义(P<0.05)。结论 rTMS联合Bobath疗法治疗中风后痉挛性瘫痪的疗效良好,有效降低肌张力,改善患者运动功Objective To investigate the efficacy of repetitive transcranial magnetic stimulation(rTMS)combined with Bobath therapy in the treatment of patients with post-stroke spastic paralysis and its effect on motor function and self-care ability.Methods A retrospective analysis of 142 patients with spastic paralysis after stroke admitted to Electric Power Teaching Hospital,Capital Medical University from May 2021 to May 2024 was divided into the combined group(n=69)and the control group(n=73)according to different treatment options.The control group was treated with rehabilitation therapy of Bobath therapy,and the combined group was treated with rehabilitation therapy of rTMS combined with Bobath therapy.The course of treatment was 3 months.The efficacy,Motor Assessment Scale(MAS),Fugl-Meyer Assessment(FMA)and modified Barthel index(MBI)scores before treatment,1,2 and 3 months after treatment,muscle tension,amplitude and latency of motor evoked potential before treatment and 3 months after treatment were compared between the two groups.Results After 3 months of treatment,the total effective rate of the combined group was 91.30%,which was higher than that of the control group(72.60%),and the difference was statistically significant(P<0.05).After 1,2 and 3 months of treatment,the MBI score,FMA score and MBI score of the two groups were gradually higher than those before treatment,and the differences were statistically significant(P<0.05).After 1,2 and 3 months of treatment,the MAS scores of the combination group were(28.94±5.13),(35.26±5.42)and(39.45±5.68)points,which were higher than those of the control group[(26.42±4.69),(32.47±6.25)and(37.24±5.32)points],and the differences were statistically significant(P<0.05).After 1,2 and 3 months of treatment,the FMA scores of the combination group were(76.24±8.35),(84.33±6.20)and(92.76±5.15)points,which were higher than those of the control group[(72.59±7.14),(80.65±6.64)and(89.64±6.23)points],and the differences were statistically significant(P<0.05).After 1,2 and 3

关 键 词：中风 痉挛性瘫痪 重复经颅磁刺激 BOBATH疗法 运动功能 

分 类 号：R74[医药卫生—神经病学与精神病学]