持续短阵脉冲刺激治疗脑卒中的疗效及对脑功能的影响  

Effect of continuous short burst pulse stimulation on cerebral apoplexy and its influence on cerebral function

作　　者：桂小彤 朱磊 时伟鹏 杨婷[1] 蒋庆新 GUI Xiaotong;ZHU Lei;SHI Weipeng;YANG Ting;JIANG Qingxin(Nanjing First Hospital,Nanjing Medical University/Nanjing First Hospital,Nanjing 210006,China)

机构地区：[1]南京医科大学附属南京医院南京市第一医院,江苏南京210006

出　　处：《中国实用神经疾病杂志》2025年第4期437-442,共6页Chinese Journal of Practical Nervous Diseases

基　　金：江苏省卫生健康委科研项目(编号:S2020071);南京市卫生科技发展专项资金项目(编号:YKK20106)。

摘　　要：目的探讨持续短阵脉冲刺激(cTBS)治疗脑卒中的疗效及对脑功能的影响。方法选取2023-01—10南京市第一医院收治的脑卒中患者116例,均存在单侧运动功能障碍,随机分为2组各58例,分别给予cTBS治疗(cTBS组)与假刺激干预(假刺激组),比较2组治疗前后神经电生理、脑电图、颅内血流动力学、血清指标,采用NIHSS量表、Fugl-Meyer量表评估神经功能缺损程度与运动功能。结果cTBS组临床疗效高于假刺激组(P<0.05)。治疗后cTBS组患侧运动诱发电位振幅高于假刺激组,中枢运动传导时间低于假刺激组(P<0.05),δ/α值、脑对称指标低于假刺激组(P<0.05),患侧大脑中动脉收缩期峰值血流速度、舒张期峰值血流速度、平均血流速度高于假刺激组(P<0.05),神经营养素-3、神经生长因子水平高于假刺激组,内皮素、脑特异性蛋白低于假刺激组(P<0.05),NIHSS评分低于假刺激组,FMA评分高于假刺激组(P<0.05)。结论cTBS可显著改善脑卒中偏瘫患者脑电活动、颅内血液循环及生物标志物水平,有效促进神经功能与运动功能恢复。Objective To investigate the effect of continuous short burst pulse stimulation(cTBS)on cerebral apoplexy and its influence on cerebral function.Methods Totally 116 stroke patients admitted to Nanjing First Hospital from January to October 2023 were selected,all of whom had unilateral motor dysfunction,and were randomly divided into two groups,58 cases in each group,and were respectively given cTBS treatment(cTBS group)and sham stimulation intervention(sham stimulation group).The neuroelectrophysiological indexes,EEG indexes,intracranial hemodynamic indexes and serum indexes were compared before and after treatment in the two groups.NIHSS and Fugl-Meyer assessment scales were used to evaluate the degree of neurological recovery and motor function.Results The clinical effect of cTBS group was higher than that of sham stimulation group(P<0.05).After treatment,the amplitude of motor evoked potential in cTBS group was higher than that in sham stimulation group,and the central motor conduction time was lower than that in sham stimulation group(P<0.05).After treatment,δ/αvalue and brain symmetry index of cTBS EEG group were lower than those of sham stimulation group(P<0.05).After treatment,Vs,Vd,Vm of affected middle cerebral artery in cTBS group were higher than those in sham stimulation group(P<0.05).After treatment,the levels of neuronutrient-3 and nerve growth factor in cTBS group were higher than those in sham stimulation group,while the levels of endothelin and brain specific protein in CTBS group were lower than those in sham stimulation group(P<0.05).After treatment,NIHSS score of cTBS group was lower than that of sham stimulation group,and the FMA score was higher than that of sham stimulation group(P<0.05).Conclusion cTBS treatment can significantly improve the level of cerebral electrical activity,intracranial blood circulation and biomarkers in stroke patients with hemiplegia,and effectively promote the recovery of nerve function and motor function.

关 键 词：脑卒中 偏瘫 持续短阵脉冲刺激 肢体运动功能 脑功能 

分 类 号：R743.3[医药卫生—神经病学与精神病学]