摘要
目的探讨反复促通疗法(RFE)联合重复经颅磁刺激(rTMS)对亚急性脑卒中患者上肢运动功能的影响。方法前瞻性选择2023年11月至2024年3月温州医科大学附属第一医院诊治的80例亚急性脑卒中患者,采用随机数字表法分为对照组、RFE组、RFE+低频rTMS组、RFE+高频rTMS组,每组20例。对照组采用常规康复治疗,RFE组采用常规康复治疗+RFE,RFE+低频rTMS组采用常规康复治疗+RFE+低频(1 Hz)rTMS治疗,RFE+高频rTMS组采用常规康复治疗+RFE+高频(10 Hz)rTMS治疗。四组均连续治疗2周,比较四组治疗前后Fugl-Meyer量表(运动功能)上肢部分(FMA-UE)评分、改良Ashworth量表(MAS)分级、改良Barthel指数(MBI)评分、偏瘫侧手的握力及Brunnstrom量表(BRSS)分级变化。结果四组治疗前FMA-UE评分、MAS分级、MBI评分及患侧握力比较差异无统计学意义(P>0.05);四组治疗后FMA-UE、MBI评分及患侧握力均有提高,MAS分级下降,组内比较差异有统计学意义(P<0.05),RFE+低频rTMS组FMA-UE、MBI评分及患侧握力最高,MAS分级最低[(43.65±2.11)分比(40.95±2.12)分、(49.20±4.06)分比(44.80±2.48)分、(32.45±2.59)kg比(29.30±2.94)kg、(0.37±0.09)级比(0.56±0.10)级],并且与RFE+高频rTMS组比较差异均有统计学意义(P<0.01)。四组治疗后BRSS分级未升级率分别为10/20、8/20、2/20、5/20,差异有统计学意义(χ^(2)=8.65,P=0.031),且RFE+低频rTMS组BRSS未升级例数最少。结论RFE联合低频rTMS治疗亚急性脑卒中疗效明显,有利于促进患者偏瘫侧肌力、握力和运动功能恢复。
Objective To study the effect of repetitive facilitative exercise(RFE)combined with repetitive transcranial magnetic stimulation(rTMS)on upper limb motor function in subacute stroke patients.Methods A total of 80 patients with subacute stroke diagnosed and treated in the First Affiliated Hospital of Wenzhou Medical University from November 2023 to March 2024 were prospectively selected and divided into control group,RFE group,RFE+low frequency rTMS group and RFE+high frequency rTMS group by random number table method,with 20 cases in each group.The control group received conventional rehabilitation therapy,the RFE group received conventional rehabilitation therapy+RFE,the RFE+low frequency rTMS group received conventional rehabilitation therapy+RFE+low frequency(1 Hz)rTMS therapy,and the RFE+high frequency rTMS group received conventional rehabilitation therapy+RFE+high frequency(10 Hz)rTMS therapy.All of four groups were treated continuously for 2 weeks.The changes of Fugl-Meyer Scale(Motor Function)Upper Limb(FMA-UE)score,Modified Ashworth Scale(MAS)score,Modified Barthel Index(MBI)score,hemiplegic hand grip strength and BrunnstromScale(BRSS)score before and after treatment were compared among the four groups.Results There were no statistical differences in the FMA-UE score,MAS grade,MBI score and hemiplegic hand grip strength among the four groups before treatment(P>0.05).After treatment,the FMA-UE,MBI scores and hemiplegic hand grip strength were increased in the four groups,and MAS grade were decreased,there were statistical differences(P<0.05).RFE+low-frequency rTMS group had the highest FMA-UE,MBI score and hemiplegic hand grip strength,and MAS grade was the lowest,and compared with RFE+high-frequency rTMS group,there were statistical differences:(43.65±2.11)scores vs.(40.95±2.12)scores,(49.20±4.06)scores vs.(44.80±2.48)scores,(32.45±2.59)kg vs.(29.30±2.94)kg,(0.37±0.09)grade vs.(0.56±0.10)grade,P<0.01.The BRSS unupgradingrate among the four groups after treatment were 10/20,8/20,2/20,5/20,there was statistical difference(χ^(2)=8.65,P=0.031),and the RFE+low-frequency rTMS group had the lowest number of BRSS unupgraded cases.Conclusions The efficacy of RFE combined with low-frequency rTMS in the treatment of subacute stroke is obvious,which is conducive to promoting the recovery of muscle strength,grip strength and motor function of the hemiplegic side of the patients.
作者
王放
刘爽
吴文秀
徐乐义
李海燕
Wang Fang;Liu Shuang;Wu Wenxiu;Xu Leyi;Li Haiyan(Department of Rehabilitation,the First Affiliated Hospital of Wenzhou Medical University,Wenzhou 335200,China)
出处
《中国医师进修杂志》
2025年第6期520-523,共4页
Chinese Journal of Postgraduates of Medicine
基金
温州市科研项目(经费自筹)(Y2023960)。
关键词
脑梗死
脑出血
反复促通疗法
重复经颅磁刺激
上肢功能
Brain infarction
Cerebral hemorrhage
Repetitive facilitation exercise
Repetitive transcranial magnetic stimulation
Upper limb function
