rTMS联合头眼感觉运动整合训练在脑卒中偏瘫患者康复治疗中的应用

doi:10.3760/cma.j.issn.1007-1245.2024.02.012

摘要/Abstract

摘要：

目的　探讨重复经颅磁刺激（rTMS）联合头眼感觉运动整合训练在脑卒中偏瘫康复治疗中的应用。方法　采用前瞻性研究方法，纳入2020年2月至2023年2月德州市立医院收治的102例脑卒中偏瘫患者作为研究对象，采用摸球法分组，奇数为对照组（51例）、偶数为观察组（51例）。对照组男26例、女25例，年龄（65.23±7.14）岁，进行常规康复治疗；观察组男25例、女26例，年龄（64.89±7.31）岁，在对照组基础上给予rTMS联合头眼感觉运动整合训练，连续治疗6周。治疗前后采用蒙特利尔认知评估量表（MoCA）、简化Fugl-Meyer运动功能评定量表（FMA）、改良Barthel指数（MBI）及简易精神状态评价量表（MMSE）对两组患者进行评估，比较两组患者临床疗效、康复效果满意度。采用t检验、χ²检验进行统计分析。结果　观察组临床治疗总有效率为92.15%（47/51），高于对照组的76.47%（39/51），差异有统计学意义（χ²=4.744，P=0.029）。治疗2个月后，观察组MoCA评分、FMA评分、MBI评分、MMSE评分均高于对照组［（26.84±5.32）分比（21.34±4.51）分、（62.38±14.86）分比（53.81±13.27）分、（69.24±21.07）分比（56.75±16.53）分、（28.47±2.01）分比（25.06±1.94）分］，差异均有统计学意义（t=5.631、3.072、3.331、8.717，均P<0.05）。观察组康复效果总满意度为90.19%（46/51），高于对照组的72.55%（37/51），差异有统计学意义（χ²=5.239，P=0.022）。结论　rTMS联合头眼感觉运动整合训练在脑卒中偏瘫康复治疗中具有显著的临床疗效和康复效果，改善认知功能、运动功能和日常生活能力，具有推广价值。

关键词:

重复经颅磁刺激, 感觉运动整合训练, 脑卒中, 偏瘫, 运动功能, 康复治疗

Abstract:

Objective　To explore the application of repetitive transcranial magnetic stimulation (rTMS) combined with head-eye sensory-motor integration training in the rehabilitation treatment of post-stroke hemiplegia. Methods　A prospective research method was used. From February 2020 to February 2023, 102 post-stroke hemiplegic patients admitted to Dezhou Municipal Hospital were enrolled in the study, and were divided into a control group with odd numbers and an observation group with even numbers by the ball-drawing method. In the control group, 26 males and 25 females, aged (65.23±7.14) years, received routine rehabilitation treatment. In the observation group, 25 males and 26 females, aged (64.89±7.31) years, were given rTMS combined with head-eye sensory-motor integration training on the basis of control group, with a course of treatment of 6 weeks. The two groups were evaluated before and after treatment using the Montreal Cognitive Assessment (MoCA), simplified Fugl-Meyer Motor Function Rating Scale (FMA), modified Barthel Index (MBI), and Mini-Mental State Examination (MMSE). The clinical efficacy and satisfaction with the rehabilitation effect were compared between the two groups. t test and χ² test were used for statistical analysis. Results　The overall clinical treatment effectiveness rate of the observation group was 92.15% (47/51), which was higher than 76.47% (39/51) of the control group, with a statistically significant difference (χ²=4.744, P=0.029). Two months after treatment, the MoCA score, FMA score, MBI score, and MMSE score in the observation group were higher than those in the control group [(26.84±5.32) points vs. (21.34±4.51) points, (62.38±14.86) points vs. (53.81±13.27) points, (69.24±21.07) points vs. (56.75±16.53) points, (28.47±2.01) points vs. (25.06±1.94) points], with statistically significant differences (t=5.631, 3.072, 3.331, and 8.717, all P<0.05). The total satisfaction rate with the rehabilitation effect in the observation group was 90.19% (46/51), which was higher than that in the control group [72.55% (37/51)], with a statistically significant difference (χ²=5.239, P=0.022). Conclusion　rTMS combined with head-eye sensory-motor integration training has significant clinical and rehabilitation effects in the rehabilitation treatment of post-stroke hemiplegia, improving the cognitive function, motor function, and daily living ability, with popularization value.

Key words:

Repetitive transcranial magnetic stimulation, Sensory-motor integration training, Stroke, Hemiplegia, Motor function, Rehabilitation treatment

翟志刚.

rTMS联合头眼感觉运动整合训练在脑卒中偏瘫患者康复治疗中的应用 [J]. 国际医药卫生导报, 2024, 30(2): 234-238.

Zhai Zhigang.

Application of repetitive transcranial magnetic stimulation combined with head-eye sensory-motor integration training in the rehabilitation treatment of post-stroke hemiplegia [J]. International Medicine and Health Guidance News, 2024, 30(2): 234-238.

参考文献

[1] 赵琴,费世早,方芬,等. 高频重复经颅磁刺激联合任务导向性训练对脑卒中后偏瘫患者上肢运动功能康复效果的影响[J]. 实用心脑肺血管病杂志,2022,30(1):113-116,123.DOI:10.12114/j.issn.1008-5971.2021.00.280.
[2] 陈奕杰,余茜,崔微,等. 不同强度低频重复经颅磁刺激对脑卒中患者运动功能和认知功能障碍的疗效[J]. 四川医学,2019,40(7):657-661.DOI:10.16252/j.cnki.issn1004- 0501-2019.07.001.
[3] 陈兰英,段艳芹,杨辉,等. 持续性被动康复训练联合中药离子导入对脑卒中偏瘫患者肢体功能及满意度的影响[J]. 西部中医药,2021,34(6):123-126.DOI:10.12174/j.issn.2096- 9600.2021.06.30.
[4] 尹贻锟,王佳林,孙君志. 不同频率重复经颅磁刺激对脑卒中后认知障碍疗效的Meta分析[J]. 中国组织工程研究,2023,27(20):3274-3280.
[5] 中华医学会神经病学分会. 中国脑血管病诊治指南与共识(2016版)[M].北京:人民卫生出版社,2016:106-107.
[6] 赵晓晶,李群喜,刘英,等. 美国国立卫生院脑卒中量表评分与脑出血患者预后的相关性探讨[J]. 中国临床医生杂志,2019,47(6):712-714.DOI:10.3969/j.issn.2095-8552. 2019.06.028.
[7] 陈清法,黄华垚,陈振强,等. 低频重复经颅磁刺激联合MOTOmed智能运动训练系统对脑卒中偏瘫患者上肢痉挛的影响[J]. 中国康复医学杂志,2021,36(4):437-442.DOI:10.3969/j.issn.1001-1242.2021.04.009.
[8] 李占标,吕运良,张振燕,等. 高频重复经颅磁刺激联合电针治疗脑卒中后偏瘫肩痛的疗效观察[J]. 中华物理医学与康复杂志,2023,45(4):317-319.DOI:10.3760/cma.j.issn.0254-1424.2023.04.006.
[9] 高元杰,钟纯正,王御林,等. 老年脑卒中患者睡眠结构异常与认知功能MMSE、MoCA评分的关系[J]. 中国老年学杂志,2020,40(16):3570-3572.DOI:10.3969/j.issn.1005- 9202.2020.16.063.
[10] 刘万磊,毛智勇,郭永俊. 基于阴阳调衡理论循经针刺在缺血性脑卒中后痉挛性偏瘫患者中的作用[J]. 国际医药卫生导报,2023,29(8):1075-1079.DOI:10.3760/cma.j.issn.1007-1245.2023.08.010.
[11] Vabalaite B, Petruseviciene L, Savickas R, et al. Effects of high-frequency (HF) repetitive transcranial magnetic stimulation (rTMS) on upper extremity motor function in stroke patients: a systematic review[J].Medicina (Kaunas),2021,57(11):1215.DOI:10.3390/medicina57111215.
[12] 李霞,宁婷玉,孙琦. 低频重复经颅磁刺激联合躯干稳定性训练对脑卒中偏瘫患者神经和平衡及步行功能的影响[J]. 国际医药卫生导报,2022,28(5):707-711.DOI:10.3760/cma.j.issn.1007-1245.2022.05.026.
[13] 黄凯琪,辛榕,凌耿强,等. 重复经颅磁刺激治疗脑卒中后下肢运动功能障碍的Scoping综述[J]. 中国康复理论与实践,2023,29(3):286-293.DOI:10.3969/j.issn.1006-9771. 2023.03.007.
[14] 宋雨寒,杨欣蕙,柯朝阳. 重复经颅磁刺激治疗主观性耳鸣的临床研究进展[J]. 中华耳科学杂志,2023,21(4):550-553. DOI:10.3969/j.issn.1672-2922.2023.04.019.
[15] 郭苗苗,吉利辉,张天恒,等. 不同模式经颅磁刺激对大鼠工作记忆中局部场电位因果网络连接的影响[J]. 中国生物医学工程学报,2023,42(2):158-167.DOI:10.3969/j.issn.0258-8021.2023.02.004.
[16] 李国华,陆艺,王胜秋. 不同频率重复经颅磁刺激治疗脑梗死后失语症的疗效[J]. 山东大学学报(医学版),2023,61(7):83-89.DOI:10.6040/j.issn.1671-7554.0.2022.1317.
[17] 陈怡婷,王倩,崔慎红,等. 双侧序贯重复经颅磁刺激干预脑卒中患者上肢运动功能的效果[J]. 中国康复理论与实践,2023,29(8):926-932.DOI:10.3969/j.issn.1006-9771. 2023.08.009.
[18] 熊丹,谢海花,李浩,等. 不同重复经颅磁刺激模式对脑卒中后上肢运动功能障碍干预效果的网状Meta分析[J]. 中国全科医学,2023,26(8):997-1007,1014.DOI:10.12114/j.issn.1007-9572.2022.0535.
[19] 王玲,易羽,黄玉婷,等. 基于"脑-肠"轴的针刺联合重复经颅磁刺激干预老年轻度认知功能障碍的效果[J]. 中国老年学杂志,2023,43(10):2414-2418.DOI:10.3969/j.issn.1005- 9202.2023.10.031.
[20] 刘欢,饶阳,孙传铸,等. 宫颈癌放疗后癌因性失眠患者的大脑功能网络与个体-经颅磁刺激干预的相关性:基于图论分析[J]. 南方医科大学学报,2023,43(9):1629-1635.DOI:10.12122/j.issn.1673-4254.2023.09.22.
[21] 王杼,余茜,李奎德,等. 重复经颅磁刺激对卒中后认知障碍合并抑郁患者脑功能活动的影响[J]. 中华物理医学与康复杂志,2023,45(10):893-898.DOI:10.3760/cma.j.issn.0254- 1424.2023.10.006.
[22] 白云冀. 穴位按压联合重复经颅磁刺激对卒中后运动功能恢复的影响:前瞻性随机对照研究[J]. 国际脑血管病杂志,2023,31(2):113-116.DOI:10.3760/cma.j.issn.1673-4165. 2023.02.006.
[23] 杨玉凤,李艳红,王雨辉,等. 电刺激和重复经颅磁刺激在带状疱疹后神经痛中的应用现状[J]. 中华皮肤科杂志,2023,56(1):86-89. DOI:10.35541/cjd.20200580.
[24] 刘旭佳,朱璐,徐阳,等. 重复经颅磁刺激联合头针治疗卒中后认知障碍的疗效[J]. 中国医科大学学报,2023,52(2):115-119.DOI:10.12007/j.issn.0258-4646.2023.02.004.
[25] 戚辰,赵嘉豪,魏雅荣,等. 不同靶点低频重复经颅磁刺激治疗震颤型帕金森病的疗效观察[J]. 中华医学杂志,2023,103(39):3112-3118.DOI:10.3760/cma.j.cn112137- 20230629-01102.
[26] 陈松美,周芷晴,徐曙天,等. 非受累侧半球高频经颅磁刺激改善脑卒中后中重度上肢偏瘫的作用及运动皮质重组特征分析[J]. 中国康复医学杂志,2023,38(2):167-173.DOI:10.3969/j.issn.1001-1242.2023.02.005.
[27] 黄春莉,韩冰,孙文,等. 针刺联合重复经颅磁刺激疗法治疗脑卒中后偏瘫足下垂41例临床研究[J]. 江苏中医药,2023,55(1):36-40.DOI:10.19844/j.cnki.1672- 397X.2023.01.010.
[28] 汪星,胡珊,黄承芳,等. 双重任务训练联合本体感觉训练对老年脑卒中后偏瘫患者认知功能、运动功能的影响[J]. 中国老年学杂志,2023,43(10):2428-2431.DOI:10.3969/j.issn.1005-9202.2023.10.035.
[29] 周娃妮,张磊,李润东,等. 重复经颅磁刺激联合运动治疗对脑卒中偏瘫患者运动功能的影响[J]. 康复学报,2020,30(3):235-239.DOI:10.3724/SP.J.1329.2020.03013.
[30] 陶峰,朱洁,王传杰,等. 改良强制性运动疗法联合低频重复经颅磁刺激对脑卒中患者偏瘫上肢运动功能的影响[J]. 中国临床医学,2021,28(4):556-561.DOI:10.12025/j.issn.1008-6358.2021.20210334.