不同频率rTMS对脑梗死患者上肢运动功能及痉挛程度的影响

发布时间：2018-02-21 12:14

本文关键词： 重复经颅磁刺激脑梗死上肢运动功能运动诱发电位中枢运动传导时间　出处：《山东大学》2017年博士论文　论文类型：学位论文

【摘要】：目的我们假设对脑梗死恢复期患者进行不同频率的重复经颅磁刺激(rTMS)将对上肢运动功能恢复及痉挛程度产生不同的效果,故采用随机对照试验方法观察不同频率的rTMS对脑梗死上肢运动功能及痉挛程度的作用并初步探讨其机制。方法随机分组并完成研究的脑梗死患者共127例,其中低频组42例为抑制组,给予病变对侧大脑半球主要运动皮质区(M1)频率为1Hz rTMS刺激(总时间1000秒);高频组43例为兴奋组,给予病灶同侧M1区频率为10Hz rTMS刺激;以及假刺激组42例,放置形、质与真线圈相近的假线圈于病灶侧M1区,给予刺激频率为10Hz的假刺激,只发出声音而无真刺激,刺激时间与高频治疗组相同(每次135秒)以下指标:运动诱发电位(MEP)皮质潜伏期、中枢运动传导时间(CMCT)、上肢FMA量表评分、上肢运动评价量表评分、上肢痉挛程度(改良Ashworth评分,MAS)、改良Bathel指数评分(MBI)分别在治疗前以及治疗2周后由专人进行评价。治疗前三组各一般资料参数评价结果无显著差异(p0.05)。结果治疗2周后MEP潜伏期、CMCT在三组中和治疗前比较均有显著降低(p0.05),治疗后LF-rTMS和HF-rTMS均较假刺激组降低显著(p0.05)。上肢运动功能FMA评分三组均较治疗前显著改善(p0.05),同样低频和高频刺激组FMA评分较假刺激组改善显著(p0.05)。上肢运动功能评分(WolfMotor Function Test),三组治疗后均较治疗前显著提高(p0.05),但治疗后运动功能评分三组之间无显著差异(p0.05)。同样,治疗后三组的MBI评分均较治疗前显著提高(p0.05),但治疗后MBI评分三组之间无显著差异(p0.05)。患肢改良的Ashworth评分(MAS),治疗前三组的痉挛评分无显著差异(p0.05),LF-rTMS和HF-rTMS组治疗后较治疗前组内比较显著改善(p0.05),但假刺激组治疗前后无显著改善(p0.05)。治疗后LF-rTMS和HF-rTMS均较假刺激组显著改善(p0.05)。结论低频和高频rTMS均可提高脑梗死恢复期患者上肢运动功能,但两者之间无显著差异,治疗效果相似。低频和高频rTMS改善痉挛的效果显著优于假刺激组,提示改善痉挛可能是提高上肢运动功能的途径之一。
[Abstract]:Objective to assume that repeated transcranial magnetic stimulation (TMR) with different frequencies in convalescent patients with cerebral infarction will have different effects on the recovery of motor function and the degree of spasticity of upper limbs. Therefore, the effects of different frequency of rTMS on motor function and spasticity of upper extremity of cerebral infarction were observed and its mechanism was preliminarily investigated by randomized controlled trial. Methods 127 patients with cerebral infarction were randomly divided and studied. 42 cases in the low frequency group were treated with 1 Hz rTMS stimulation (total time 1000 seconds), 43 cases in the high frequency group were excitatory group, and 10 Hz rTMS stimulation was given to the ipsilateral M1 region of the lesion. In the sham stimulation group, 42 cases were given pseudostimuli with 10 Hz stimulation frequency, which were placed in shape and similar in quality to true coil in M1 region of lesion side. Only sound was emitted without true stimulation. The stimulation time was the same as that in the high frequency treatment group (135 seconds each time): latency of motor evoked potential (MEP) cortex, central motor conduction time (CMCTT), upper limb FMA scale and upper limb motor evaluation scale. The degree of spasticity of upper limb (modified Ashworth score, modified Bathel index score) was evaluated by special person before treatment and 2 weeks after treatment. There was no significant difference in the evaluation results of general data parameters between the three groups before treatment (p 0.05). MEP latency was significantly decreased in the three groups before and after treatment, LF-rTMS and HF-rTMS were significantly lower than those in the sham stimulation group (P 0.05). The FMA score of upper limb motor function in all three groups was significantly improved compared with that before treatment, and the same low frequency and high frequency prickles were observed in all the three groups. The FMA score of the excitation group was significantly improved than that of the sham stimulation group (p 0.05). The motor function score of the upper limb was significantly improved by Wolf Motor Function Test. The motor function scores of the three groups were significantly higher than those of the control group after treatment, but there was no significant difference between the three groups in the motor function score after the treatment (P 0.05). Similarly, there was no significant difference in the motor function score between the three groups after treatment. The MBI scores of the three groups after treatment were significantly higher than those before treatment, but there was no significant difference between the three groups in the MBI scores after treatment. The modified Ashworth score of the affected limbs was no significant difference. There was no significant difference in the spasticity scores between the three groups before treatment and between the two groups after treatment. In the former group, there was a significant improvement in p0.05, but no significant improvement was found in the sham stimulation group before and after treatment. Both LF-rTMS and HF-rTMS significantly improved the motor function of upper extremities in the convalescent patients with cerebral infarction after treatment. Conclusion both low frequency and high frequency rTMS can improve the motor function of upper extremities in convalescent patients with cerebral infarction. But there was no significant difference between the two groups and the therapeutic effect was similar. The effect of low frequency rTMS and high frequency rTMS on the improvement of spasm was significantly better than that of sham stimulation group, which suggested that improving spasm might be one of the ways to improve the motor function of upper limbs.
【学位授予单位】：山东大学
【学位级别】：博士
【学位授予年份】：2017
【分类号】：R743.3

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