不同频率重复经颅磁刺激对脑卒中后运动功能障碍恢复的影响

发布时间：2018-07-03 04:19

本文选题：重复经颅磁刺激 + 脑卒中　；参考：《河北医科大学》2017年硕士论文

【摘要】：目的:脑卒中的发病率逐年升高,作为有高致残率的疾病之一,脑卒中后遗症的恢复一直备受关注。运动功能障碍是脑卒中后发生率较高的后遗症之一,患者常因此导致日常生活活动能力的下降,而运动功能障碍中又常以上肢功能障碍为康复治疗的难点。重复经颅磁刺激(repetitive transcranial magnetic stimulation,r TMS)是基于电磁感应的原理,在极短时间内产生作用于某一特定皮质部位的磁场,并给予重复连续刺激,产生可持续一段时间的累积效应,刺激局部和远隔区域的大脑功能的一项技术。r TMS作为一种新型无创的康复治疗手段,具有定位准确、安全、无交叉感染的特点,逐渐受到康复医学界的关注。目前r TMS治疗过程中方案的选择尚未达成共识。本文所做的研究,旨在比较不同频率的r TMS联合常规康复训练,对卒中后患者运动功能恢复的效果,为脑卒中后运动功能障碍患者r TMS的应用提供科学的依据。方法:选取河北省人民医院康复医学科门诊或住院病人81例,入组患者均无治疗禁忌症,并符合纳入、排除标准。将81例患者随机分成三组,分别为低频r TMS组24例,高频r TMS组31例(治疗中3例脱落),r TMS假刺激组26例。低频r TMS组治疗部位:健侧大脑半球中央前回M1区;刺激频率:1Hz;刺激时间:20分钟;配合常规康复训练。高频r TMS组治疗部位:患侧大脑半球中央前回M1区;刺激频率:10Hz;刺激时间:20分钟;配合常规康复训练。r TMS假刺激组:给予r TMS假刺激;配合常规康复训练。三组治疗时间:r TMS治疗每次20分钟,每日一次,治疗时程两周,每周5天,共10次;常规康复训练每次70-80分钟,每日一次,治疗时程两周,每周5天,共10次。所有患者在治疗前和治疗后分别进行Fugl-Meyer运动功能量表(Fugl-Meyer Assessment of motor Recovery,FMA)患侧上肢、下肢的运动功能评定,Wolf偏瘫上肢功能评测量表(The Wolf Motor Function Test,WMFT)评定,卒中患者运动功能评估量表(Motor Assessment Scale,MAS)评定,Berg平衡功能量表(Berg Balance Scale,BBS)评定,改良日常生活活动能力量表(Modified Barthel Index,MBI)评定。结果:1 r TMS对脑卒中后运动功能恢复的影响1.1 FMA上肢评分、WMFT评分治疗前,低频r TMS治疗组、高频r TMS治疗组与对照组三组之间,FMA上肢部分评分、WMFT评分无统计学差异(P0.05);治疗后,高频r TMS治疗组和低频r TMS治疗组FMA上肢部分评分、WMFT评分均明显高于对照组(P0.05),高频r TMS治疗组评分高于低频r TMS治疗组(P0.05);三组之中,每组治疗前与治疗后相比较,FMA上肢评分、WMFT评分均有统计学差异(P0.01);1.2 FMA下肢评分治疗前,低频r TMS治疗组、高频r TMS治疗组与对照组三组之间FMA下肢评分无统计学差异(P0.05);治疗后,高频r TMS治疗组和低频r TMS治疗组FMA下肢评分均明显高于对照组(P0.05),高频r TMS治疗组评分与低频r TMS治疗组之间无统计学差异(P0.05);三组之中,每组治疗前与治疗后FMA下肢评分比较均有统计学差异(P0.01);1.3 MAS评分治疗前,低频r TMS治疗组、高频r TMS治疗组与对照组三组之间MAS评分无统计学差异(P0.05);治疗后,三组间MAS评分无统计学差异(P0.05);三组之中,每组治疗前与治疗后MAS评分比较均有统计学差异(P0.01);2 r TMS对平衡功能(BBS评分)的影响治疗前,低频r TMS治疗组、高频r TMS治疗组与对照组三组之间BBS评分无统计学差异(P0.05);治疗后,三组间分值无统计学差异(P0.05);三组之中,每组治疗前与治疗后BBS评分比较均有统计学差异(P0.01);3 r TMS对Barthel指数(MBI)评分的影响治疗前,低频r TMS治疗组、高频r TMS治疗组与对照组三组之间MBI分值无统计学差异(P0.05);治疗后,三组间MBI评分无统计学差异(P0.05);三组之中,每组治疗前与治疗后MBI评分比较均有统计学差异(P0.01)。结论:重复经颅磁刺激治疗可促进脑卒中患者运动功能的恢复和改善;本次实验中,10Hz高频重复经颅磁刺激较1Hz低频重复经颅磁刺激对促进脑卒中患者上肢运动功能的恢复效果更佳。
[Abstract]:Objective: the incidence of stroke is increasing year by year. As one of the diseases with high disability rate, the recovery of cerebral apoplexy sequelae has been paid much attention. Motor dysfunction is one of the sequelae of higher incidence of stroke after stroke, and the patient often leads to the decline of daily living ability, and the motor dysfunction often has upper limb dysfunction. The repetitive transcranial magnetic stimulation (repetitive transcranial magnetic stimulation, R TMS) is based on the principle of electromagnetic induction, producing a magnetic field that acts on a specific cortex at a very short time, and gives repeated continuous stimulation to produce a sustained period of cumulative effect, stimulating local and distant regions. A technique of brain function,.R TMS, as a new noninvasive method of rehabilitation, has the characteristics of accurate location, safety and no cross infection. It has gradually attracted the attention of the rehabilitation medical community. The choice of the scheme in the process of R TMS treatment has not yet reached a consensus. The research done in this paper is aimed at comparing the normal rehabilitation of R TMS with different frequencies. Training, the effect of recovery of motor function after stroke, provide scientific basis for the application of R TMS in patients with post-stroke motor dysfunction. Methods: 81 patients in Hebei People's Hospital rehabilitation medicine department or hospitalized patients were selected, and all the patients had no contraindications, and the compliance was included and the exclusion criteria were excluded. The 81 patients were randomly divided into three groups. 24 cases of low frequency R TMS group, 31 cases of high frequency R TMS group (3 cases of abscission in treatment), 26 cases of R TMS false stimulation group. Low frequency R TMS group treatment site: the healthy side of the cerebral hemisphere precentral gyrus M1 region; stimulation frequency: 1Hz; stimulation time: 20 minutes; combined with conventional rehabilitation training. High frequency R TMS group treatment area; stimulation frequency: 10: stimulation frequency 10: 10 Hz; stimulation time: 20 minutes; combined with conventional rehabilitation training.R TMS false stimulation group: R TMS false stimulation; combined with routine rehabilitation training. The three groups of treatment time: R TMS treatment 20 minutes each time, once a day, two weeks, 5 days a week, a total of 70-80 minutes, once a day, once a day, two weeks for the treatment course, and 10 times a week, 5 days a week. All patients were subjected to the Fugl-Meyer exercise function scale (Fugl-Meyer Assessment of motor Recovery, FMA) with the lateral upper limb, the motor function assessment of the lower extremities, the assessment of the function of the Wolf hemiplegic upper limb (The Wolf Motor Function), and the exercise assessment scale for stroke patients. AS) assessment, the assessment of the Berg balance function scale (Berg Balance Scale, BBS), the improvement of the daily living ability scale (Modified Barthel Index, MBI). Results: the effect of 1 R TMS on the recovery of motor function after stroke was 1.1. There was no statistical difference between the upper limb part score and the WMFT score (P0.05). After the treatment, the grade of FMA upper limb in the high frequency R TMS treatment group and the low frequency R TMS group was significantly higher than the control group (P0.05), and the high frequency R TMS treatment group was higher than the low frequency r treatment group; the three groups were compared with the treatment group before treatment. MFT scores were statistically different (P0.01); before the 1.2 FMA lower extremity score treatment, low frequency R TMS treatment group, high frequency R TMS treatment group and the control group had no statistical difference between the three groups (P0.05). After treatment, high frequency R TMS treatment group and low frequency r treatment group were significantly higher than the control group. There was no statistical difference between the low frequency R TMS treatment group (P0.05), and in the three groups, there were statistically significant differences between each group before and after the treatment of FMA lower limb scores (P0.01); before the 1.3 MAS score, the low frequency R TMS treatment group, the high frequency R TMS treatment group and the control group had no statistical difference between the three groups (P0.05); after treatment, the three groups did not score the scores. Statistical difference (P0.05); in the three groups, there were statistical differences between each group before and after the treatment (P0.01), and the effect of 2 R TMS on the balance function (BBS score) before treatment, low frequency R TMS treatment group, and the BBS score between the high frequency R TMS treatment group and the control group was not statistically significant (P0.05); after treatment, there was no statistical difference between the three groups. In the three groups, there were statistically significant differences between the three groups before and after the treatment (P0.01), and the effect of 3 R TMS on the Barthel index (MBI) score had no statistical difference between the low frequency R TMS treatment group, the high frequency R TMS treatment group and the control group, and the three groups had no statistical difference between the three groups. 5); in the three groups, there were statistical differences between each group before and after the treatment (P0.01). Conclusion: repetitive transcranial magnetic stimulation can promote the recovery and improvement of motor function in stroke patients. In this experiment, 10Hz high frequency transcranial magnetic stimulation of 10Hz is more than 1Hz low frequency reduplication by cranial magnetic stimulation to promote upper limb movement function of stroke patients The recovery effect is better.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R743.3

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