外周磁刺激联合中枢磁刺激对脑梗死患者上肢运动功能的影响

陈艳艳; 李树强; 崔健; 胡源; 刘冰洁; 吴睿

doi:10.16766/j.cnki.issn.1674-4152.002870

外周磁刺激联合中枢磁刺激对脑梗死患者上肢运动功能的影响

doi: 10.16766/j.cnki.issn.1674-4152.002870

陈艳艳¹,
李树强¹,
崔健¹,
胡源¹,
刘冰洁²,
吴睿^1, ,

1.
郑州大学第二附属医院康复医学科，河南郑州 450014
2.
郑州大学第二附属医院老年科

基金项目:

河南省医学省部共建项目 LHGJ20210389

详细信息

通讯作者:
吴睿，E-mail：wurui670617@zzu.edu.cn

中图分类号: R743.33 R454.1
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- 文章访问数: 333
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- 被引次数: 0
出版历程
- 收稿日期: 2022-02-25
- 网络出版日期: 2023-04-20

Effects of peripheral magnetic stimulation and transcranial magnetic stimulation on upper extremity motor function in patients with cerebral infarction

1.
Department of Neurological Rehabilitation, the Second Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450014, China

摘要

摘要: 目的应用外周磁刺激联合中枢磁刺激的康复方法，观察该方法对脑梗死患者上肢运动功能的恢复效果。方法选取2020年9月—2021年11月在郑州大学第二附属医院住院的脑梗死患者共42例为研究对象，经评定均存在上肢运动功能障碍，采用随机数字表法分为对照组(20例)与观察组(22例)。2组均给予常规康复治疗，对照组给予中枢磁刺激治疗，观察组在对照组的基础上加用外周磁刺激治疗。治疗前、后采用上肢Fugl-Meyer运动功能评分量表(UL-FMA)评估患者上肢运动功能恢复情况，采用改良Barthel指数(MBI)评估患者日常生活能力，采用弥散张量成像评估患者受损神经纤维束修复情况。结果治疗4周后，观察组UL-FMA评分[32.50(15.75, 46.50)分]、MBI[76.50(59.50, 91.25)分]均较治疗前明显提高(均P＜0.05)，对照组UL-FMA评分[29.50(10.25, 40.00)分]、MBI[89.00(50.00, 90.00)分]均较治疗前明显提高(均P＜0.05)；观察组治疗前后UL-FMA评分差值[12.00(9.75, 13.25)分]与对照组[7.00(5.00, 9.00)分]比较差异有统计学意义(P＜0.05)；观察组治疗前后MBI差值[18.50(10.00, 22.50)分]与对照组[10.00(7.00, 13.75)分]比较差异有统计学意义(P＜0.05)。2组患者受损的神经纤维束密度均有所增加。结论外周磁刺激联合中枢磁刺激促进了脑梗死患者上肢运动功能的恢复，提高了患者的日常生活能力。
- 中枢磁刺激 /
- 外周磁刺激 /
- 脑梗死 /
- 上肢运动功能
Abstract: Objective To observe the effect of peripheral magnetic stimulation and transcranial magnetic stimulation on the recovery of upper limb motor function in patients with cerebral infarction. Methods A total of 42 patients with cerebral infarction who were admitted to the Second Affiliated Hospital of Zhengzhou University from September 2020 to November 2021 were included in the study. They were assessed for upper limb motor dysfunction, and divided into the control group (n=20) and observation group (n=22) by using the random number table method. Both groups received routine rehabilitation treatment, and the control group was given transcranial magnetic stimulation. On the basis of the control group, the observation group was given peripheral magnetic stimulation. Before and after the treatment, upper limber Fugl-Meyer assessment of motor recovery (UL-FMA) was used to evaluate patients' upper limb motor function, the modified Barthel index (MBI) was used to evaluate patients' ability of daily living, and diffusion tensor imaging data were used to evaluate the repair of damaged nerve fibre bundles. Results After 4 weeks of treatment, the UL-FMA score [32.50 (15.75, 46.50) points] and MBI [76.50 (59.50, 91.25) points] in the observation group were significantly higher than those before treatment (all P < 0.05), while the UL-FMA score [29.50 (10.25, 40.00) points] and MBI [89.00 (50.00, 90.00) points] in the control group were significantly higher than those before treatment (all P < 0.05). The difference of UL-FMA scores before and after treatment [12.00 (9.75, 13.25) scores] in the observation group was statistically significant compared with the UL-FMA deviations before and after treatment [7.00 (5.00, 9.00) scores] in the control group (P < 0.05). The difference of MBI before and after treatment [18.50 (10.00, 22.50) scores] in the observation group was statistically significant compared with the MBI deviations [10.00(7.00, 13.75) scores] in the control group (P < 0.05). The density of damaged nerve fibre bundles increased in both groups. Conclusion Transcranial magnetic stimulation combined with peripheral magnetic stimulation promote the upper limb motor function in patients after cerebral infarct and improve patients' activities of daily living.
- Transcranial magnetic stimulation /
- Peripheral magnetic stimulation /
- Cerebral infarction /
- Upper extremity motor function

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图 1 对照组治疗前后DTI影像

注：A为治疗前，示左侧皮质脊髓束较右侧稀疏；B为治疗后，示左侧皮质脊髓束密度增加。

Figure 1. DTI images of control group before and after treatment

下载: 全尺寸图片幻灯片

图 2 观察组治疗前后DTI影像

注：A为治疗前，示右侧皮质脊髓束连续性中断；B为治疗后，示右侧皮质脊髓束连续性部分恢复。

Figure 2. DTI images of observation group before and after treatment

下载: 全尺寸图片幻灯片

表 1 2组脑梗死合并上肢运动功能障碍患者一般资料比较

Table 1. Comparison of general data of cerebral infarction patients with upper limb motor dysfunction between two groups

组别	例数	性别(例)		年龄(x±s, 岁)	病程(x±s, d)	病灶侧(例)		Brunnstrom分期(例)
组别	例数	男性	女性	年龄(x±s, 岁)	病程(x±s, d)	左	右	Ⅱ	Ⅲ	Ⅳ
对照组	20	14	6	59.55±8.86	8.93±4.01	5	15	7	6	7
观察组	22	16	6	62.18±10.24	7.23±0.66	5	17	7	8	7
统计量		0.038^a		0.886^b	-1.879^b	0.030^a		0.191^c
P值		0.845		0.381	0.075	0.863		0.909
注：^a为χ²值，^b为t值，^c为Z值。

下载: 导出CSV

表 2 2组脑梗死合并上肢运动功能障碍患者治疗前后MBI指数比较[M(P₂₅, P₇₅), 分]

Table 2. Comparison of MBI index of cerebral infarction patients with upper limb motor dysfunction before and after treatment between two groups [M(P₂₅, P₇₅), points]

组别	例数	治疗前	治疗后	差值	Z值	P值
对照组	20	77.50(35.00, 84.25)	89.00(50.00, 90.00)	10.00(7.00, 13.75)	-3.925	< 0.001
观察组	22	57.50(35.00, 80.00)	76.50(59.50, 91.25)	18.50(10.00, 22.50)	-4.111	< 0.001
Z值		-0.914	-0.865	-2.780
P值		0.361	0.387	0.005

下载: 导出CSV

表 3 2组脑梗死合并上肢运动功能障碍患者治疗前后UL-FMA评分比较[M(P₂₅, P₇₅), 分]

Table 3. Comparison of UL-FMA scores of cerebral infarction patients with upper limb motor dysfunction before and after treatment between two groups [M(P₂₅, P₇₅), points]

组别	例数	治疗前	治疗后	差值	Z值	P值
对照组	20	20.50(4.00, 35.50)	29.50(10.25, 40.00)	7.00(5.00, 9.00)	-3.937	< 0.001
观察组	22	20.00(4.00, 34.25)	32.50(15.75, 46.50)	12.00(9.75, 13.25)	-4.120	< 0.001
Z值		-0.218	-1.312	-4.757
P值		0.827	0.190	< 0.001

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