间歇性θ节律刺激对脑卒中恢复期患者大脑皮质兴奋性及上肢运动功能影响的安全性及有效性分析

关键词：间歇性θ节律刺激  脑卒中  大脑皮质兴奋性  上肢运动功能

Keywords:intermittent theta burst stimulation  stroke  cortical excitability  upper limb motor function

摘要：

      摘要 目的：探究间歇性θ节律刺激对脑卒中恢复期患者大脑皮质兴奋性及上肢运动功能影响的安全性及有效性。 方法：选取2022年1月—2023年4月在山东大学齐鲁医院（青岛）康复科接受康复治疗的30例脑卒中恢复期患者，采用随机数字法分为试验组（n=15）和对照组（n=15），两组均进行常规康复训练，试验组在常规康复基础上增加间歇性θ节律刺激，对照组在常规康复基础上增加间歇性θ节律假刺激，两组进行4周每周5次的干预。干预前后对两组患者健侧和患侧均进行神经电生理指标测试，同时进行干预前后上肢运动功能的评估。 结果：经4周干预后，两组健侧神经电生理指标干预前后及组间均无显著性差异（P＞0.05）；试验组干预后患侧运动诱发电位（MEP）最大波幅高于干预前，且有显著性差异（P＜0.05）；试验组干预后患侧MEP潜伏期、皮质静息期（CSP）值、静息运动阈值（RMT）值均低于干预前和对照组，且有显著性差异（P＜0.01，P＜0.05）；试验组干预后Fugl-Meyer上肢功能评分、MBI评分、患侧握力以及九孔柱用时较干预前均有改善，且有显著性差异（P<0.01，P<0.05），试验组干预后Fugl-Meyer上肢功能评分、MBI评分、患侧九孔柱用时较对照组均有改善，且有显著性差异（P<0.01，P<0.05）。 结论：间歇性θ节律刺激结合常规康复训练对脑卒中恢复期患者健侧的大脑皮质兴奋性未出现明显影响，且可以改善脑卒中恢复期患者患侧的大脑皮质兴奋性，提升上肢运动功能。

Abstract:

      Abstract Objective： Exploring the safety and efficacy of intermittent theta rhythm stimulation on cortical excitability and upper limb motor function in patients with stroke at recovery stage. Method： From January， 2022 to April 2023，30 patients with stroke at recovery stage who received rehabilitation treatment were randomly divided into the experimental group （n=15） and the control group （n=15） using the random number method. Both groups were subjected to routine rehabilitation training. The experimental group was given additional intermittent theta rhythm stimulation on the basis of routine rehabilitation， and the control group added intermittent theta rhythm sham stimulation， 5 times a week for 4 weeks. Neurophysiologic indexes were tested on both the healthy and affected sides of the patients in the 2 groups before and after the intervention， as well as the assessment of upper limb motor function. Result： After 4 weeks of intervention， there were no statistical differences in MEP maximum wave amplitude， MEP latency， CMCT value， CSP value and RMT value of the healthy side between before and after intervention and between the groups（P>0.05）； MEP maximum wave amplitude of the affected side of the experimental group was higher than before intervention（P<0.05）；the affected side of the experimental group had a lower MEP latency，CSP value，and RMT value than before intervention and the control group（P<0.01，P<0.05）. Fugl-Meyer upper limb function scores，MBI scores，grip strength on the affected side，and nine-hole post time spent in the experimental group improved after the intervention compared to before the intervention（P<0.01，P<0.05）. Fugl-Meyer upper extremity function scores，MBI scores， and time spent on the affected side of the nine-hole column improved in the experimental group after the intervention compared to the control group（P<0.01，P<0.05）. Conclusion： Intermittent theta rhythm stimulation combined with conventional rehabilitation training did not show significant effects on the cortical excitability of the healthy side of patients with stroke at recovery stage. However, it could improve the cortical excitability of the affected side of patients with stroke at recovery stage and improve the motor function of the upper limbs.