双侧重复经颅磁刺激联合调制中频电刺激对脑卒中偏瘫患者上肢运动功能及皮质血氧的影响

关键词：脑卒中  上肢功能  重复经颅磁刺激  中频电刺激  皮质血氧

Keywords:stroke  upper limb  repetitive transcranial magnetic stimulation  modulated medium frequency current therapy  cortical blood oxygen

摘要：

      摘要 目的：探究低频联合高频双侧重复经颅磁刺激（LF-HF rTMS）联合调制中频电刺激对脑卒中偏瘫患者上肢运动功能及皮质血氧的影响。 方法：选取符合标准的患者60例，应用随机数字表法分为3组，即对照组、中枢组及联合组，每组20例。每组患者均给予常规药物治疗及康复治疗，在此基础上，联合组给予LF-HF rTMS联合调制中频电刺激治疗，中枢组给予LF-HF rTMS治疗，共治疗4周。观察治疗前后三组患者的Fugl-Meyer评定量表上肢部分（FMA-UE）、改良Barthel指数（MBI）评分及大脑氧合血红蛋白（O2Hb）水平的变化。 结果：通过组内比较得出治疗后三组患者的FMA-UE、MBI评分及O2Hb水平变化的均值均较治疗前提高，差异均具有显著性意义（P<0.001）。通过组间比较得出，治疗后在FMA-UE、MBI评分及O2Hb水平变化改善方面，联合组优于其他两组、中枢组优于对照组，差异均具有显著性意义（P<0.05）。 结论：LF-HF rTMS联合调制中频电刺激治疗能有效改善脑卒中偏瘫患者的上肢运动功能，一定程度上提示了LF-HF rTMS联合调制中频电刺激能增强脑卒中患者的脑功能重塑。

Abstract:

      Abstract Objective： To observe the effectiveness of low-frequency rTMS combined with high-frequency rTMS （LF-HF rTMS） and modulated medium frequency current therapy on upper limb function and cortical blood oxygenation in patients with upper limb dysfunction following a stroke. Method： Sixty eligible patients were selected and randomly divided into three groups： the control group， the central stimulation group， and the combined stimulation group， with 20 patients in each group. All groups received conventional drug and rehabilitation treatments. In addition， the combined stimulation group received LF-HF rTMS and modulated intermediate frequency electrical stimulation， while the central stimulation group received only LF-HF rTMS， for a total duration of four weeks. Assessments were conducted before treatment and after 4 weeks of treatment， including the Fugl-Meyer assessment-upper extremities （FMA-UE） score， the modified Barthel index （MBI） score， and changes in brain oxygenated hemoglobin （O2Hb） levels. Result： Following treatment， all three groups demonstrated statistically significant enhancements in FMA-UE and MBI scores， as well as mean changes of O2Hb levels， when compared to their pre-treatment values （P<0.001）. Inter-group comparisons revealed that the combined stimulation group exhibited superior improvements in FMA-UE， MBI scores， and O2Hb levels over the other two groups， with these differences also being statistically significant （P<0.05）. Additionally， the central stimulation group outperformed the control group in terms of FMA-UE and MBI scores， and O2Hb level changes， with a statistically significant difference （P<0.05）. Conclusion： The combined application of LF-HF rTMS and modulated medium frequency current therapy is effective in enhancing upper limb motor functions in patients with stroke-induced hemiplegia. These results suggest that the treatment may facilitate brain functional remodeling in stroke patients.