CAJ | 학술논문

目的观察低频重复经颅磁刺激(rTMS)对脑梗死患者神经功能恢复的影响.方法共选取30例脑梗死偏瘫患者,采用随机数字表法将其分为健侧刺激组、患侧刺激组及对照组(每组10例),各组患者均给予常规药物治疗,患侧刺激组及健侧刺激组在此基础上分别对患侧或健侧脑皮质M1区进行rTMS治疗,持续治疗10 d.分别于治疗前、治疗后10 d及40 d时对各组患者进行疗效评定,采用美国国立卫生院神经功能缺损评分(NIHSS)、改良巴氏指数(MBI)对患者神经功能及日常生活活动(ADL)能力进行评定,同时检测各组患侧脑区运动诱发电位(MEP)潜伏期及中枢运动传导时间(CMCT);另外每组各随机挑选3例患者检测治疗前及治疗后40 d时的磁共振波谱(MRS)数据,对各组氮-乙酰天门冬氨酸/肌酸比值(NAA/Cr)进行比较.结果健侧刺激组及患侧刺激组NIHSS及MBI评分均较治疗前及对照组明显改善,且以健侧刺激组的改善幅度相对较显著,与患侧刺激组间差异具有统计学意义(P<0.05);各组患者MEP潜伏期及CMCT均较治疗前有一定程度改善,其中健侧刺激组CMCT在治疗后10 d及40 d时均显著优于对照组及患侧刺激组;健侧刺激组及患侧刺激组NAA/Cr比值均较对照组明显提高.结论低频rTMS治疗能提高急性期脑梗死患者皮质兴奋性及ADL能力,缓解神经元受损程度;刺激健侧或患侧脑半球M1区均对脑梗死患者神经受损功能恢复具有促进作用,并且以刺激健侧脑半球的疗效相对较显著.
목적 관찰저빈중복경로자자격(rTMS)대뇌경사환자신경공능회복적영향.방법 공선취30례뇌경사편탄환자,채용수궤수자표법장기분위건측자격조、환측자격조급대조조(매조10례),각조환자균급여상규약물치료,환측자격조급건측자격조재차기출상분별대환측혹건측뇌피질M1구진행rTMS치료,지속치료10 d.분별우치료전、치료후10 d급40 d시대각조환자진행료효평정,채용미국국립위생원신경공능결손평분(NIHSS)、개량파씨지수(MBI)대환자신경공능급일상생활활동(ADL)능력진행평정,동시검측각조환측뇌구운동유발전위(MEP)잠복기급중추운동전도시간(CMCT);령외매조각수궤도선3례환자검측치료전급치료후40 d시적자공진파보(MRS)수거,대각조담-을선천문동안산/기산비치(NAA/Cr)진행비교.결과 건측자격조급환측자격조NIHSS급MBI평분균교치료전급대조조명현개선,차이건측자격조적개선폭도상대교현저,여환측자격조간차이구유통계학의의(P<0.05);각조환자MEP잠복기급CMCT균교치료전유일정정도개선,기중건측자격조CMCT재치료후10 d급40 d시균현저우우대조조급환측자격조;건측자격조급환측자격조NAA/Cr비치균교대조조명현제고.결론 저빈rTMS치료능제고급성기뇌경사환자피질흥강성급ADL능력,완해신경원수손정도;자격건측혹환측뇌반구M1구균대뇌경사환자신경수손공능회복구유촉진작용,병차이자격건측뇌반구적료효상대교현저.
Objective To study the effect of low frequency repetitive transcranial magnetic stimulation (rTMS) on the recovery of neural function in patients with cerebral infarction.Methods Thirty cerebral infarction patients with hemiparalysis were divided randomly into three groups: unaffected side stimulation group ( 1Hz rTMS on M1 area of unaffected hemisphere, n = 10), affected side stimulation group ( 1Hz rTMS on M1 area of affected hemisphere, n = 10), and control group without rTMS, n = 10).All the groups were assessed with their motor function and ADL scores ( NIHSS, MBI) and corticospinal excitability (MEP, CMCT ) before and after 10 and 40 days of treatment.Three patients were chosen randomly in each group who accepted magnetic resonance spectroscopy (MRS) examination before and after 40 days of treatment and assessed with regard to the ratio of N-acetyl aspartate/creating(NAA/Cr).Results Before treatment the scores of National Institute of Health Stroke Scale (NIHSS), modified Barthel Index( MBI), Motor evoked potential (MEP) and central motor conduction time (CMCT) were not statistically different among the three groups ( P > 0.05 ).After treatment, scores of NIHSS and MBI were obviously higher than those before treatment (P < 0.01 ) in rTMS groups no matter the rTMS was applied on the affected or unaffected hemisphere.However, the score in unaffected side stimulation group was higher than that in the affected side stimulation group ( P < 0.05 ).The MEP latency and CMCT was significantly shorter after treatment in all the stimulation groups, with the unaffected side stimulation group improved to a significantly greater extent, in terms of MEP latency and CMCT than the affected side stimulation and control groups at the 10th d and 40th d of treatment(P <0.05 or P <0.01 ).There was a significantly higher ratio of NAA/Cr in two rTMS treatment groups compared with control group.Conclusion Low frequency rTMS on M1 of the unaffected or affected hemisphere can both improve neural function in patients with acute cerebral infarction, rTMS on unaffected hemisphere seems more effective than that on affected hemisphere.