本文選題：缺血性腦卒中 + 重復(fù)經(jīng)顱磁刺激��； 參考：《川北醫(yī)學(xué)院》2017年碩士論文

【摘要】：目的:采用靜息態(tài)功能磁共振成像(Resting State Functional Magnetic Resonance Imaging,rs-fMRI)及臨床運(yùn)動(dòng)功能評(píng)分量表評(píng)估重復(fù)經(jīng)顱磁刺激(Repetitive Transcranial Magnetic Stimulation,rTMS)對(duì)缺血性腦卒中后運(yùn)動(dòng)功能障礙患者的康復(fù)療效對(duì)運(yùn)動(dòng)相關(guān)功能網(wǎng)絡(luò)的影響。方法:納入我院神經(jīng)內(nèi)科大腦中動(dòng)脈(Middle Cerebral Artery,MCA)區(qū)域缺血性腦卒中患者22例,隨機(jī)分為兩組,其中真刺激組(rTMS組)11人,偽刺激組(Sham Stimulation,Sham組)11人。rTMS組給予患側(cè)初級(jí)運(yùn)動(dòng)皮層10天的高頻rTMS治療,刺激頻率10Hz,刺激強(qiáng)度90%運(yùn)動(dòng)閾值;Sham組接受具有相同噪聲與時(shí)間的假刺激治療;兩組患者治療時(shí)間及其余常規(guī)治療方法相同。治療前、后分別對(duì)兩組患者進(jìn)行臨床運(yùn)動(dòng)功能評(píng)分和rs-fMRI圖像采集。采用獨(dú)立成分分析(Independent Component Analysis,ICA)及延時(shí)相關(guān)方法提取腦卒中患者的運(yùn)動(dòng)相關(guān)靜息態(tài)功能腦網(wǎng)絡(luò),并分析網(wǎng)絡(luò)信息間的相關(guān)性。對(duì)比分析rTMS治療前后及治療后rTMS組與Sham組之間美國(guó)國(guó)立衛(wèi)生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)、簡(jiǎn)易運(yùn)動(dòng)功能評(píng)分(Simple Fugel-Meyer Assessment,FMA)、日常生活能力評(píng)分(Barthel index,BI)及運(yùn)動(dòng)相關(guān)網(wǎng)絡(luò)、網(wǎng)絡(luò)間相關(guān)性的變化和差異情況。結(jié)果:(1)與治療前相比,治療后rTMS組與Sham組的NIHSS、FMA及BI評(píng)分較均有顯著改善,且治療后rTMS組比Sham組在FMA及BI評(píng)分上改善更明顯,兩者之間存在統(tǒng)計(jì)學(xué)差異,NIHSS兩組差異不顯著。(2)選取運(yùn)動(dòng)網(wǎng)絡(luò)、小腦網(wǎng)絡(luò)、執(zhí)行控制網(wǎng)絡(luò)、右側(cè)額頂網(wǎng)絡(luò)及突顯網(wǎng)絡(luò)5個(gè)運(yùn)動(dòng)相關(guān)、靜息態(tài)網(wǎng)絡(luò)進(jìn)行研究。與治療前相比,rTMS組治療后運(yùn)動(dòng)網(wǎng)絡(luò)雙側(cè)輔助運(yùn)動(dòng)皮層、患側(cè)中央前回的功能連通性增加,與Sham組相比,除上述腦區(qū)外,患側(cè)中央后回的功能連通性也增加;小腦網(wǎng)絡(luò)的健側(cè)小腦的功能連通性增加;右側(cè)額頂網(wǎng)絡(luò)在右側(cè)頂葉的功能連通性增加。(3)治療后運(yùn)動(dòng)網(wǎng)絡(luò)與其他幾個(gè)運(yùn)動(dòng)相關(guān)網(wǎng)絡(luò)間相關(guān)性增加。結(jié)論:高頻rTMS刺激腦卒中患者大腦患側(cè)初級(jí)運(yùn)動(dòng)皮層,可以改善患者的運(yùn)動(dòng)功能,臨床效果的改善可能與rTMS提高運(yùn)動(dòng)功能相關(guān)網(wǎng)絡(luò)的聯(lián)通性,促進(jìn)運(yùn)動(dòng)相關(guān)網(wǎng)絡(luò)間的信息整合能力有關(guān)。
[Abstract]:Objective: to evaluate the rehabilitation effect of repetitive transcranial magnetic stimulation (TMS) and repetitive Transcranial Magnetic stimulation (RTMS) in patients with motor dysfunction after ischemic stroke by using resting State Functional Magnetic Resonance imagingrs-fMRI and clinical motor function scale.The impact of the functional network.Methods: Twenty-two patients with ischemic stroke in middle Cerebral Arteryma region of neurology department in our hospital were randomly divided into two groups, including 11 patients in the true stimulation group and 11 patients in the rTMS group.The sham stimulation group (n = 11) was treated with high frequency rTMS for 10 days in the affected primary motor cortex. The stimulation frequency was 10 Hz and the stimulation intensity was 90%. The sham group received pseudostimuli with the same noise and time.The treatment time and other routine treatment methods were the same between the two groups.Before and after treatment, the clinical motor function scores and rs-fMRI images were collected.Independent component analysis (Component) and time-delay correlation were used to extract the motion-related resting functional brain network of stroke patients, and to analyze the correlation between the information of the network.The National Institutes of Health Stroke scale (NIH), simple Fugel-Meyer Assessment (rTMS), activity of Daily living (ADL) and exercise related network (NIH) were compared between rTMS group and Sham group before and after rTMS treatment.Changes and differences in the correlation between networks.Results compared with before treatment, the scores of NIHSS FMA and BI in rTMS group and Sham group were significantly improved, and the FMA and BI scores in rTMS group were significantly better than those in Sham group after treatment.There is a statistical difference between the two groups. There is no significant difference between the two groups. (2) five motion related, resting and resting networks are selected, including motor network, cerebellar network, executive control network, right frontal apex network and salient network.The functional connectivity of the precentral gyrus of the affected side increased compared with that before treatment in the rTMS group, and the functional connectivity of the postcentral gyrus of the affected side was also increased in addition to the above-mentioned areas in the Sham group.The functional connectivity of the contralateral cerebellum of the cerebellar network was increased, and the functional connectivity of the right frontal parietal network in the right parietal lobe was increased.Conclusion: high frequency rTMS stimulation of primary motor cortex in stroke patients can improve the motor function of the patients. The improvement of clinical effect may be related to the improvement of the connectivity of motor function related networks by rTMS.The ability to promote information integration among sports-related networks is relevant.
【學(xué)位授予單位】：川北醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R743.3;R445.2

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本文編號(hào)：1748471