發(fā)布時(shí)間：2018-07-03 04:19

  本文選題：重復(fù)經(jīng)顱磁刺激 + 腦卒中��； 參考：《河北醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:腦卒中的發(fā)病率逐年升高,作為有高致殘率的疾病之一,腦卒中后遺癥的恢復(fù)一直備受關(guān)注。運(yùn)動(dòng)功能障礙是腦卒中后發(fā)生率較高的后遺癥之一,患者常因此導(dǎo)致日常生活活動(dòng)能力的下降,而運(yùn)動(dòng)功能障礙中又常以上肢功能障礙為康復(fù)治療的難點(diǎn)。重復(fù)經(jīng)顱磁刺激(repetitive transcranial magnetic stimulation,r TMS)是基于電磁感應(yīng)的原理,在極短時(shí)間內(nèi)產(chǎn)生作用于某一特定皮質(zhì)部位的磁場(chǎng),并給予重復(fù)連續(xù)刺激,產(chǎn)生可持續(xù)一段時(shí)間的累積效應(yīng),刺激局部和遠(yuǎn)隔區(qū)域的大腦功能的一項(xiàng)技術(shù)。r TMS作為一種新型無創(chuàng)的康復(fù)治療手段,具有定位準(zhǔn)確、安全、無交叉感染的特點(diǎn),逐漸受到康復(fù)醫(yī)學(xué)界的關(guān)注。目前r TMS治療過程中方案的選擇尚未達(dá)成共識(shí)。本文所做的研究,旨在比較不同頻率的r TMS聯(lián)合常規(guī)康復(fù)訓(xùn)練,對(duì)卒中后患者運(yùn)動(dòng)功能恢復(fù)的效果,為腦卒中后運(yùn)動(dòng)功能障礙患者r TMS的應(yīng)用提供科學(xué)的依據(jù)。方法:選取河北省人民醫(yī)院康復(fù)醫(yī)學(xué)科門診或住院病人81例,入組患者均無治療禁忌癥,并符合納入、排除標(biāo)準(zhǔn)。將81例患者隨機(jī)分成三組,分別為低頻r TMS組24例,高頻r TMS組31例(治療中3例脫落),r TMS假刺激組26例。低頻r TMS組治療部位:健側(cè)大腦半球中央前回M1區(qū);刺激頻率:1Hz;刺激時(shí)間:20分鐘;配合常規(guī)康復(fù)訓(xùn)練。高頻r TMS組治療部位:患側(cè)大腦半球中央前回M1區(qū);刺激頻率:10Hz;刺激時(shí)間:20分鐘;配合常規(guī)康復(fù)訓(xùn)練。r TMS假刺激組:給予r TMS假刺激;配合常規(guī)康復(fù)訓(xùn)練。三組治療時(shí)間:r TMS治療每次20分鐘,每日一次,治療時(shí)程兩周,每周5天,共10次;常規(guī)康復(fù)訓(xùn)練每次70-80分鐘,每日一次,治療時(shí)程兩周,每周5天,共10次。所有患者在治療前和治療后分別進(jìn)行Fugl-Meyer運(yùn)動(dòng)功能量表(Fugl-Meyer Assessment of motor Recovery,FMA)患側(cè)上肢、下肢的運(yùn)動(dòng)功能評(píng)定,Wolf偏癱上肢功能評(píng)測(cè)量表(The Wolf Motor Function Test,WMFT)評(píng)定,卒中患者運(yùn)動(dòng)功能評(píng)估量表(Motor Assessment Scale,MAS)評(píng)定,Berg平衡功能量表(Berg Balance Scale,BBS)評(píng)定,改良日常生活活動(dòng)能力量表(Modified Barthel Index,MBI)評(píng)定。結(jié)果:1 r TMS對(duì)腦卒中后運(yùn)動(dòng)功能恢復(fù)的影響1.1 FMA上肢評(píng)分、WMFT評(píng)分治療前,低頻r TMS治療組、高頻r TMS治療組與對(duì)照組三組之間,FMA上肢部分評(píng)分、WMFT評(píng)分無統(tǒng)計(jì)學(xué)差異(P0.05);治療后,高頻r TMS治療組和低頻r TMS治療組FMA上肢部分評(píng)分、WMFT評(píng)分均明顯高于對(duì)照組(P0.05),高頻r TMS治療組評(píng)分高于低頻r TMS治療組(P0.05);三組之中,每組治療前與治療后相比較,FMA上肢評(píng)分、WMFT評(píng)分均有統(tǒng)計(jì)學(xué)差異(P0.01);1.2 FMA下肢評(píng)分治療前,低頻r TMS治療組、高頻r TMS治療組與對(duì)照組三組之間FMA下肢評(píng)分無統(tǒng)計(jì)學(xué)差異(P0.05);治療后,高頻r TMS治療組和低頻r TMS治療組FMA下肢評(píng)分均明顯高于對(duì)照組(P0.05),高頻r TMS治療組評(píng)分與低頻r TMS治療組之間無統(tǒng)計(jì)學(xué)差異(P0.05);三組之中,每組治療前與治療后FMA下肢評(píng)分比較均有統(tǒng)計(jì)學(xué)差異(P0.01);1.3 MAS評(píng)分治療前,低頻r TMS治療組、高頻r TMS治療組與對(duì)照組三組之間MAS評(píng)分無統(tǒng)計(jì)學(xué)差異(P0.05);治療后,三組間MAS評(píng)分無統(tǒng)計(jì)學(xué)差異(P0.05);三組之中,每組治療前與治療后MAS評(píng)分比較均有統(tǒng)計(jì)學(xué)差異(P0.01);2 r TMS對(duì)平衡功能(BBS評(píng)分)的影響治療前,低頻r TMS治療組、高頻r TMS治療組與對(duì)照組三組之間BBS評(píng)分無統(tǒng)計(jì)學(xué)差異(P0.05);治療后,三組間分值無統(tǒng)計(jì)學(xué)差異(P0.05);三組之中,每組治療前與治療后BBS評(píng)分比較均有統(tǒng)計(jì)學(xué)差異(P0.01);3 r TMS對(duì)Barthel指數(shù)(MBI)評(píng)分的影響治療前,低頻r TMS治療組、高頻r TMS治療組與對(duì)照組三組之間MBI分值無統(tǒng)計(jì)學(xué)差異(P0.05);治療后,三組間MBI評(píng)分無統(tǒng)計(jì)學(xué)差異(P0.05);三組之中,每組治療前與治療后MBI評(píng)分比較均有統(tǒng)計(jì)學(xué)差異(P0.01)。結(jié)論:重復(fù)經(jīng)顱磁刺激治療可促進(jìn)腦卒中患者運(yùn)動(dòng)功能的恢復(fù)和改善;本次實(shí)驗(yàn)中,10Hz高頻重復(fù)經(jīng)顱磁刺激較1Hz低頻重復(fù)經(jīng)顱磁刺激對(duì)促進(jìn)腦卒中患者上肢運(yùn)動(dòng)功能的恢復(fù)效果更佳。
[Abstract]:Objective: the incidence of stroke is increasing year by year. As one of the diseases with high disability rate, the recovery of cerebral apoplexy sequelae has been paid much attention. Motor dysfunction is one of the sequelae of higher incidence of stroke after stroke, and the patient often leads to the decline of daily living ability, and the motor dysfunction often has upper limb dysfunction. The repetitive transcranial magnetic stimulation (repetitive transcranial magnetic stimulation, R TMS) is based on the principle of electromagnetic induction, producing a magnetic field that acts on a specific cortex at a very short time, and gives repeated continuous stimulation to produce a sustained period of cumulative effect, stimulating local and distant regions. A technique of brain function,.R TMS, as a new noninvasive method of rehabilitation, has the characteristics of accurate location, safety and no cross infection. It has gradually attracted the attention of the rehabilitation medical community. The choice of the scheme in the process of R TMS treatment has not yet reached a consensus. The research done in this paper is aimed at comparing the normal rehabilitation of R TMS with different frequencies. Training, the effect of recovery of motor function after stroke, provide scientific basis for the application of R TMS in patients with post-stroke motor dysfunction. Methods: 81 patients in Hebei People's Hospital rehabilitation medicine department or hospitalized patients were selected, and all the patients had no contraindications, and the compliance was included and the exclusion criteria were excluded. The 81 patients were randomly divided into three groups. 24 cases of low frequency R TMS group, 31 cases of high frequency R TMS group (3 cases of abscission in treatment), 26 cases of R TMS false stimulation group. Low frequency R TMS group treatment site: the healthy side of the cerebral hemisphere precentral gyrus M1 region; stimulation frequency: 1Hz; stimulation time: 20 minutes; combined with conventional rehabilitation training. High frequency R TMS group treatment area; stimulation frequency: 10: stimulation frequency 10: 10 Hz; stimulation time: 20 minutes; combined with conventional rehabilitation training.R TMS false stimulation group: R TMS false stimulation; combined with routine rehabilitation training. The three groups of treatment time: R TMS treatment 20 minutes each time, once a day, two weeks, 5 days a week, a total of 70-80 minutes, once a day, once a day, two weeks for the treatment course, and 10 times a week, 5 days a week. All patients were subjected to the Fugl-Meyer exercise function scale (Fugl-Meyer Assessment of motor Recovery, FMA) with the lateral upper limb, the motor function assessment of the lower extremities, the assessment of the function of the Wolf hemiplegic upper limb (The Wolf Motor Function), and the exercise assessment scale for stroke patients. AS) assessment, the assessment of the Berg balance function scale (Berg Balance Scale, BBS), the improvement of the daily living ability scale (Modified Barthel Index, MBI). Results: the effect of 1 R TMS on the recovery of motor function after stroke was 1.1. There was no statistical difference between the upper limb part score and the WMFT score (P0.05). After the treatment, the grade of FMA upper limb in the high frequency R TMS treatment group and the low frequency R TMS group was significantly higher than the control group (P0.05), and the high frequency R TMS treatment group was higher than the low frequency r treatment group; the three groups were compared with the treatment group before treatment. MFT scores were statistically different (P0.01); before the 1.2 FMA lower extremity score treatment, low frequency R TMS treatment group, high frequency R TMS treatment group and the control group had no statistical difference between the three groups (P0.05). After treatment, high frequency R TMS treatment group and low frequency r treatment group were significantly higher than the control group. There was no statistical difference between the low frequency R TMS treatment group (P0.05), and in the three groups, there were statistically significant differences between each group before and after the treatment of FMA lower limb scores (P0.01); before the 1.3 MAS score, the low frequency R TMS treatment group, the high frequency R TMS treatment group and the control group had no statistical difference between the three groups (P0.05); after treatment, the three groups did not score the scores. Statistical difference (P0.05); in the three groups, there were statistical differences between each group before and after the treatment (P0.01), and the effect of 2 R TMS on the balance function (BBS score) before treatment, low frequency R TMS treatment group, and the BBS score between the high frequency R TMS treatment group and the control group was not statistically significant (P0.05); after treatment, there was no statistical difference between the three groups. In the three groups, there were statistically significant differences between the three groups before and after the treatment (P0.01), and the effect of 3 R TMS on the Barthel index (MBI) score had no statistical difference between the low frequency R TMS treatment group, the high frequency R TMS treatment group and the control group, and the three groups had no statistical difference between the three groups. 5); in the three groups, there were statistical differences between each group before and after the treatment (P0.01). Conclusion: repetitive transcranial magnetic stimulation can promote the recovery and improvement of motor function in stroke patients. In this experiment, 10Hz high frequency transcranial magnetic stimulation of 10Hz is more than 1Hz low frequency reduplication by cranial magnetic stimulation to promote upper limb movement function of stroke patients The recovery effect is better.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R743.3

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