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中华物理医学与康复杂志
中华物理医学与康复杂志

黄晓琳

月刊

0254-1424

cjpmr@tjh.tjmu.edu.cn

027-83662874

430030

湖北省武汉市解放大道1095号同济医院内

中华物理医学与康复杂志/Journal Chinese Journal of Physical Medicine and RehabilitationCSCD北大核心CSTPCD
查看更多>>中华医学会主办。本刊主要内容包括：贯彻党和国家的卫生工作方针政策，理论与实践相结合，提高与普及相结合，积极倡导百花齐放、百家争鸣；全面介绍物理治疗、物理医学与康复领域内领先的科研成果和新理论、新技术、新方法、新经验以及对物理因子治疗、康复临床、疗养等有指导作用，且与康复医学密切相关的基础理论研究，同时密切关注国际康复医学发展的新动向。主要栏目包括论著、综述、研究报告、经验交流、继续教育、讲座、病例报告、会议纪要、书评、国内外学术动态、学术活动预告等。
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    成人气管切开拔管中国专家共识(上)

    陆晓易浩
    481-487页
    查看更多>>摘要：气管切开后的有效管理及成功拔管对于促进患者身心康复，改善其生活质量意义重大。但迄今尚缺少围绕气管切开后系列管理问题的高质量专家共识或指南。依据《世界卫生组织指南制订手册》，本共识历经临床问题调研、证据检索与评价、初步推荐意见形成、德尔菲问卷调查等环节，基于相关临床研究、系统评价、临床指南等当前最佳证据撰写。本共识以拔管流程为主体，以气道管理、康复治疗为两翼，围绕七大临床问题提供共识性意见，并据此构建气管切开拔管流程图，以期为成人气管切开管理及拔管提供流程化引导，提高我国人工气道问题的综合管理能力。

    气管切开气道管理肺康复吞咽康复拔管指征拔管后处理

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    有氧运动对自发性高血压大鼠肾脏纤维化及细胞凋亡的影响

    王倩倩刘静万琼易浩...
    488-493页
    查看更多>>摘要：目的 观察规律有氧运动对自发性高血压大鼠肾脏纤维化及细胞凋亡的影响。 方法 采用随机数字表法将30只6周龄雄性自发性高血压大鼠(SHR)分为高血压安静组(简称安静组)及高血压运动组(简称运动组)，每组15只。同期选取10只年龄、性别相匹配的Wistar-Kyoto大鼠纳入正常血压对照组(简称正常对照组)。运动组大鼠给予12周游泳运动(每天运动60 min，每周运动5 d)，安静组及正常对照组大鼠均在鼠笼内安静饲养。于训练前及末次训练结束后检测各组大鼠尾动脉血压；于末次训练结束后测定各组大鼠24 h尿蛋白、血尿素氮及血清肌酐含量，利用Masson染色观察肾脏间质纤维化程度并计算胶原容积分数(CVF)，采用TUNEL染色法记录肾小管上皮组织凋亡细胞数量并计算细胞凋亡率，利用Western blot法检测肾脏转化生长因子β1(TGF-β1)、Smad2/3、Smad7、Bax和Bcl-2蛋白表达量。 结果 与干预前比较，干预后安静组收缩压、舒张压及平均动脉压均显著升高(P<0.05)，运动组收缩压、舒张压及平均动脉压均显著降低(P<0.05)，正常对照组血压无明显变化(P>0.05)。与正常对照组比较，干预后安静组血压、24 h尿蛋白、血尿素氮及血清肌酐含量、细胞凋亡率、TGF-β1、Smad2/3和Bax蛋白表达量均明显增加(P<0.05)，Smad7及Bcl-2蛋白表达量均明显降低(P<0.05)；与安静组比较，干预后运动组大鼠血压、24 h尿蛋白、血尿素氮及血清肌酐含量、细胞凋亡率、TGF-β1、Smad2/3和Bax蛋白表达量均显著下降(P<0.05)，Smad7及Bcl-2蛋白表达量均显著增加(P<0.05)。 结论 规律有氧运动能通过抑制肾脏纤维化及细胞凋亡改善自发性高血压大鼠肾功能障碍。 Objective To explore any effect of regular aerobic exercise on renal fibrosis and apoptosis in rats with spontaneous hypertension. Methods Thirty 6-week-old male spontaneously hypertensive rats were randomly divided into a sedentary group (group HS) and an exercise group (group HE). Ten age- and sex-matched Wistar-Kyoto rats formed a control group. The rats in group HE underwent 12 weeks of swimming exercise lasting 60 minutes, five times a week, while the other two groups were kept quiet in their cages. Before and after the training, the tail artery blood pressure of each rat was measured. Renal function was evaluated after the experiment by measuring 24h urine protein, blood urea nitrogen and serum creatinine levels, while the degree of renal interstitial fibrosis was measured using Masson staining and the collagen volume fraction was calculated. The number of apoptotic cells in the renal tubular epithelial tissue was recorded by TUNEL staining and the apoptosis rate was calculated. The expression of renal transforming growth factor β1 (TGF-β1), Smad2/3, Smad7, Bax and Bcl-2 protein were detected using western blotting. Results After the intervention, the average systolic and diastolic blood pressure and mean arterial pressure of group HS had increased significantly, while those of group HE had decreased significantly, with no significant changes in those measurements among the control group. Compared with the control group, after the intervention, the average blood pressure, 24h urinary protein, blood urea nitrogen and serum creatinine, as well as the cell apoptosis rate and expression of TGF-β1, Smad2/3 and Bax had increased significantly, and that of Smad7 and Bcl-2 had decreased significantly in group HS. And compared with group HS, in group HE the average blood pressure, 24h urinary protein, blood urea nitrogen, serum creatinine and the cell apoptosis rate had decreased significantly, together with the expression of TGF-β1, Smad2/3 and Bax, but the average expression of Smad7 and Bcl-2 had increased significantly. Conclusion Regular aerobic exercise can relieve the renal dysfunction seen in spontaneous hypertension, at least in rats, by inhibiting renal fibrosis and apoptosis.

    有氧运动高血压高血压肾病肾脏纤维化细胞凋亡

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    国际功能、残疾和健康分类康复组合-17在临床多学科住院患者中应用的信效度研究

    张霞李嘉慧金娟潘菲...
    494-499页
    查看更多>>摘要：目的 验证国际功能、残疾和健康分类(ICF)康复组合-17在临床多学科患者功能评估中的信度和效度。 方法 选取来自江苏省三家三级医院的康复医学科、骨科、神经内科和神经外科的住院患者359例。在入院和出院时均采用ICF康复组合-17对所有患者进行评估，计算评估工具的内部一致性。用组内相关系数(ICC)检验评估者间和评估者内信度，用主轴法的直接斜交转轴法进行因子分析，检验ICF康复组合-17的结构效度。 结果 ICF康复组合-17的内部一致性Cronbach′s α系数为0.945。评估者间信度分析显示，ICF康复组合-17总分的ICC为0.946；除b280痛感外，该量表的剩余条目ICC为0.630~0.948(P<0.001)。评估者内信度分析显示，ICF康复组合-17总分和条目的ICC为0.471~0.947(P<0.001)。经过因子分析，得到3个特征值大于1的因子，累计解释变异量为74.123%，无双重负荷的条目。将3个公因子分别命名为"运动能力"，"睡眠感知交往能力"和"生活自理能力"。 结论 ICF康复组合-17在多学科住院患者功能评定中具有良好的内部一致性、评估者间信度、评估者内信度和结构效度。 Objective To explore the reliability and validity of the International Classification of Functioning, Disability and Health′s 17-item Rehabilitation Set (ICF-RS-17) when used to evaluate multidisciplinary inpatients. Methods A total of 359 inpatients in the departments of rehabilitation, orthopedics, neurology, and neurosurgery of three hospitals in Jiangsu province were assessed with the ICF-RS-17 at admission and at discharge, and the internal consistency of the tool was calculated. Inter-rater and intra-rater reliability were quantified using interclass correlation coefficients (ICCs). Structural validity was analyzed using factor analysis. Results The tool′s Cronbach′s α was 0.945. The overall inter-rater ICC was 0.946 with the ICCs of all of the items except b280 sensation of pain within the range from 0.630 to 0.948. The overall intra-rater ICCs ranged from 0.471 to 0.947. The factor analysis found three factors with eigenvalues greater than 1, accounting for 74% of the variation, without double-loaded items. The three influential factors were exercise ability, sleep perception communication ability and self-care ability. Conclusion The ICF-RS-17 has good internal consistency, inter-rater and intra-rater reliability and structural validity in the evaluation of multidisciplinary inpatients.

    临床结局评价ICF康复组合功能信度效度

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    构音评估与训练系统的声学分析研究

    王刚王楠严嘉健卢思宇...
    500-505页
    查看更多>>摘要：目的 比较智能提取语音参数的构音评估与训练系统和人工提取语音参数的Praat声学软件在重要参数上的差异。 方法 选取32例正常受试者，分别用构音评估与训练系统和传统Praat语音软件进行语音采集，前者可以即时智能分析出持续元音/a/、/i/、/u/的平均基频(mF0)、第一共振峰(F1)、第二共振峰(F2)，传统Praat软件则是通过人工提取采录语音参数并进行数据分析。对上述两种语音分析工具的重要声学参数进行一致性分析。 结果 采用构音评估与训练系统对同一受试者进行第1次评估和第2次评估，除元音/u/的mF0(ICC＝0.75)重测信度较好外，元音/a/的mF0(ICC＝0.97)、F1(ICC＝0.97)和F2(ICC＝0.98)，元音/i/的mF0(ICC＝0.93)、F1(ICC＝1.00)和F2(ICC＝0.95)，元音/u/的F1(ICC＝0.98)和F2(ICC＝0.94)的ICC值均高于0.90，说明构音评估与训练系统的重测信度极好。两种声学分析软件元音/a/的mF0(ICC＝0.99)、F1(ICC＝0.96)和F2(ICC＝0.90)，元音/i/的mF0(ICC＝0.98)、F1(ICC＝0.94)和F2(ICC＝0.94)，元音/u/的mF0(ICC＝0.95)和F1(ICC＝0.94)的ICC值均高于0.90，说明两种声学分析软件在分析元音/a/、/i/的mF0、F1和F2，元音/u/的F1和F2方面的一致性极好。元音/u/的F2 ICC值介于0.75~0.90，说明两种声学分析软件在分析元音/u/的F2方面的一致性较好。两种声学分析软件的元音/a/、/i/、/u/的mF0、F1、F2、共振峰集中率(FCR)、元音清晰度指数(VAI)、舌距、元音空间面积(VSA)、下颌距在Bland-Altman图中数据点多分布在95%可信区间内，说明两种声学分析软件在语音测量中具有较高的准确性。男性长元音/a/的mF0(151.35±30.94)、/i/的mF0(163.84±27.92)、/u/的mF0(170.96±31.99)均低于女性长元音/a/的mF0(277.93±23.48)、/i/的mF0(280.34±27.23)、/u/的mF0(284.97±37.08)，差异均有统计学意义(P<0.05)。 结论 构音评估与训练系统的重测信度较好，在自然状态下的构音检查结果与Praat检查结果比较的一致性较好，在构音检查上可以相互替代。 Objective To compare the differences in important parameters between the articulation assessment and training system of intelligently extracted speech with those from the Praat acoustic software and those manually extracted. Methods The speech of thirty-two normal subjects was captured using the intelligent articulation assessment and training system and using Praat acoustic software. The former analyzed the mean fundamental frequencies (mF0s), the first formant peaks (F1s) and the second formant peak (F2s) of the sustained vowels /a/, /i/ and /u/. The speech parameters collected by the traditional Praat software were extracted and analyzed by professionals. The two tools′ consistency in terms of these important acoustic parameters was analyzed. Results The results with all 32 subjects when retested returned ICC values above 0.9 with all three vowels with the exception of mF0 for /u/ (ICC=0.75), indicating excellent retest reliability for the articulation assessment and training system. The ICC values also indicated excellent consistency between the two kinds of software in analyzing mF0, F1 and F2 of the three vowels. The mF0, F1, F2, FCR, VAI, tongue spacing, VSA, and mandibular spacing of all three vowels were mostly distributed within the 95% confidence interval of the data points in Bland-Altman plots, indicating the high accuracy of both acoustic analysis systems in speech measurement. The mean fundamental frequency values of the male long vowels /a/, /i/ and /u/ were all significantly lower than for the female long versions. Conclusions The retest reliability of the articulation assessment and training system was good, and the results of the articulation check in the natural state were in good consistency compared to the Praat check and were interchangeable in the articulation check.

    构音评估与训练系统Praat声学分析软件语音参数一致性

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    神经电生理监测在面肌痉挛患者术前评估及其预后判断中的应用

    何颖李玉琢陈静潘明茜...
    506-510页
    查看更多>>摘要：目的 分析偏侧面肌痉挛患者术前肌电图与痉挛评估的诊断价值及术中电生理监测与预后的关系，为临床诊治提供帮助。 方法 选取31例偏侧面肌痉挛患者进行临床痉挛程度评分，按临床痉挛程度评分分为一般痉挛组(27例)和严重痉挛组(4例)，对所有患者进行术前神经电生理检查，记录颤搐放电、面神经传导速度(MCV)、瞬目反射、侧方扩散(LSR)、脑干听觉诱发电位(BAEP)、瞬目反射；术中进行电生理监测，记录术中LSR情况。根据术中LSR消失与否，将患者分为LSR消失组和LSR残留组，分别于术后1周、术后3个月和术后半年，观察和比较这2组患者的面肌痉挛术后临床疗效评估情况。 结果 一般痉挛组和严重痉挛组患者的术前肌电图检查，LSR均为阳性表现，面神经MCV均在正常范围，而针极肌电图观察到的颤搐放电和瞬目反射、术前BAEP的组间差异有统计学意义(P<0.05)。根据术后31例患者的LSR是否消失，患者分为LSR残留组(15例)和LSR消失组(16例)两组，比较各组术后1周(痊愈患者残留组1例，消失组3例；明显缓解患者残留组3例，消失组7例)、术后3个月(痊愈患者残留组5例，消失组7例；明显缓解患者残留组3例，消失组6例)及术后半年时(痊愈患者残留组5例，消失组12例；明显缓解患者残留组9例，消失组2例)患者的面肌痉挛恢复情况，LSR消失组和LSR残留组组内上述3个时间点的临床疗效评估比较，痉挛恢复差异均有统计学意义(P<0.05)，且术后半年时间点优于术后3个月且优于术后1周时间点(P<0.05)；术后同一时间点的痉挛恢复比较，术后1周时间点组间差异有统计学意义(P<0.05)，且为消失组显著优于残留组(P<0.05)，而术后3个月和术后半年时间点的组间差异均无统计学意义(P>0.05)。 结论 术前肌电图能对面肌痉挛范围及程度、面神经兴奋性提供客观诊断评估依据；术中电生理实时监测，能帮助术者客观评估减压效果，及时发现避免周围神经牵拉损伤情况。 Objective To analyze the diagnostic value of preoperative electromyography and spasticity assessment for patients with hemifacial spasm, and to define a relationship between intraoperative electrophysiological examination and prognosis in order to provide help for clinical diagnosis and treatment. Methods Thirty-one patients with hemifacial spasm were selected for the clinical spasticity scoring and divided into a general spasm group (n=27) and a severe spasm group (n=4). All received preoperative neurophysiological examination to record their twitch discharge, facial nerve conduction velocity (MCV), lateral spread (LSR) of the spasm, brainstem auditory evoked potential (BAEP), and blink reflex. Electrophysiological monitoring then recorded intraoperative LSR. According to whether the LSR disappeared or not, the patients were divided into the LSR disappearance group (of 15) and the LSR residual group (of 16), and facial muscle activity was recorded again one, three and six months after the operation. Results Preoperative EMG examination of both groups showed positive LSR and that facial nerve MCV was within the normal range. There were, though, significant differences between the two groups in the twitching discharge by needle electromyography, blink reflex and preoperative BAEP. One week after the operation, one member of the residual group and 3 from the disappearance patients of the former and latter group had recovered in terms of LSR, with 3 and 7 cases significantly relieved, respectively. Two months later, the corresponding figures were 5 and 7, 3 and 6, respectively. Half of a year after the surgery, 5 from the residual group and 12 from the disappearance group had fully recovered in terms of LSR, while 9 and 2 cases were significantly relieved. Altogether, there were significant differences within the two groups in terms of recovery among all the time points, with significantly better recovery in the LSR disappearance group than the LSR residual group at 1 week after operation, while there were no significant differences between the two groups in recovery 3 and 6 months after their operation. Conclusions Preoperative electromyography can provide objective assessments of the scope, severity, and facial nerve excitability of patients with hemifacial spasm. Real-time intraoperative electrophysiology monitoring can help surgeons to objectively assess the effect of decompression and to find and avoid nerve traction injury in surrounding areas quickly.

    偏侧面肌痉挛神经电生理预后

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    神经重症康复病房气管切开术后拔管困难患者的临床特点分析

    张明孙兴良赵靖刘延明...
    511-516页
    查看更多>>摘要：目的 探讨神经重症康复病房气管切开术后拔管困难患者的临床特点。 方法 回顾性分析2015年1月至2019年5月由淄博市中心医院康复科神经重症康复病房收治的气管切开术后患者122例，根据患者是否成功拔管分为2组，拔管成功组(73例)和拔管困难组(49例)。采用全面无反应性量表(FOUR)和昏迷恢复量表(CRS-R)评定患者的意识状态，采用口腔摄入功能量表(FOIS)评定患者的进食能力，采用纤维内窥喉镜观察气道解剖结构，采用Marianjoy分泌物五分评分量表、Rosenbek渗漏-误吸量表(PAS)行分泌物潴留及吞咽误吸评分。先采用单因素分析，再进行多因素Logistic回归分析，筛选危险因素。 结果 单因素分析显示，年龄、意识状态、吞咽功能、分泌物潴留、误吸和声门开放水平可能是影响神经重症气管切开术后患者拔管的因素(P<0.05)。Logistic回归分析显示，咽喉部分泌物潴留多[OR＝9.380，95%CI(3.010，29.231)，P<0.05]和声门开放水平差[OR＝0.186，95%CI(0.083，0.417)，P<0.05]是神经重症气管切开术后患者拔管的危险因素。 结论 咽喉部分泌物潴留多和声门开放水平差是神经重症气管切开术后患者拔管困难的独立危险因素。纤维内窥喉镜在诊治过程中起着十分重要的作用。 Objective To study the clinical characteristics of patients with difficulty in decannulation after a tracheotomy in a neurological intensive care unit. Methods A total of 122 patients undergoing tracheotomy were divided into a decannulation success group (n=73) and a difficult decannulation group (n=49). The Full Outline of Unresponsiveness (FOUR) and the revised version of the Coma Recovery Scale (CRS-R) were used to assess the consciousness of those in both groups. Their swallowing ability, airway anatomy, secretion retention and aspiration were documented using the Functional Oral Intake Scale (FOIS), fiberoptic endoscopic examination, Marianjoy′s 5-point secretion severity scale and the penetration-aspiration scale (PAS). Univariate analysis and multiva-riate logistic regression analysis were conducted to isolate risk factors. Results The univariate analysis showed that age, status of consciousness, swallowing ability, secretion retention, aspiration and opening of the glottis may be indicators of difficult decannulation after a tracheotomy among those with severe neurological diseases. The logistic regression analysis found that too much retention of pharyngeal secretions and insufficient opening of the glottis should also be treated as risk factors for difficult decannulation with such patients. Conclusions Too much retention of pharyngeal secretions and poor opening of the glottis are independent risk factors for difficult decannulation after a tracheotomy. Endoscopic examination can play an important role in the prediction and treatment of difficult decannulation.

    神经重症康复病房气管切开术拔管困难纤维内窥镜检查危险因素

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    悬吊模式下的核心稳定性训练对脑卒中患者平衡功能的影响

    罗思嘉龚剑秋朱童董晓琼...
    517-521页
    查看更多>>摘要：目的 观察悬吊训练模式下的核心稳定性训练对脑卒中患者平衡功能的影响。 方法 选取符合标准的60例脑卒中患者按随机数字表法分成对照组和实验组，每组30例。2组患者均接受脑卒中后常规的康复训练；在此基础上，对照组进行传统核心稳定性训练，实验组则进行悬吊训练模式下核心稳定性训练，每日训练1次，每周5次，连续训练4周。分别于治疗前和治疗4周后(治疗后)，采用Prokin平衡仪对2组患者的站立位平衡能力进行评定，并记录患者睁眼、闭眼平衡测试时的运动轨迹长度及运动椭圆面积；同时利用表面肌电图(sEMG)记录平衡测试时双侧竖脊肌和多裂肌肌电信号的平均肌电(AEMG)值。 结果 ①平衡功能变化：治疗后，睁眼闭眼平衡测试，2组患者压力中心的运动轨迹长度、运动椭圆面积均少于组内治疗前(P<0.01)；实验组患者压力中心的运动轨迹长度[睁眼(226.40±88.59)mm、闭眼(312.07±118.45)mm]、运动椭圆面积[睁眼(198.83±84.99)mm2、闭眼(303.50±123.86)mm2]均少于对照组[运动轨迹长度：睁眼(291.23±117.71)mm、闭眼(405.27±181.05)mm；运动椭圆面积：睁眼(250.47±109.23)mm2、闭眼(379.03±144.91)mm2]，组间差异有统计学意义(P<0.05)。②表面肌电图变化：治疗后，睁眼和闭眼平衡测试时，2组患者双侧竖脊肌与多裂肌的AEMG值均大于组内治疗前(P<0.01)；闭眼平衡测试时，实验组患侧多裂肌的AEMG值[(58.48±10.40)μV]显著大于对照组[(52.39±10.63)μV]，且组间差异有统计学意义(P<0.05)。 结论 悬吊训练模式下的核心稳定性训练能显著改善脑卒中患者的平衡功能，其效果优于传统核心稳定性训练。 Objective To observe the impact of core stability training in the sling exercise therapy pattern on the balance of stroke survivors. Methods Sixty stroke survivors were randomly divided into a control group (n=30) and an experimental group (n=30). In addition to routine rehabilitation training, the control group received traditional core stability training, while the experimental group underwent core stability training applying the sling exercise therapy pattern. Before and after 4 weeks of training, the standing balance of both groups was evaluated using the Prokin balance trainer, with the length and area of motion recorded when performing the balance test with the eyes open and closed. Surface electromyography was used to record the average EMG (AEMG) values of the bilateral erector spinae and multifidus muscles during the balance testing. Results After the 4 weeks of training the length and the area of progression of the center of the pressure were both significantly smaller for both groups than before the training with the eyes both open and closed. The average length and area in the experimental group were significantly less than among the controls. The AEMG values recorded during the balance tests were significantly higher than those before the intervention for both groups, with the multifidus muscle averages on the affected side significantly greater in the experimental group than among the controls when performing the balance test with the eyes closed. Conclusion Core stability training in the sling exercise therapy pattern is superior to conventional core stability training because it can better improve the balance of stroke survivors.

    脑卒中悬吊训练核心稳定性训练平衡功能表面肌电

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    悬吊辅助下不同强度核心肌群强化训练对脑卒中患者平衡和步行功能的影响

    钟聪聪楼雅洁程一淇刘亚杰...
    522-524页
    查看更多>>摘要：目的 观察悬吊辅助下不同强度核心肌群强化训练对脑卒中患者平衡和步行功能的影响。 方法 选取脑卒中患者68例，随机分为核心1组和核心2组，每组34例。2组患者均给予内科治疗和常规康复训练45 min，核心1组进行悬吊辅助下核心肌群强化训练15 min，核心2组进行悬吊辅助下核心肌群强化训练30 min。每日1次，每周5 d，共训练4周。分别于治疗前和治疗4周(治疗后)，采用Berg平衡量表(BBS)评分、Holden功能性步行量表(FAC)分级、步幅、步速和患侧步长对2组患者的平衡和步行功能进行评估。 结果 治疗后，核心1组和核心2组的BBS评分、FAC分级、步幅、步速和患侧步长均显著优于治疗前，差异均有统计学意义(P<0.05)，且核心2组效果优于核心1组(P<0.05)。 结论 悬吊辅助下核心肌群强化训练可有效改善脑卒中患者的平衡和步行功能，且30 min的训练强度效果优于15 min的训练。

    悬吊核心肌群脑卒中平衡步行功能

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    针刺联合重复经颅磁刺激治疗脑卒中后运动功能障碍的疗效观察

    余鸿斌张慧珍凌琛
    525-527页
    查看更多>>摘要：目的 观察针刺联合重复经颅磁刺激(rTMS)治疗脑卒中后运动功能障碍的疗效。 方法 选取2021年1月至2022年8月在我院接受康复治疗的脑卒中患者70例，按照随机数字表法将其分为对照组和观察组，每组35例。两组患者均接受常规康复和普通针刺治疗，观察组在此基础上增加rTMS治疗。治疗前、治疗6周后(治疗后)，采用Fugl-Meyer量表(FMA)、Barthel指数(BI)对两组患者进行疗效评定，记录总有效率和不良反应。 结果 两组患者治疗后FMA、BI评分均增高(P<0.05)，且观察组治疗后FMA[(79.89±25.56)分]、BI评分[(60.05±12.24)分]高于对照组(P<0.05)。治疗后，观察组总有效率(94.3%)显著高于对照组(80.0%)，观察组不良反应率(2.9%)显著低于对照组(20.0%)，差异有统计学意义(P<0.05)。 结论 针刺联合rTMS治疗，能够显著改善脑卒中患者的肢体运动功能障碍和日常生活活动能力，提高康复训练的总体有效率，安全性较好。

    针刺重复经颅磁刺激脑卒中Barthel指数Fugl-Meyer量表不良反应

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    经颅磁刺激联合背根神经节脉冲射频治疗带状疱疹神经痛的疗效观察

    王静陶熔马松鹤马卓娅...
    528-532页
    查看更多>>摘要：目的 观察重复经颅磁刺激(rTMS)联合背根神经节脉冲射频(RF)治疗急性期带状疱疹神经痛的临床疗效。 方法 采用随机数字表法将84例带状疱疹神经痛患者(病程≤7 d)分为对照组、rTMS组、RF组及观察组，每组21例。所有患者均给予加巴喷丁、伐昔洛韦、甲钴胺等药物口服，rTMS组在此基础上辅以rTMS治疗，每周治疗5 d，连续治疗2周，RF组于入组后第15天时辅以背根神经节RF治疗，观察组则给予rTMS及RF联合治疗(方法同上)。于治疗前、治疗后3 d、7 d、16 d、30 d、60 d时分别采用疼痛视觉模拟评分法(VAS)、汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)、生活质量评估量表(QOL-SF36)及匹兹堡睡眠质量指数(PSQI)量表对各组患者进行疗效评定。 结果 治疗后3 d、7 d、16 d、30 d、60 d时观察组疼痛VAS、HAMA、HAMD、QOL-SF36及PSQI评分均较治疗前明显改善(P<0.05)。与同期对照组比较，观察组疼痛VAS、HAMA、HAMD、QOL-SF36及PSQI评分在治疗后16 d、30 d、60 d时均明显改善(P<0.05)；与同期rTMS组比较，观察组疼痛VAS、HAMA及HAMD评分在治疗后16 d、30 d、60 d时均显著改善(P<0.05)；与同期RF组比较，观察组疼痛VAS、HAMA、HAMD及PSQI评分在治疗后30 d、60 d时均显著改善(P<0.05)。 结论 rTMS联合背根神经节RF治疗能有效缓解早期带状疱疹神经痛患者疼痛症状，减轻焦虑、抑郁程度，显著改善患者睡眠及生活质量，该联合疗法值得临床推广、应用。 Objective To observe the clinical efficacy of combining repeated transcranial magnetic stimulation (rTMS) with radiofrequency ablation (RF) of dorsal root ganglia in treating herpes zoster infection and neuralgia. Methods Eighty-four individuals with a herpes zoster infection who had suffered from neuralgia for no more than 7 days were divided randomly into a control group, an rTMS group, an RF group, and an observation group, each of 21. All were treated with gabapentin, valciclovir and mecobalamin. The rTMS group received rTMS treatment, 5 days per week, for 2 consecutive weeks. The RF group received RF treatment of the dorsal root ganglia on the 15th day after enrollment, while the observation group received only the medication. Before the experiment as well as after 3, 7, 16, 30 and 60 days, all of the subjects self-assessed their discomfort using a pain visual analog scale (VAS). The Hamilton Depression Scale (HAMD), Hamilton Anxiety Scale (HAMA), Quality of Life Assessment Scale (QOL-SF36), and Pittsburgh Sleep Quality Index (PSQI) were also administered. Results The average VAS, HAMA, HAMD, QOL-SF36, and PSQI scores of the observation group improved continuously and significantly during and after the treatment. Beyond 16 days all of those results were significantly better than the control group′s averages, and the observation group′s average VAS, HAMA and HAMD results were also significantly better than those of the rTMS group. The observation group′s average VAS, HAMA, HAMD and PSQI scores had improved significantly more than the RF group′s averages beyond 30 days. Conclusion Combining rTMS and dorsal root ganglion RF can effectively alleviate the early pain symptoms of herpes zoster infection and neuralgia, relieve anxiety and depression, and significantly improve sleep and life quality. Such therapy is worthy of clinical promotion and application.

    重复经颅磁刺激脉冲射频背根神经节带状疱疹神经痛

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