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镜像神经元康复策略联合经颅磁刺激对卒中后神经与功能康复的作用研究

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目的:研究镜像神经元康复策略(Mirror Neuron System,MNS)联合经颅磁刺激(Transcra-nial Magnetic Stimulation,TMS)对卒中后神经与功能康复的作用。方法:选取 2019 年 1 月至 2023 年 6月某部队康复中心收治的198 例卒中后遗留有运动功能障碍患者,采用随机数字表法分为三组,各 66例。三组均给予常规康复指导,磁刺激组给予TMS治疗,镜像组给予MNS 治疗,联合组给予TMS+MNS治疗。比较三组干预前、干预2 周后、干预4 周后神经功能(NIHSS)、上下肢运动功能(FMA)、日常生活能力(ADL)、平衡能力(BBS)、上肢与下肢肌张力(MAS)、健患侧步长差、患侧负重时间百分比及语言功能。结果:联合组干预2 周、4 周后 NIHSS 评分低于磁刺激组、镜像组,差异具有统计学意义(P<0。05),磁刺激组、镜像组组间比较,差异无统计学意义(P>0。05);联合组干预 2 周、4 周后 FMA-上肢、FMA-下肢评分高于磁刺激组、镜像组,且镜像组高于磁刺激组,差异具有统计学意义(P<0。05);联合组干预2 周、4 周后ADL评分、BBS评分高于磁刺激组、镜像组,且镜像组高于磁刺激组,差异具有统计学意义(P<0。05);联合组干预4 周后上肢和下肢MAS分级0~1 级患者占比高于磁刺激组、镜像组,且磁刺激组高于镜像组,差异具有统计学意义(P<0。05);联合组干预 2 周、4 周后健患侧步长差低于磁刺激组、镜像组,患侧负重时间百分比高于磁刺激组、镜像组,且镜像组变化幅度大于磁刺激组,差异具有统计学意义(P<0。05);联合组干预2 周、4 周后语言功能中阅读理解、复述、流畅度、命名评分高于磁刺激组、镜像组,且磁刺激组高于镜像组,差异具有统计学意义(P<0。05)。结论:MNS联合TMS 能促进卒中后神经与功能康复,有利于改善患者日常生活能力,且二者各有优势,互相补充,联合治疗效果显著,值得临床推广。
Study on the Effects of Mirror Neuron Rehabilitation Strategy Combined with Transcranial Magnetic Stimulation on Neurological and Functional Recovery Post-Stroke
Objective:To study the effects of the Mirror Neuron System(MNS)rehabilitation strategy combined with Transcranial Magnetic Stimulation(TMS)on neurological and functional recovery post-stroke.Methods:A total of 198 patients with motor dysfunction following a stroke,treated at a military rehabilitation center from January 2019 to June 2023,were selected and randomly divided into three groups of 66 patients each.All three groups received conventional rehabilitation guidance;the TMS group received TMS treatment,the MNS group received MNS treatment,and the combined group received TMS+MNS treatment.Neurological function(NIHSS),upper and lower limb motor function(FMA),activities of daily living(ADL),balance ability(BBS),upper and lower limb muscle tone(MAS),step length difference between healthy and affect-ed sides,percentage of weight-bearing time on the affected side,and language function were compared among the three groups before the intervention,after 2 weeks of intervention,and after 4 weeks of intervention.Re-sults:After 2 and 4 weeks of intervention,the NIHSS scores of the combined group were lower than those of the TMS group and the MNS group,with statistically significant differences(P<0.05);there was no statisti-cally significant difference between the TMS group and the MNS group(P>0.05).After 2 and 4 weeks of in-tervention,the FMA-upper limb and FMA-lower limb scores of the combined group were higher than those of the TMS group and the MNS group,and the MNS group scored higher than the TMS group,with statistically significant differences(P<0.05).After 2 and 4 weeks of intervention,the ADL scores and BBS scores of the combined group were higher than those of the TMS group and the MNS group,and the MNS group scored high-er than the TMS group,with statistically significant differences(P<0.05).After 4 weeks of intervention,the proportion of patients with upper and lower limb MAS grades 0-1 in the combined group was higher than in the TMS group and the MNS group,and higher in the TMS group than in the MNS group,with statistically signifi-cant differences(P<0.05).After 2 and 4 weeks of intervention,the step length difference between the healthy and affected sides in the combined group was lower than that in the TMS group and the MNS group,and the percentage of weight-bearing time on the affected side was higher than that in the TMS group and the MNS group,with greater changes observed in the MNS group compared to the TMS group,with statistically significant differences(P<0.05).After 2 and 4 weeks of intervention,scores for reading comprehension,repetition,fluency,and naming in language function were higher in the combined group than in the TMS group and the MNS group,and higher in the TMS group than in the MNS group,with statistically significant differences(P<0.05).Conclusion:MNS combined with TMS can promote neurological and functional recov-ery post-stroke,and improve patients'activities of daily living,and each method has its advantages and com-plements the other.The combined treatment is significantly effective and worthy of clinical promotion.

Mirror neuron rehabilitation strategyTranscranial magnetic stimulationStrokeNeurological rehabilitationBalance abilityUpper and lower limb motor function

范白燕、朱建文、左惠荣、王蕾、黄赛云、林莉

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中国人民解放军陆军厦门特勤疗养中心疗养一科,福建 厦门 361005

镜像神经元康复策略 经颅磁刺激 卒中 神经康复 平衡能力 上下肢运动功能

2020年福建省卫生健康科技计划项目资助计划项目

2020GGA506

2024

河北医学
河北省医学会

河北医学

CSTPCD
影响因子:1.915
ISSN:1006-6233
年,卷(期):2024.30(6)
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