摘要
目的 研究重复经颅刺激(rTMS)联合双侧训练对脑卒中患者平衡功能、氨基酸类神经递质(AAN)、认知能力的影响.方法 前瞻性选择2020年9月至2023年10月于甘肃省康复中心医院治疗的110例脑卒中患者,按照随机数字表法将患者分为试验组、对照组,每组各55例.对照组康复方法为常规康复联合rTMS,试验组康复方法为常规康复、rTMS联合双侧训练.观察并比较两组治疗前、治疗4周后下肢运动功能、平衡能力、血清AAN(γ-氨基丁酸、天冬氨酸、谷氨酸及甘氨酸)水平、认知能力.结果 治疗4周后,两组Fugl-Meyer下肢运动功能评估量表(FMA-LE)评分、Berg平衡功能量表(BBS)评分、蒙特利尔认知评估量表(MoCA)评分均较治疗前升高,且试验组FMA-LE评分、BBS评分、MoCA 评分分别为(25.09±2.74)分、(43.97±4.62)分、(28.36±2.92)分,均高于对照组[(19.84±2.18)分、(35.72±3.84)分、(25.14±2.61)分],差异均有统计学意义(P＜0.05).治疗4周后,两组γ-氨基丁酸、甘氨酸水平均较治疗前升高,天冬氨酸、谷氨酸水平均较治疗前降低,且试验组的γ-氨基丁酸、甘氨酸水平分别为(5.87±0.61)、(3.09±0.32)mmol/L,均显著高于对照组[(4.79±0.49)、(2.46±0.27)mmol/L],天冬氨酸、谷氨酸水平分别为(1.29±0.14)、(11.96±1.34)mmol/L,均显著低于对照组[(1.93±0.21)、(15.89±1.72)mmol/L],差异均有统计学意义(P＜0.05).结论 rTMS联合双侧训练可提高脑卒中患者平衡功能及认知能力,改善AAN水平,缓解患者抑郁情绪,有助于患者康复.
Abstract
Objective To study the effects of repeated transcranial stimulation(rTMS)combined with bilateral training on balance func-tion,amino acid neurotransmitt(AAN)and cognitive ability in stroke patients.Methods A total of 110 stroke patients treated in Gansu Rehabili-tation Center Hospital from September 2020 to October 2023 were prospectively selected,and all patients were divided into the experimental group and the control group according to the random number table method,with 55 patients in each group.The rehabilitation method of the control group was routine rehabilitation combined with rTMS,and the rehabilitation method of the experimental group was routine rehabilitation combined with rTMS combined with bilateral training.The lower extremity motor function,balance ability,serum AAN(gamma-aminobutyric acid,aspartate,glutamic acid,glycine and other amino acid neurotransmitt),cognitive ability were observed before and after 4 weeks of treatment.Results After 4 weeks of treatment,the Fugl Meyer lower limb motor function assessment scale(FMA-LE)score,Berg balance scale(BBS)score,and Mont-real cognitive assessment scale(MoCA)score in two groups were higher than those before treatment,the FMA-LE score,BBS score,and MoCA score in the experimental group were(25.09±2.74)points,(43.97±4.62)points,and(28.36±2.92)points,respectively,which were higher than those in the control group[19.84±2.18)points,(35.72±3.84)points,and(25.14±2.61)points],and the differences were statistically significant(P＜0.05).After 4 weeks of treatment,the levels of gamma aminobutyric acid and glycine in two groups were higher than those before treatment,while the levels of aspartic acid and glutamic acid were lower than those before treatment,the levels of gamma aminobutyric acid and glycine in the experimental group were(5.87±0.61)and(3.09±0.32)mmol/L,respectively,which were significantly higher than those in the control group[(4.79±0.49)and(2.46±0.27)mmol/L],the levels of aspartic acid and glutamic acid were(1.29±0.14)and(11.96±1.34)mmol/L,respectively,which were significantly lower than those in the control group[(1.93±0.21)and(15.89±1.72)mmol/L].The differences were statistically significant(P＜0.05).Conclusion rTMS combined with bilateral training can improve the balance function and cognitive ability of stroke patients,improve the level of amino acid neurotransmitt,to relieve depression in patients,and contribute to the rehabilitation of patients.
基金项目
甘肃省中医药科学技术研究项目(GZK-2019-66)
NETL
NSTL
万方数据