摘要
目的 探究高频重复经颅磁刺激(rTMS)联合量化康复训练在脑梗死后姿势控制障碍患者中的应用价值.方法 选取2020 年1 月—2023 年1 月接受治疗的脑梗死后姿势控制障碍120 例,采用随机数字表法随机将其分为3 组各40 例,观察组采用高频rTMS联合量化康复训练,对照 1 组给予高频rTMS治疗,对照 2 组采取量化康复训练.观察3 组干预后临床效果,干预前后神经及认知功能[美国国立卫生研究院卒中量表(NIHSS)、简易智能状态检查量表(MMSE)、蒙特利尔认知评估量表(MoCA)评分]、上下肢运动功能及平衡功能[上下肢Fugl-Meyer功能评分量表(FMA)、卒中患者姿势控制量表(PASS)、Brunel 平衡量表(BBS)评分]、步态运动参数、表面肌电图均方根值(RMS)、脑卒中专门生活质量评估量表(SS-QOL)评分.结果 干预后,观察组总有效率(92.50%,37/40)高于对照1组(72.50%,29/40)和对照2 组(70.00%,28/40)(P<0.05).干预后,观察组NIHSS评分<对照 1 组<对照 2 组,MMSE、MoCA评分>对照1 组>对照2 组;观察组上下肢FMA、PASS、BBS评分及步频、步速、跨步长比率均较对照 1组和对照2 组高;观察组肱二头肌屈肘和肱三头肌屈伸肘表面肌电图RMS高于对照1 组和对照2 组;观察组SS-QOL各项评分均较对照1 组和对照2 组高(P<0.05).结论 rTMS联合量化康复训练可提高脑梗死后姿势控制障碍患者临床疗效,改善肢体功能与躯体平衡能力,促进神经功能与认知恢复,且可改善肌张力与步态参数,提升生活质量.
Abstract
Objective To explore the application value of high-frequency repetitive transcranial magnetic stimulation(rTMS)combined with quantitative rehabilitation training in patients with postural control disorders after cerebral infarction.Methods A total of 120 patients with postural control disorder after cerebral infarction who received treatment in our hospital from January 2020 to January 2023 were selected and divided into three groups,with 40 cases in each group,by random num-ber table method.The observation group received high-frequency rTMS combined with quantitative rehabilitation training.Control group one received high-frequency rTMS treatment,and control group two received quantitative rehabilitation training.The clinical efficacy,neurological and cognitive functions[National Institute of Health Stroke Scale(NIHSS),Mini-mental State Examination(MMSE),Montreal Cognitive Assessment(MoCA)],upper and lower limb motor function and balance function[Fugl-Meyer Assessment Scale(FMA),Postural Assessment Scale for Stroke Patients(PASS),Brunel Balance Scale(BBS)],gait motion parameters,root mean square(RMS)value by surface electromyography,Stroke-Specific Quality of Life Scale(SS-QOL)score before and after intervention were observed in the three groups.Results After intervention,the total effective rate of observation group(92.50%,37/40)was higher than that of control group one(72.50%,29/40)and control group two(70.00%,28/40)(P<0.05).After the intervention,the NIHSS score of the observation group was the lowest,followed by control group one and control group two,while the MMSE and MoCA scores were the highest,followed by control group one and control group two(P<0.05).After intervention,the FMA scores,PASS and BBS score of upper and lower limbs,and the ratio of stride frequency,stride speed,and stride length in observation group were higher than those in control group one and control group two(P<0.05).After intervention,the RMS of elbow flexion,elbow flexion and elbow extension in observation group were higher than those in control group one and control group two(P<0.05).After interven-tion,the scores of SS-QOL scale in observation group were higher than those in control group one and control group two(P<0.05).Conclusion rTMS combined with quantitative rehabilitation training can improve the clinical efficacy of patients with postural control disorder after cerebral infarction,improve limb function and body balance ability,promote the recovery of neu-ral function and cognitive function,improve muscle tone and gait parameters,and improve the quality of life.
维普
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