屈新辉 龚凌云 刘诗英 胡凡 张昆南 吴晓牧

[摘要] 目的：探讨低频重复经颅磁刺激（rTMS）对急性脑梗死患者运动功能恢复的疗效。方法：128例急性脑梗死患者随机分入rTMS组和对照组，每组各64例。两组均进行常规药物治疗及康复训练，rTMS组加经颅磁刺激。比较两组治疗前后的运动诱发电位（MEP）、中枢运动传导时间（CMCT）和美国国立卫生研究中风量表（NIHSS）、Fugl-Meyer评分（FMA）、Barthel指数（BI）。结果：治疗后两组MEP、CMCT、NIHSS、FMA、BI较治疗前改善（均P<0.05），rTMS组治疗后优于对照组（均P<0.05）。结论：rTMS可以提高运动神经系统的兴奋性，缩短患者中枢运动传导时间；有助于改善急性脑梗死患者的神经功能缺损，提高患者运动功能和日常生活能力。

[关键词] 康复；经颅磁刺激；急性脑梗死；运动功能

[中图分类号] R743[文献标识码]Ａ [文章编号]1673-7210（2011）11（c）-057-03

Effect of low frequency repetitive transcranial magnetic stimulation on the recovery of motor function in the patients with acute cerebral infarction

QU Xinhui, GONG Lingyun, LIU Shiying, HU Fan, ZHANG Kunnan, WU Xiaomu*

Department of Neurology, Jiangxi Provincial People′s Hospital, Jiangxi Province, Nanchang 330006, China

[Abstract] Objective: To study the effect of low frequency repetitive transcranial magnetic stimulation (rTMS) on the recovery of motor function in the patients with acute cerebral infarction. Methods: 128 patients with acute stroke were divided into two groups randomly: rTMS group (n=64) and control group (n=64). Two groups were received routine pharmacotherapy and recovery education. Additional, rTMS group was received low frequency repetitive transcranial magnetic stimulation. Motion evoked potential (MEP), center motion conduction time (CMCT), NIHSS score, Fugl-Meyer score (FMA) and Barthel index (BI) of the two groups were compared. Results: After treatment, the MEP, CMCT, NIHSS score, Fugl-Meyer score and Barthel index of both groups were improved (all P<0.05). Compared with control group, the MEP of rTMS group was better, the CMCT, NIHSS score of rTMS group were lower, the Fugl-Meyer score and Barthel index of rTMS group were higher (all P<0.05). Conclusion: Low-rTMS can elevate excitability of motor nervous system, cut down CMCT of the patients. Moreover, Low-rTMS treatment improve neurologic deficits and enhance motor function and activities of daily living of the patients with acute cerebral infarction.

[Key words] Recovery; Transcranial magnetic stimulation; Acute cerebral infarction; Motor function

在我国，脑梗死是常见病、多发病，而存活患者多遗留有运动功能障碍，因此寻找有效的促进运动功能恢复的康复措施越来越受到人们的关注。重复经颅磁刺激（repetitive transcranialmagnetic stimulation，rTMS）是在TMS基础上发展起来的新型神经电生理技术，是诱导中枢神经系统可塑性变化的重要手段，其对刺激局部或远隔区域神经功能有干预或调控作用[1]。本研究旨在探讨低频重复经颅磁刺激（rTMS）对急性脑梗死患者运动功能恢复的影响。

1 资料与方法

1.1 一般资料

将2009年7月~2011年6月在江西省人民医院神经内科住院的128例急性脑梗死患者随机分为rTMS组和对照组。rTMS组64例，其中，男35例，女29例；年龄55~73岁，平均（63.0±5.8）岁；对照组64例，其中，男33例，女31例，年龄58~74岁，平均（62.5±4.7）岁。两组患者在性别、年龄、病程、神经功能评分[美国国立卫生研究中风量表（NIHSS）、Fugl-Meyer评分（FMA）、Barthel指数（BI）]等方面比较，差异均无统计学意义（P>0.05），具有可比性。

1.2入选及排除标准

入选标准：①经颅CT或MRI证实脑梗死；②首次发病；③发生在颈内动脉系统的脑梗死；……