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目的：观察针刺联合经颅磁刺激(rTMS)与深层肌肉刺激(DMS)对脑卒中后上肢痉挛患者日常生活能力、运动功能、痉挛状态及皮质血氧水平的影响。方法：选取脑卒中后上肢痉挛患者80例，按照随机数字表法分为针刺组、rTMS组、DMS组、联合组各20例，四组患者根据自身情况均接受常规药物治疗和康复训练，针刺组给予针刺治疗，rTMS组在针刺组的基础上给予rTMS治疗，DMS组在针刺组的基础上给予DMS治疗，联合组在针刺组的基础上联合rTMS与DMS治疗，四组均治疗4周。观察治疗前后四组患者的改良Barthel指数(MBI)评分、简化Fugl-Meyer上肢运动功能评定量表(FMA-UE)评分、改良Ashworth评分量表(MAS)评分、大脑氧合血红蛋白(O_2Hb)水平。结果：治疗后四组患者的MBI、FMA-UE、MAS评分及O_2Hb水平变化的S积分与均值均较治疗前明显改善(P<0.01)，且联合组MBI、FMA-UE、MAS评分改善明显优于其他三组(P<0.01);rTMS组、DMS组、联合组大脑O_2Hb水平变化S积分均优于针刺组(P<0.05)，且联合组优于rTMS组(P<0.01);rTMS组、DMS组、联合组大脑O_2Hb水平变化均值均优于针刺组(P<0.01)，且联合组优于rTMS组、DMS组(P<0.05)。结论：针刺联合rTMS与DMS治疗脑卒中后上肢痉挛可显著改善患者日常生活能力、运动功能和痉挛状态，提高大脑皮质血氧水平可能为机制之一。
Abstract：Objective:To observe the effect of acupuncture combined with repetitive transcranial magnetic stimulation(rTMS) and deep muscle stimulation(DMS) in patients with upper limb spasm after stroke on daily living ability,motor function,spastic state and its effect on cortical blood oxygen level. Methods:A total of 80 patients with upper limb spasm after stroke were selected and divided into the acupuncture group,rTMS group,DMS group and acupuncture combined with rTMS and DMS group according to the random number table method,with 20 cases in each group. Patients in the four groups received conventional drug treatment and rehabilitation training according to their own conditions. The acupuncture group was given acupuncture treatment,and the rTMS group was given rTMS treatment on the basis of the treatment of the acupuncture group. The DMS group was treated with DMS on the basis of the treatment of the acupuncture group,and the combined group was treated with rTMS and DMS on the basis of the treatment of the acupuncture group. All four groups were treated for 4 weeks. The modified barthel index(MBI) score,simplified Fugl-Meyer upper limb motor function rating scale(FMA-UE) score,modified ashworth rating scale(MAS) score and brain oxygenated hemoglobin(O_2Hb) level were observed before and after treatment.Results:After treatment,the MBI,FMA-UE,MAS scores and S score and mean of changes in O_2Hb levels of the four groups were significantly improved compared with those before treatment(P<0.01),and the MBI,FMA-UE,MAS scores of the combined group were significantly improved than those of the other three groups(P<0.01). The S score changes of brain O_2Hb level in rTMS group,DMS group and combined group were better than those in acupuncture group(P<0.05),and the score of the combined group was better than that in rTMS group(P<0.01). The mean changes of O_2Hb level in rTMS group,DMS group and combined group were better than those in the acupuncture group(P<0.01),and the scores of the combined group was better than those in rTMS group and DMS group(P<0.05). Conclusions:Acupuncture combined with rTMS and DMS for upper limb spasm after stroke can significantly improve patients' daily living ability,motor function and spastic state,and improving the cortical blood oxygen level may be one of its mechanisms.
[1]WISSEL J,VERRIER M,SIMPSON D M,et al. Poststroke spasticity:predictors of early development and considerations for therapeutic intervention[J]. PM R,2015,7(1):60-67.
[2]BURRIDGE J H,WOOD D E,HERMENS H J,et al.Theoretical and methodological considerations in the measurement of spasticity[J]. Disabil Rehabil,2005,27(1/2):69-80.
[3]ZOROWITZ R D,GILLARD P J,BRAININ M. Poststroke spasticity:sequelae and burden on stroke survivors and caregivers[J]. Neurology,2013,80(Suppl 2):S45-S52.
[4]LUNDSTR?M E,SMITS A,BORG J,et al. Four-fold increase in direct costs of stroke survivors with spasticity compared with stroke survivors without spasticity:the first year after the event[J]. Stroke,2010,41(2):319-324.
[5]庞青民，赵欲晓，邵素菊，等.醒脑开窍针刺法通过调控mTOR-EAAT2通路影响脑卒中后痉挛大鼠大脑皮层神经递质代谢[J].中国病理生理杂志，2021,37(11):2001-2007.
[6]LEFAUCHEUR J P,ALEMAN A,BAEKEN C,et al.Evidence-based guidelines on the therapeutic use of repetitive transcranial magnetic stimulation(rTMS):an update(2014-2018)[J]. Clin Neurophysiol,2020,131(2):474-528.
[7]鲍赛荣，林利华，单莎瑞，等.电动深层肌肉刺激对脑卒中患者肱二头肌张力、弹性及硬度的影响[J].中国组织工程研究，2021,25(20):3138-3143.
[8]彭斌，吴波.中国急性缺血性脑卒中诊治指南2018[J].中华神经科杂志，2018,51(9):666-682.
[9]中华医学会神经病学分会，中华医学会神经病学分会脑血管病学组.中国脑出血诊治指南（2019）[J].中华神经科杂志，2019,52(12):994-1005.
[10]张泓.康复评定学[M].北京：中国中医药出版社，2019.
[11]国家中医药管理局脑病急症协作组.中风病诊断与疗效评定标准（试行）[J].北京中医药大学学报，1996,19(1):55-56.
[12]唐强.临床康复学[M].北京：中国中医药出版社，2017:34.
[13]武光丽，杨军，孙向峰.温针灸结合常规康复对痉挛型双瘫儿童下肢功能的影响[J].山东中医杂志，2021,40(6):610-613.
[14]任聪颖.针刺联合康复训练治疗脑卒中后肢体痉挛的临床疗效及对CSI、MAS评分的影响[J].中医研究，2022,35(2):12-15.
[15]张洁，孙慧君，鲁剑萍.中医护理适宜技术在脑卒中痉挛性偏瘫患者下肢功能康复中的应用[J].上海护理，2019,19(11):42-45.
[16]李伟艺，张菊，武尧，等.针刺分期论治联合自拟通痹舒挛汤治疗卒中后痉挛性偏瘫疗效及对FGF23/Klotho系统、神经递质的影响[J].现代中西医结合杂志，2021,30(31):3496-3500.
[17]耿翊宁.温针灸辅以中药汤剂对老年脑卒中后肢体痉挛患者神经递质及细胞凋亡相关指标的影响[J].中国老年学杂志，2020,40(16):3383-3387.
[18]许静，张捷，韦玲，等.“解痉纠偏”针法结合康复训练治疗偏瘫痉挛临床观察[J].中西医结合心脑血管病杂志，2018,16(19):2782-2785.
[19]LEFAUCHEUR J P. Transcranial magnetic stimulation[J]. Handb Clin Neurol,2019,160:559-580.
[20]LUK K Y,OUYANG H X,PANG M Y C. Lowfrequency rTMS over contralesional M1 increases ipsilesional cortical excitability and motor function with decreased interhemispheric asymmetry in subacute stroke:a randomized controlled study[J]. Neural Plast,2022,2022:3815357.
[21]LEóN RUIZ M,RODRíGUEZ SARASA M L,SANJUáN RODRíGUEZ L,et al. Current evidence on transcranial magnetic stimulation and its potential usefulness in post-stroke neurorehabilitation:opening new doors to the treatment of cerebrovascular disease[J]. Neurologia,2018,33(7):459-472.
[22]TAHIR S,BAIG M O,RATHORE F A,et al. The emerging role of focal muscle vibration in rehabilitation of neurological disorders[J]. J Pak Med Assoc,2022,72(10):2126-2128.
[23]MASUD A A,SHEN C L,LUK H Y,et al. Impact of local vibration training on neuromuscular activity,muscle cell,and muscle strength:a review[J]. Crit Rev Biomed Eng,2022,50(1):1-17.
[24]KOLBA?I E N,HUSEYINSINOGLU B E,BAYRAKTARO?LU Z. Effect of upper limb focal muscle vibration on cortical activity:a systematic review with a focus on primary motor cortex[J]. Eur J Neurosci,2022,56(3):4141-4153.
[25]ALASHRAM A R,PADUA E,ROMAGNOLI C,et al.Effectiveness of focal muscle vibration on hemiplegic upper extremity spasticity in individuals with stroke:a systematic review[J]. NeuroRehabilitation,2019,45(4):471-481.
基本信息:
DOI：10.16295/j.cnki.0257-358x.2024.03.003
中图分类号:R246.6
引用信息:
[1]雷俊芳,范晓华,臧姝琦,等.针刺联合重复经颅磁刺激与深层肌肉刺激治疗脑卒中后上肢痉挛疗效及对皮质血氧的影响[J].山东中医杂志,2024,43(03):231-238+247.DOI:10.16295/j.cnki.0257-358x.2024.03.003.
基金信息:
山东省老年医学学会基金项目（编号：LKJGG2021Z018）; 山东中医药大学科研创新团队项目（编号：220316）
2024-03-05
2024-03-05