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目的探讨经颅磁刺激(TMS)对脑梗死患者上肢功能康复效果的评估价值。方法选择2012年1月至2015年6月间我院收治的92例脑梗死患者,根据患者病灶侧脑区TMS检查结果的不同分为两组,其中对照组45例患者的运动诱发电位波幅小于50uV,观察组47例患者的运动诱发电位波幅高于或等于50uV。2组患者均给予相同的药物及康复训练。分别比较两组患者治疗前、治疗4周后和治疗8周后的患侧脑区运动诱发电位皮质潜伏期(CL)、中枢运动传导时间(CMCT),同时采用Barthel指数量表(BI)评分评定日常生活能力以及FuglMeyer运动功能量表(FMA)评定上肢运动功能恢复情况,并进行相关性分析。结果两组患者治疗后上肢FMA以及BI评分较治疗前明显提高(P<0.05);治疗8周时观察组患者上肢FMA评分以及BI评分均显著优于对照组水平(P<0.05)。治疗后两组患者CL及CMCT均逐渐缩短(P<0.05);治疗8周时观察组患者CL及CMCT水平均显著优于对照组(P<0.05)。直线相关分析显示患者患肢CL和CMCT与FMA以及BI评分呈正相关(P<0.05)。结论经颅磁刺激检测具有安全方便的特点,可有效预测脑梗死患者肢运动功能恢复情况,对科学制订康复干预方案具有重要作用。
Objective To investigate the value of transcranial magnetic stimulation (TMS) in evaluating the functional rehabilitation of upper limbs in patients with cerebral infarction. Methods Ninety-two patients with cerebral infarction admitted to our hospital from January 2012 to June 2015 were divided into two groups according to the results of TMS examination. The amplitude of motor-evoked potential in 45 patients in the control group was less than 50uV, 47 patients in the observation group exercise evoked potential amplitude greater than or equal to 50uV. Both groups were given the same medication and rehabilitation training. The cerebral cortex latency (CL) and central motor conduction time (CMCT) were compared between the two groups before treatment, after 4 weeks of treatment and after 8 weeks of treatment. The Barthel Index Scale (BI) Daily living ability and FuglMeyer Motor Function Scale (FMA) to assess the recovery of upper limb motor function, and carry out correlation analysis. Results The score of FMA and BI in the upper extremities was significantly increased in both groups after treatment (P <0.05). The FMA score and BI score of the upper extremity in the observation group were significantly higher than those in the control group (P <0.05) after 8 weeks of treatment. After treatment, the CL and CMCT of both groups were gradually shortened (P <0.05). The levels of CL and CMCT in the observation group were significantly better than those in the control group at 8 weeks (P <0.05). Linear correlation analysis showed that there was a positive correlation between CL and CMCT in limbs and FMA and BI scores (P <0.05). Conclusion Transcranial magnetic stimulation has the characteristics of safety and convenience, which can effectively predict the recovery of limb motor function in patients with cerebral infarction. It plays an important role in the scientific formulation of rehabilitation intervention programs.