脑卒中痉挛性患者经颅磁刺激联合物理治疗后上肢功能恢复状况的临床观察

摘要 目的：探讨脑卒中痉挛性患者经颅磁刺激联合物理治疗后上肢功能改善状况的临床观察。方法：选取我院2018年1月到2020年1月共收治的80例脑卒中患者，所有患者均出现不同部位痉挛现象，将患者随机分为观察组与对照组，每组40例。给予对照组患者常规治疗与康复训练，观察组患者在常规治疗基础上应用低频重复经颅刺激联合肌电生物反馈模式下的康复训练。对比两组患者的治疗效果与上肢功能改善情况。结果：观察组治疗总有效率95.00 %，高于对照组72.50 %（P＜0.05）；治疗前两组患者的NIHSS评分应用神经功能缺损量表（Neurological deficit scale，NIHSS）、MMSE评分应用认知功能量表（Cognitive function scale，MMSE）、ADL评分应用日常生活能力量表（Activities of daily living scale，ADL）评分对比无显著差异（P＞0.05），治疗后，观察组的NIHSS评分低于对照组，ADL评分高于对照组（P＜0.05）；治疗前两组患者的肱二头肌和肱三头肌均方根值（Root mean square，RMS）对比无显著差异（P＞0.05），治疗后，观察组患者的肱二头肌RMS低于对照组，肱三头肌RMS高于对照组（P＜0.05）；治疗前两组患者的运动功能评估表中的上肢功能部分（Upper limb function in motor function assessment table，FMA-UE）、手部精细化动作及上肢功能测量表（Measurement table of hand fine movement and upper limb function，Carroll）评分对比无显著差异（P＞0.05），治疗后，观察组患者的FMA-UE、Carroll评分高于对照组（P＜0.05）。结论：对脑卒中上肢痉挛患者在常规治疗与康复训练的基础上应用低频重复经颅刺激联合肌电生物反馈模式下的康复训练，虽然对患者的认知功能无明显影响，但是能提升患者上肢痉挛的治疗效果，促进患者上肢功能恢复，提高生活能力，值得临床应用推广。

Clinical Observation on the Improvement of Upper Limb Function after Transcranial Magnetic Stimulation Combined with Physical Therapy in Patients with Spastic Stroke

ABSTRACT Objective: To investigate the effect of transcranial magnetic stimulation (TMS) combined with physical therapy on upper limb function in patients with spastic stroke. Methods: 80 cases of stroke patients in our hospital from January 2018 to January 2020 were selected as the research object, all patients had different parts of spasm phenomenon, the patients were randomly divided into observation group and control group, 40 cases in each group. Patients in the control group were given conventional treatment and rehabilitation training, while patients in the observation group were given rehabilitation training under the mode of low frequency repetitive transcranial stimulation combined with electromyographic biofeedback on the basis of conventional treatment. The treatment effect and the improvement of upper limb function of the two groups were compared. Results: The total effective rate of the observation group was 95.00 %, which was higher than 72.50 % of the control group (P<0.05); before treatment, there was no significant difference in NIHSS, MMSE and ADL scores between the two groups(P>0.05); after treatment, the NIHSS score of the observation group was lower than that of the control group, and the ADL score was higher than that of the control group (P<0.05). Before treatment, there was no significant difference in the RMS of the biceps and triceps of the two groups of patients (P>0.05). After treatment, the RMS of the biceps of the observation group was lower than that of the control group, and the RMS of the triceps was higher than that of the control group (P<0.05); there was no significant difference in FMA-UE and Carroll scores of the two groups before treatment (P>0.05). After treatment, the FMA-UE and Carroll scores of the observation group were higher than those of the control group(P<0.05). Conclusion: Low frequency repetitive transcranial stimulation combined with electromyographic biofeedback rehabilitation training on the basis of conventional treatment and rehabilitation training can improve the treatment effect of upper limb spasm, promote the recovery of upper limb function and improve the ability of life, although it has no obvious effect on the cognitive function of patients, it is worthy of clinical application and promotion.