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目的对比低频重复性经颅磁刺激(rTMS)联合感知提醒(SC)治疗与单独使用rTMS治疗对脑卒中亚急性期单侧忽略患者忽略严重程度、上肢功能以及日常生活活动能力的影响。方法采用随机对照研究、评定者盲法设计,将33例右侧脑卒中后单侧忽略患者随机分为rTMS+SC组(n=16)和rTMS组(n=17)。在常规康复治疗基础上,rTMS+SC组患者同时接受rTMS以及SC治疗,rTMS组患者仅接受rTMS治疗。rTMS治疗采用经颅磁刺激仪,刺激左侧后顶叶皮层,刺激频率1 Hz,刺激强度为90%静息运动阈值,治疗时间为1次/d,5d/周,连续治疗2周;SC治疗采用佩戴提醒腕表,每天累计提醒时间为3h,5d/周,连续佩戴2周。治疗前及治疗2周后分别评定单侧忽略严重程度〔单侧行为忽略常规子量表(BIT-C)和凯瑟琳博格量表(CBS)〕,上肢运动功能〔上肢运动评分量表(FMA)、上肢活动量表(ARAT)〕以及日常生活自理能力〔改良巴氏指数(MBI)〕。结果治疗2周后,两组患者各项指标均较治疗前有改善。与单纯rTMS治疗比较,rTMS+SC组在BIT-C方面改善更好(P<0.05)。其余CBS、上肢功能(FMA、ARAT)指标治疗后两组差异无统计学意义。结论 rTMS联合SC能更有效的改善脑卒中患者单侧忽略症状,可望作为单侧忽略的多技术联合治疗策略之一在临床推广应用。
Objective To compare the effects of low frequency repetitive transcranial magnetic stimulation (rTMS) combined with perceptive reminder (SC) and rTMS alone on neglected severity, upper extremity function and activities of daily living in subacute stroke patients. Methods A randomized, controlled trial was conducted. Blinded patients were randomly divided into three groups: rTMS + SC group (n = 16) and rTMS group (n = 17). On the basis of routine rehabilitation, patients in rTMS + SC group received both rTMS and SC, while those in rTMS group received only rTMS. The rTMS treatment used the transcranial magnetic stimulator to stimulate the left posterior parietal cortex, the stimulation frequency was 1 Hz, the stimulation intensity was 90% resting movement threshold, the treatment time was 1 time / d and 5 days / week for 2 weeks. SC Treatment using wearing reminder watch, the daily reminder time 3h, 5d / week, continuous wear 2 weeks. The unilateral severity of neglect (BIT-C and CBS), upper extremity motor function (FMA ), Upper Extremity Activity Scale (ARAT)] and daily living self-care ability [Modified Pakistan Index (MBI)]. Results After 2 weeks of treatment, the indexes of both groups improved compared with those before treatment. Compared with rTMS alone, rTMS + SC group improved better in BIT-C (P <0.05). The remaining CBS, upper limb function (FMA, ARAT) indicators after treatment no significant difference between the two groups. Conclusion The combination of rTMS and SC can more effectively improve the symptoms of unilateral neglect in patients with stroke, and it is expected to be used clinically as one of the multi-technical combined treatment strategies which are unilateral neglect.