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陈建敏,王志勇,吴 頔,倪国新.重复经颅磁刺激对卒中后中枢性疼痛患者感觉阈值疗效的研究[J].中国康复医学杂志,2020,(7):820~824
重复经颅磁刺激对卒中后中枢性疼痛患者感觉阈值疗效的研究    点此下载全文
陈建敏  王志勇  吴 頔  倪国新
福建医科大学附属第一医院康复科,福建省福州市,350005
基金项目:福建医科大学启航基金项目(2017XQ1062)
DOI:10.3969/j.issn.1001-1242.2020.07.010
摘要点击次数: 149
全文下载次数: 96
摘要:
      摘要 目的:评估卒中后中枢性疼痛(CPSP)各类感觉纤维的阈值,并观察重复经颅磁刺激(rTMS)的疗效。 方法:采用随机数字法将2017年11月—2018年11月期间共40例卒中后中枢性疼痛患者分成经颅磁刺激组及常规治疗组,每组20例。2组患者均给予常规的药物和康复治疗。经颅磁刺激组在此基础上对患侧M1区给予rTMS。于治疗前,治疗2周后分别采用视觉模拟量表(VAS)、感觉阈值检测(CPT)及上肢Fugl-Meyer量表对疼痛程度、纤维阈值及上肢运动功能进行评估。 结果:治疗前,2组患者VAS、CPT、FMA-UE比较,差异无显著性意义(P>0.05).治疗后,2组患者VAS较治疗前下降(P<0.05);经颅磁刺激组CPT在5Hz、250Hz、2000Hz的阈值及FMA-UE较治疗前均有改善(P<0.05)。治疗后,经颅磁刺激组VAS评分为(4.2±1.8)、CPT 3个频率阈值分别为(282.3±139.6、154.5±130.2、145.4±176.2)、FMA-UE评分为(40.1±18.6),均较常规治疗组更优,差异有显著性意义(P<0.05)。治疗后CPT与VAS之间存在显著正相关(P<0.05)。 结论:CPT可用于CPSP患者各类感觉纤维阈值的定量评估。rTMS可改善CPSP的疼痛程度及感觉阈值,同时提高患侧上肢的运动功能。
关键词:重复经颅磁刺激  卒中后中枢性疼痛  感觉阈值检测
The effect of repeated transcranial magnetic stimulation on the perception threshold in patients with central post-stroke pain    Download Fulltext
Department of Rehabilitation Medicine,The First Affiliated Hospital of Fujian Medical University, Fujian, Fuzhou, 350005
Fund Project:
Abstract:
      Abstract Objective:To assess the perception threshold of nerve fibers and to observe the effect of repeated transcranial magnetic stimulation (rTMS) in patients with central post-stroke pain(CPSP). Method:Forty stroke survivors with central post-stroke pain were randomly assigned to an rTMS treatment group or a control group,each of 20 cases. Both groups were given routine medication and rehabilitation treatment,while the treatment group was additionally provided with 2 weeks of rTMS treatment over the primary motor cortex(M1).Before and after the 2 -weeks intervention, the pain level , the perception thresholds of nerve fibers and function of the upper limb were evaluated using the visual analog scale (VAS ), current perception threshold (CPT) examination and the upper section of Fugl-Meyer assessment (FMA-UE). Result:Before the intervention, no differences were found between the two groups in terms of any of the assessments. After the intervention, the average VAS of both groups decreased significantly. After the intervention, the average CPT values of rTMS treatment group was significantly lower and FMA-UE was significantly better. After the intervention, significant differences were observed in the average VAS, CPT values and FMA-UE between the rTMS treatment group and control group. The CPT values was positively correlated with the VAS after treatment. Conclusion:CPT can evaluate the perception thresholds of nerve fibers in patients with CPSP quantitatively. rTMS can relieve the pain and improve the sensory function of CPSP while improve the motor function of the affected upper limbs of stroke patients.
Keywords:repeated transcranial magnetic stimulation  central post-stroke pain  current perception threshold
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