低频重复经颅磁刺激联合分期针灸疗法对脑卒中后偏瘫患者表面肌电信号及康复效果的影响

目的：观察低频重复经颅磁刺激（LF-rTMS）联合分期针灸疗法对脑卒中后偏瘫患者表面肌电信号及康复效果的影响。方法：将106例脑卒中后偏瘫患者随机分为LF-rTMS组37例、针灸组35例、联合组34例。LF-rTMS组采用LF-rTMS治疗，针灸组采用分期针灸治疗，联合组采用LF-rTMS联合分期针灸治疗。治疗6周后，比较3组表面肌电信号[均方根值（RMS）、协同收缩率（CR）]、康复效果[上肢运动功能（U-FMA）、改良Ashworth量表（MAS）、改良Barthel指数（MBI）]、Brunnstrom分期康复情况。结果：治疗后，3组屈肘肱二头肌、伸肘肱三头肌RMS均较治疗前增大（P<0.05），屈肘肱二头肌、伸肘肱三头肌CR均较治疗前缩小（P<0.05）；且联合组屈肘肱二头肌、伸肘肱三头肌RMS均大于LF-rTMS组、针灸组（P<0.05），针灸组屈肘肱二头肌与伸肘肱三头肌RMS均大于LF-rTMS组（P<0.05）；联合组屈肘肱二头肌、伸肘肱三头肌CR均小于LF-rTMS组、针灸组（P<0.05），针灸组屈肘肱二头肌与伸肘肱三头肌CR均小于LF-...

Effect of LF-rTMS Combined with Staging Acupuncture on Surface Electromyographyand Rehabilitation in Post-stroke Patients with Hemiplegia

Abstract： Objective： To observe the effect of low-frequency repetitive transcranial magneticstimulation (LF-rTMS) combined with staging acupuncture on surface electromyography and rehabilitation inpost-stroke patients with hemiplegia. Methods：A total of 106 post-stroke patients with hemiplegia wererandomly divided into the LF-rTMS group (37 cases)， the acupuncture group (35 cases) and thecombination group (34 cases). The LF-rTMS group was treated with LF-rTMS；the acupuncture group wastreated with acupuncture by stages，and the combination group was treated with LF-rTMS combined withstaging acupuncture. After 6 weeks of treatment，surface electromyography [root mean square (RMS) andco-contraction rate (CR)]，rehabilitation effect [Upper Fugl-Meyer Motor Function Assessment (U-FMA)，Modified Ashworth Scale (MAS) and Modified Barthel Index (MBI)]，and rehabilitation by Brunnstrom stageswere compared between the three groups. Results：After treatment，the RMS of elbow flexor biceps andelbow extension triceps was respectively increased when compared with that before treatment (P＜0.05)，and the CR of elbow flexor biceps and elbow extension triceps was respectively decreased when comparedwith that before treatment (P＜0.05)； the RMS of elbow flexor biceps and elbow extension triceps in thecombination group was respectively higher than that in the LF-rTMS group and that in the acupuncturegroup (P＜0.05)，and the RMS of elbow flexor biceps and elbow extension triceps in the acupuncture groupwas higher than that in the LF-rTMS group (P＜0.05)；the CR of elbow flexor biceps and elbow extensiontriceps in the combination group was respectively lower than that in the LF-rTMS group and that in theacupuncture group (P＜0.05)， and the CR of elbow flexor biceps and elbow extension triceps in theacupuncture group was respectively lower than that in the LF-rTMS group (P＜0.05). After treatment，theproportion of cases in the rehabilitation period (Stage Ⅳ + Ⅴ) in the three groups was increased whencompared with that before treatment (P＜0.05)，and the proportion of cases in the combination group washigher than that in the LF-rTMS group and that in the acupuncture group (P＜0.05). After treatment， theU-FMA and MBI scores were increased when compared with those before treatment (P＜0.05)， and theMAS scores were decreased when compared with those before treatment (P＜0.05)；the U-FMA and MBIscores in the combination group were higher than those in the LF-rTMS group and the acupuncture group(P＜0.05)，and the MAS score was lower than that in the LF-rTMS group and that in the acupuncture group(P＜0.05)； the U-FMA and MBI in the acupuncture group were higher than those in the LF-rTMS group(P＜0.05)，and the MAS score was lower than that in the LF-rTMS group (P＜0.05). Conclusion：LF-rTMScombined with staging acupuncture can alleviate the spasticity of upper limbs in post-stroke patients withhemiplegia， improve motor function and daily living ability， which may be related to the regulation ofsurface electromyography of affected limbs.