【摘要】 目的：探讨镜像疗法(MT)联合重复经颅磁刺激(rTMS)对脑卒中后上肢运动功能障碍的康复治疗效果。方法：选取2021年12月-2023年6月本院康复科住院的初发脑卒中患者68例，随机分为对照组、MT组、rTMS组、联合组。对照组采用脑卒中后常规康复治疗，3～4 h/d, 6 d/周，共4周；MT组、rTMS组分别在常规康复治疗基础上采用MT疗法、5Hz rTMS疗法；联合组在常规康复治疗基础上联合MT及rTMS疗法。四组分别在治疗前和治疗4周后采用简式Fugl-Meyer评定量表-上肢部分(FMA-UE)、改良Barthel指数(MBI)进行评价，同时测量患侧脑区的运动诱发电位(MEP)皮质潜伏期(CL)和中枢运动传导时间(CMCT)。结果：共65例患者完成试验，其中MT组脱落2例，联合组脱落1例。经治疗后，四组患者FMA-UE、MBI评分均较治疗前显著提高(P<0.05),MT组、rTMS组、联合组均优于对照组，且联合组最优(P<0.05);四组患者CL和CMCT均较治疗前显著缩短(P<0.05),MT组、rTMS组、联合组均低于对照组，且联合组低于MT组和rTMS组(P<0.05)。结论：MT和rTMS均能改善脑卒中患者患侧大脑皮质的兴奋性和上肢运动功能，早期进行MT联合rTMS治疗对患侧上肢运动功能改善效果更佳。更多还原

【Abstract】 Objective To explore the rehabilitation effect of mirror therapy(MT) combined with repetitive transcranial magnetic stimulation(rTMS) on upper limb motor dysfunction after stroke. Methods A total of 68 newly diagnosed stroke patients admitted to the Department of Rehabilitation Medicine, Xiangyang No.1 People′s Hospital, Hubei University of Medicine from December 2021 to June 2023 were selected. They were randomly divided into a control group, MT group, rTMS group, and combination group. The control group received routine rehabilitation treatment after stroke, 3～4 h/d, 6 d/week, for 4 weeks in total. The MT group and the rTMS group received additional MT therapy and 5 Hz rTMS therapy, respectively after routine rehabilitation treatment. The combination group was treated with MT therapy and rTMS therapy on the basis of the control group. The four groups were evaluated using the simplified Fugl-Meyer Assessment Upper Extremity(FMA-UE) and modified Barthel Index(MBI) before and 4 weeks after treatment. The cortical latency(CL) and central motor conduction time(CMCT) of the affected brain area were also measured. Results A total of 65 patients completed the trial, with 2 cases of dropout in the MT group and 1 case of dropout in the combination group. After treatment, the FMA-UE and MBI scores of the four groups were improved compared with those before treatment(P<0.05), and the MT group, rTMS group, and the combination group were better than the control group, with the combination group achieving the optimal results(P<0.05). Compared with the conditions before treatment, the CL and CMCT of the four groups were reduced(P<0.05); the MT group, rTMS group and combination group were lower than the control group, with the combination group having the lowest results(P<0.05). Conclusion Both MT and rTMS can improve the excitability and upper limb motor function of the affected cerebral cortex of stroke patients. Early treatment with combined MT and rTMS has a desirable effect on improving the upper limb motor function of the affected side.更多还原