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目的 探讨针刺联合重复经颅磁刺激（rTMS）对卒中后患者手功能康复疗效。方法 选择170例脑卒中恢复期患者，随机分为对照组和实验组，每组85例。治疗组进行针刺+重复经颅磁刺激+康复训练+基础治疗，对照组进行重复经颅磁刺激+康复训练+基础治疗。治疗2个疗程（1个月）后评估患者上肢功能，疗效评定采用NIHSS评分、简式Fugl-Meyer运动功能评分法、Brunnstrom上肢运动功能分期、改良Ashworth肌张力评定分级。结果 试验组治疗后NIHSS、改良Ashworth肌张力评定分级评分显著低于对照组（P<0.05）,Fugl-Meyer评分、Brunnstrom上肢运动功能分期评分试验组显著大于对照组（P<0.05）。结论 在常规康复和基础治疗基础上，加用针刺联合rTMS治疗卒中后上肢运动功能障碍，其疗效显著优于单纯使用rTMS联合常规康复和基础治疗。该联合方案能更有效地改善神经功能缺损，促进上肢运动功能恢复，提高运动恢复阶段，降低肌张力，具有显著的临床协同增效作用，值得临床推广应用。
Abstract：Objective To explore the therapeutic effect of acupuncture combined with repetitive transcranial magnetic stimulation(rTMS) on hand function rehabilitation in patients after stroke. Methods 170 patients in the recovery period of stroke were selected and randomly divided into a control group and an experimental group, with 85 cases in each group. The treatment group was treated with acupuncture + repetitive transcranial magnetic stimulation + rehabilitation training + basic treatment, while the control group was treated with repetitive transcranial magnetic stimulation + rehabilitation training + basic treatment. After two courses of treatment(one month), the upper limb function of the patients was evaluated. The therapeutic effect was evaluated using the NIHSS score, the simple Fugl-Meyer assessment of motor function, the Brunnstrom upper limb motor function staging, and the modified Ashworth muscle tone assessment classification. Results After treatment, the NIHSS and modified Ashworth muscle tone grading scores of the experimental group were significantly lower than those of the control group(P<0.05), while the Fugl-Meyer score and Brunnstrom upper limb motor function staging score of the experimental group were significantly higher than those of the control group(P<0.05). Conclusion On the basis of conventional rehabilitation and basic treatment, the addition of acupuncture combined with rTMS in the treatment of upper limb motor dysfunction after stroke has a significantly better therapeutic effect than the sole use of rTMS combined with conventional rehabilitation and basic treatment. This combined protocol can more effectively improve neurological deficits, promote the recovery of upper limb motor function, enhance the motor recovery stage, and reduce muscle tone. It has a significant clinical synergistic effect and is worthy of clinical promotion and application.
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基本信息:
DOI：10.26946/j.cnki.1000-3649.sczy.2507230011
中图分类号:R743.3
引用信息:
[1]朱仁豪,向泽东,刘婵娟,等.针刺联合重复经颅磁刺激治疗卒中后上肢运动功能障碍的临床疗效观察[J].四川中医,2025,43(10):114-120.DOI:10.26946/j.cnki.1000-3649.sczy.2507230011.
基金信息:
四川省中医药管理局科学技术研究专项（2023MS425）