现代仪器与医疗

rTMS对MEP缺失的重度脑卒中患者上肢运动功能障碍的疗效及脑机制研究

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钟燕彪 ¹^,²^,³ , 陶茜 ⁴ , 杨健 ⁵ , 罗云 ¹ , 肖丽 ¹ , 吴钰文 ⁴ , 王茂源 ¹^,²^,³^,^*

现代仪器与医疗 | 专栏 2025,31(5): 30-36

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现代仪器与医疗 |专栏 2025 , 31 (5) : 30 -36

rTMS对MEP缺失的重度脑卒中患者上肢运动功能障碍的疗效及脑机制研究

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钟燕彪¹^,²^,³, 陶茜⁴, 杨健⁵, 罗云¹, 肖丽¹, 吴钰文⁴, 王茂源¹^,²^,³^,^*

作者信息

^1.赣南医科大学第一附属医院康复医学科，赣州　341400

^2.赣州市智能康复技术创新中心，赣州　341400

^3.赣州市康复医学重点实验室，赣州　341400

^4.赣南医科大学第一临床医学院，赣州　341400

^5.赣南医科大学康复学院，赣州　341400

通讯作者:

王茂源，男，博士研究生，主任医师，研究方向：运动康复

作者简介:

钟燕彪，男，博士研究生，主治医师，研究方向：神经系统疾病康复

Study on the efficacy and brain mechanism of rTMS on upper limb motor dysfunction in severe stroke patients with MEP absence

Yanbiao Zhong¹^,²^,³, Qian Tao⁴, Jian Yang⁵, Yun Luo¹, Li Xiao¹, Yuwen Wu⁴, Maoyuan Wang¹^,²^,³^,^*

Affiliations

^1.Department of Rehabilitation Medicine, the First Affiliated Hospital of Gannan Medical University, Ganzhou 341400, China

^2.Ganzhou Technology Innovation Center for Intelligent Rehabilitation, Ganzhou 341400, China

^3.Ganzhou Key Laboratory of Rehabilitation Medicine, Ganzhou 341400, China

^4.The First School of Clinical Medicine, Gannan Medical University, Ganzhou 341400, China

^5.School of Rehabilitation, Gannan Medical University, Ganzhou 341400, China

出版时间: 2025-10-10 doi: 10.11876/mimt202505004

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摘要

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目的

探讨基于结构保留度的重复经颅磁刺激（repeated transcranial magnetic stimulation，rTMS）对脑卒中后上肢运动功能障碍的临床疗效及脑机制。

方法

将运动诱发电位（motor evoked potential，MEP）是否引出作为结构保留度的评价指标，纳入脑卒中伴有上肢运动功能障碍且MEP缺失的患者60例，采用随机数字表方法将上述患者随机分为健侧高频组、健侧低频组、患侧高频组及假刺激组，分别在试验前后进行上肢部分的Fugl-Meyer评定（upper limb Fugl-Meyer assessment，UL-FMA）量表、功能独立性评定（functional independence measure，FIM）量表及功能性近红外光谱（functional near-infrared spectroscopy，fNIRS）评估。

结果

各组患者一般资料、治疗前的UL-FMA评分、FIM评分、感兴趣区的氧合血红蛋白（oxyhemoglobin，HbO）浓度均值比较，差异均无统计学意义（P>0.05）；UL-FMA评分各组与治疗前比较，差异有统计学意义（P<0.05）；健侧高频组与假刺激组比较，差异有统计学意义（P<0.05）。FIM评分各组与治疗前比较，差异有统计学意义（P<0.05），组间比较4组间差异无统计学意义（P>0.05）。与假刺激组相比，健侧高频组治疗前后HbO激活改变主要位于患侧的前运动皮层（PMC）、辅助运动皮层（SMA）、额叶眼动区（FEF），差异具有统计学意义（P<0.05）。

结论

对于MEP缺失的重度脑卒中患者，健侧高频rTMS在改善其上肢运动功能（UL-FMA）和诱导患侧特定脑区（PMC、SMA、FEF）激活方面的疗效要优于假刺激，然而，其相对于健侧低频、患侧高频的优势仍需要更大的样本量、长期随访进一步研究。

关键词

运动诱发电位 / 重复经颅磁刺激 / 脑卒中 / 上肢运动功能障碍

Abstract

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Objective

To explore the clinical efficacy and brain mechanism of repetitive transcranial magnetic stimulation (rTMS) based on structural preservation in treating upper limb motor dysfunction after stroke.

Methods

Motor evoked potential (MEP) elicitation was used as the evaluation index of structural preservation. A total of 60 stroke patients with upper limb motor dysfunction and absent MEP were enrolled. They were randomly divided into the contralateral high-frequency group, contralateral low-frequency group, ipsilateral high-frequency group, and sham stimulation group using the random number table and double-blind method. Before and after the experiment, the upper limb Fugl-Meyer assessment (UL-FMA), functional independence measure (FIM), and functional near-infrared spectroscopy (fNIRS) were performed.

Results

There were no statistically significant differences in general data, pre-treatment UL-FMA scores, FIM scores, or mean oxyhemoglobin (HbO) concentration in the region of interest among the groups (P>0.05). After treatment, the UL-FMA scores of each group were significantly different from those before treatment (P<0.05), and the contralateral high-frequency group showed a statistically significant difference compared with the sham stimulation group (P<0.05). The FIM scores of each group were significantly different from those before treatment (P<0.05), but there was no statistically significant difference among the four groups (P>0.05). Compared with the sham stimulation group, the changes in HbO activation before and after treatment in the contralateral high-frequency group were mainly located in the ipsilateral premotor cortex (PMC), supplementary motor area (SMA), and frontal eye field (FEF), with statistically significant differences (P<0.05).

Conclusion

In severe stroke patients with absent MEP, contralateral high-frequency repetitive transcranial magnetic stimulation (rTMS) yields greater improvements in upper limb motor function (UL-FMA) and induces stronger activation of specific ipsilateral brain regions (PMC, SMA, FEF) compared to sham stimulation. Nevertheless, its efficacy relative to contralateral low-frequency and ipsilateral high-frequency rTMS warrants further validation through larger-scale studies.

Key words

Motor evoked potential / Repetitive transcranial magnetic stimulation / Stroke / Upper limb motor dysfunction

引用本文

钟燕彪, 陶茜, 杨健, 罗云, 肖丽, 吴钰文, 王茂源. rTMS对MEP缺失的重度脑卒中患者上肢运动功能障碍的疗效及脑机制研究. 现代仪器与医疗, 2025 , 31 (5) : 30 -36 . DOI: 10.11876/mimt202505004

Yanbiao Zhong, Qian Tao, Jian Yang, Yun Luo, Li Xiao, Yuwen Wu, Maoyuan Wang. Study on the efficacy and brain mechanism of rTMS on upper limb motor dysfunction in severe stroke patients with MEP absence[J]. Modern Instruments & Medical Treatment, 2025 , 31 (5) : 30 -36 . DOI: 10.11876/mimt202505004

基金

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江西省卫生健康委科技计划项目(202210943)
赣州市科技计划项目(GZ2021ZSF028)

参考文献

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参考文献引证文献

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2025年第31卷第5期

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doi: 10.11876/mimt202505004

首发时间：2026-10-23
出版时间：2025-10-10

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基金

江西省卫生健康委科技计划项目(202210943)

赣州市科技计划项目(GZ2021ZSF028)

作者信息

^1.赣南医科大学第一附属医院康复医学科，赣州　341400

^2.赣州市智能康复技术创新中心，赣州　341400

^3.赣州市康复医学重点实验室，赣州　341400

^4.赣南医科大学第一临床医学院，赣州　341400

^5.赣南医科大学康复学院，赣州　341400

通讯作者:

王茂源，男，博士研究生，主任医师，研究方向：运动康复

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2种不同金属材料的力学参数

科 Family	属数 Number of genus	种数 Number of species	占总种数比例 Percentage of total species (%)	属 Genus	种数 Number of species	占总种数比例 Percentage of total species (%)
鹅膏菌科Amanitaceae	2	11	5.26	鹅膏菌属 Amanita	10	4.78
小菇科 Mycenaceae	2	12	5.74	丝盖伞属 Inocybe	5	2.39
多孔菌科 Polyporaceae	8	14	6.70	蜡蘑属 Laccaria	5	2.39
红菇科 Russulaceae	3	23	11.00	小皮伞属 Marasmius	6	2.87
				小菇属 Mycena	11	5.26
				光柄菇属 Pluteus	5	2.39
				红菇属 Russula	17	8.13
				栓菌属 Trametes	5	2.39

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