目的 研究重复经颅磁刺激(rTMS)联合功能电刺激(FES)对全面发育迟缓(GDD)患儿的疗效,为改善GDD患儿语言康复提供临床参考依据。方法 以2020年1月—2022年4月在南宁市妇幼保健院所就诊的54例GDD患儿为研究对象,分为对照组和实验组,对照组予康复训练+rTMS干预,实验组在对照组的基础上增加FES干预,在干预前后进行Gesell发育诊断量表评定发育商数(DQ)并进行统计学分析。结果 干预前两组患儿一般资料与Gesell评定5个维度DQ值差异无统计学意义(P＞0.05),经6个月的干预后两组患儿Gesell评定5个维度DQ值较干预前均提高且差异具有统计学意义(P＜0.05),干预后实验组言语能维度DQ为(51.11±18.84),高于对照组的(40.93±15.47),且差异具有统计学意义(t=2.171,P=0.034),干预后实验组言语能疗效显效率(55.6%)与有效率(29.6%)均高于对照组(显效率14.8%,有效率22.2%)且差异具有统计学意义(Z=3.963,P＜0.001)。结论 rTMS联合FES的“中枢-外周”协同模式可明显改善GDD患儿的语言发展,降低家庭与社会的长期治疗成本。
Abstract
Objective To analyze the effect of repetitive transcranial magnetic stimulation (rTMS) combined with functional electrical stimulation (FES) in children with global developmental delay (GDD). Methods A total of 54 children with GDD, who were treated in Nanning Maternal and Child Health Hospital from January 2020 to April 2022, were included in this study, and were divided into control group and experimental group. The control group received rehabilitation training and rTMS, while the experimental group received FES additionally. Development quotient (DQ) was assessed by Gesell Development Scale before and after intervention and statistical analysis was performed. Results There were no statistically significant difference in the general characteristics and DQ of the five dimensions by Gesell before intervention between the two groups(P＞0.05). After 6 months of intervention, DQ of the five dimensions by Gesell of children in the two groups were significantly improved compared with those before intervention (P＜0.05). DQ of speech ability dimension in the experimental group (51.11±18.84)was significantly higher than that in the control group (40.93±15.47) after intervention (t=2.171, P＜0.05). Significant effective rate (55.6% vs.14.8%) and effective rate (29.6% vs. 22.2%) of speech ability dimension in experimental group were significantly higher than those in control group after intervention (Z=3.963, P＜0.05). Conclusion The mode of rTMS combined with FES can significantly improve the language development of children with GDD, and reduce the long-term treatment cost of family and society.
关键词
全面发育迟缓 /
重复经颅磁刺激 /
功能电刺激 /
协同模式
Key words
global development delay /
repetitive transcranial magnetic stimulation /
functional electrical stimulation /
cooperation mode
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1] Mithyantha R, Kneen R, McCann E, et al. Current evidence-based recommendations on investigating children with global developmental delay[J]. Arch Dis childhood, 2017, 102(11):1071-1076.
[2] 何金华,周洪涛,魏选东,等.重复经颅磁刺激辅助干预发育迟缓儿童临床疗效观察[J].中国中西医结合儿科学,2020,12(4):349-353.
[3] 徐艳红,李静,唐久来.儿童全面性发育落后的高危因素、临床特征和预后[J].中华实用儿科临床杂志,2016,31(10):783-786.
[4] 段红莉,张中平,许秀,等.初发脑卒中后构音障碍的中医针刺、言语训练联合电刺激干预效果[J].世界中医药,2019,14(01):187-190.
[5] 赵伊婷,杨旭博,徐开寿.脑性瘫痪患儿吞咽障碍的研究进展[J].中华物理医学与康复杂志,2021,43(12):1149-1152.
[6] Choo YY, Agarwal P, How CH, et al. Developmental delay:identification and management at primary care level[J]. Singap Med J, 2019, 60(3):119-123.
[7] 孙思媛,高雪婷,肖琳,等.晚期早产儿160例Gesell婴幼儿智能测评研究[J].陕西医学杂志,2019,48(9):1171-1174.
[8] 柯海娟,唐久来.64例全面性发育迟缓患儿病因及疗效分析[J].中国儿童保健杂志,2016,24(6):658-661.
[9] Sachdeva P, Sitaraman S, Minocha P, et al. Etiological profile of children with global developmental delay:A single center study[J]. J Pediatr Neurol, 2019, 17(3):111-117.
[10] 阎俊,张红晓.儿童全面发育迟缓的早期诊断与干预措施[J].中医儿科杂志,2017,13(4):13-16.
[11] 毛华芳,雷海艳.重复经颅磁刺激联合综合康复训练干预对全面性发育迟缓患儿神经行为发育的影响[J].智慧健康,2021,7(21):17-19.
[12] 许毅,李达,谭立文,等.重复经颅磁刺激治疗专家共识[J].转化医学杂志,2018,7(1):4-9.
[13] Finisguerra A, Borgatti R, Urgesi C. Non-invasive brain stimulation for the rehabilitation of children and adolescents with neurodevelopmental disorders:A systematic review[J]. Front Psychol, 2019, 10:135.
[14] 谢秀杰. 低频脉冲电刺激联合作业疗法在精神发育迟缓患儿中的应用效果[J].河南医学研究,2020,29(26):4855-4857.
[15] 陈宇香. 低频脉冲电治疗运动发育迟缓患儿的近远期疗效[J].哈尔滨医药,2019,39(1):54-55.
[16] 刘柏秋,苏丽代. 语言训练、电刺激治疗儿童语言发育迟缓40例[J].中国民族民间医药,2011,20(13):55.
[17] 付蕊,徐桂芝,朱海军,等.经颅磁刺激对学习记忆及大脑神经突触可塑性影响的研究进展[J].生物医学工程学杂志,2021,38(4):783-789.
[18] 贾杰.“中枢-外周-中枢”闭环康复-脑卒中后手功能康复新理念[J].中国康复医学杂志,2016,31(11):1180-1182.
[19] Brunoni AR, Nitsche MA, Bolognini N, et al. Clinical research with transcranial direct current stimulation (tDCS):challenges and future directions[J]. Brain Stimulation, 2012, 5(3):175-195.
基金
国家自然科学基金资助项目(81901394)
PDF(548 KB)
