重覆經顱磁刺激術（rTMS）對腦中風病人的應用與成效──護理照護角色探討與應用指南

Application and Effectiveness of Repetitive Transcranial Magnetic Stimulation (rTMS) in Post-Stroke Patients: Exploration of Nursing Care Roles and Application Guidelines

重複經顱磁刺激術（repetitive transcranial magnetic stimulation, rTMS）作為一種非侵入性神經調控技術，已成為腦中風復健的重要創新工具。腦中風高居全球第二大死因及第三大致殘原因，60歲以上族群風險尤高，全球每年約有1,200萬腦中風病人。腦中風分為缺血性（85%，血管阻塞）與出血性（10%–15%，血管破裂），急性期治療包括血栓溶解劑與手術，慢性期治療則結合復健及rTMS等技術。研究指出，85%病人經3-6個月復健可改善，而rTMS透過磁場穿透顱骨誘發皮層電流，調節神經元興奮性與神經可塑性，以高頻（> 1 Hz）增強受損區活性、低頻（≤1 Hz）抑制未受損區過度活化，平衡大腦半球活動，並調節γ-aminobutyric acid、谷氨酸等神經傳導物質。臨床研究證實，rTMS顯著改善運動功能，如上肢Fugl-Meyer評分提升（p = .037）、Barthel指數標準化平均差（SMD = 0.580, p < .05），且效果可持續一年；針對失語症病人，低頻或雙頻rTMS經20次療程可提升語言流暢性與命名能力，並改善吞嚥功能。認知方面，rTMS治療使蒙特利爾認知評估（Montreal Cognitive Assessment）得分顯著提高（p < .001），執行功能測試時間縮短；心理層面則透過刺激背外側前額葉皮質，降低腦中風後憂鬱病人的漢氏憂鬱量表評分25%–30%（p < .01）。護理人員於rTMS治療中扮演關鍵角色，涵蓋治療前禁忌症評估（如心律調節器、金屬植入物）、衛教以減輕焦慮、確保環境無電磁干擾，並監測治療中生命徵象及副作用（如頭痛、癲癇），追蹤返家後反應。綜言之，未來研究可聚焦最佳刺激參數與長期療效，以深化臨床應用價值，藉此提供並邁向更優質的照護品質。

Repetitive transcranial magnetic stimulation (rTMS), a non-invasive neuromodulation technique, has emerged as a promising intervention in post-stroke rehabilitation. With approximately 12 million new stroke cases annually, stroke remains the second leading cause of death and the third leading cause of disability worldwide, with this condition particularly prevalent in individuals over 60 years of age. Strokes are primarily classified as ischemic (85%) or hemorrhagic (10%–15%), with acute-phase treatments involving thrombolytics or surgery, and chronic-phase management integrating rehabilitation and techniques such as rTMS. The current evidence suggests that 85% of patients affected by stroke show functional improvement within 3–6 months of rehabilitation. rTMS modulates cortical excitability and neuroplasticity by inducing electric currents in the magnetic fields across the skull. High-frequency rTMS ( > 1 Hz) enhances excitability in lesioned regions, while low-frequency rTMS (≤1 Hz) inhibits hyperactivity in non-lesioned areas, thereby rebalancing interhemispheric activity and regulating neurotransmitters such asγ-aminobutyric acid and glutamate. Clinical studies have demonstrated rTMS to significantly enhance the recovery of motor skills, including increased upper limb Fugl-Meyer scores (p = .037) and standardized mean differences in Barthel Index (SMD = 0.580, p < .05), with effects lasting up to one year. In cases with aphasia, 20 sessions of low- or dual-frequency rTMS have been shown to improve fluency and naming ability as well as swallowing function. Cognitively, rTMS has been shown to enhance Montreal Cognitive Assessment scores (p < .001) and reduce task completion time on executive function tests. Psychologically, stimulation of the dorsolateral prefrontal cortex has been shown to reduce Hamilton Depression Rating Scale scores in post-stroke depression patients by 25%–30% (p < .01). Nurses play a pivotal role in rTMS treatments, including pre-treatment screening for contraindications (e.g., pacemakers, metal implants), providing patient education to alleviate anxiety, ensuring an interference-free environment, monitoring vital signs and adverse effects (e.g., headache, seizures), and conducting post-treatment follow-ups. In conclusion, future research should be conducted to explore optimal stimulation parameters and long-term efficacy to further advance clinical applications and enhance quality of care.