摘要
目的 观察高频重复经颅磁刺激（rTMS）对脑卒中后执行功能障碍患者的康复疗效.方法 选取2016年3月至2017年4月就诊于广州医科大学附属第二医院康复科、神经科的36例脑卒中执行功能障碍患者,用随机数字表法随机分为试验组（n=18）和对照组（n=18）.试验组予以每日10 Hz,共700脉冲的左额叶背外侧皮质（DLPFC）rTMS治疗以及认知功能训练,对照组予rTMS伪刺激和同样的认知功能训练,持续时间共4周.治疗前后采用简易精神状态检查量表（MMSE）、威斯康星卡片分类测验（WCST）、数字符号测验（DST）和数字广度测验（DS）对两组患者进行评定,分析并比较两组的数据结果.结果 4周后,试验组和对照组的脑卒中执行功能障碍患者在WCST完成应答总数组内、组间比较差异均无统计学意义.但对照组治疗后的MMSE[（17.44±4.73）分]、DST评分[4.50（2.75,8.25）分]较治疗前有改善[MMSE（15.28±4.61）分,t=-8.371,P=0.000;DST评分4.00（2.75,7.25）分,Z=-2.122,P=0.049],DS评分及WCST完成正确数、持续错误数、完成分类数较治疗前改善不明显.治疗后的试验组MMSE[（20.67±4.59）分]、DST[7.50（4.75,12.50）分]、DS评分[顺背7.00（7.00,8.00）分,倒背3.00（2.00,4.00）分]及WCST完成正确数[（24.61±8.30）分]、持续错误数[（12.17±5.08）分]、完成分类数[2.00（2.00,3.00）分]较治疗前均有改善[MMSE（15.50±5.24）分,t=-21.013,P=0.000;DST 3.00（1.00,7.00）分,Z=-3.757,P=0.000;DS评分顺背6.00（5.00,6.00）分,Z=-3.703,P=0.000;DS评分倒背2.00（1.00,3.00）分,Z=-3.494,P=0.000;WCST完成正确数（16.50±9.34）分,t=-6.544,P=0.000,持续错误数（18.06±5.63）分,t=9.744,P=0.000,完成分类数1.00（1.00,2.00）分,Z=-3.900,P=0.000],且疗效优于对照组.结论 高频rTMS联合认知功能训练可以改善脑卒中患者的执行功能障碍,且疗效优于单一的认知功能训练.
Objective To observe the effect of high frequency repetitive transcranial magnetic stimulation （ rTMS） on executive function in patients after stroke .Methods Thirty-six stroke patients with executive dysfunction in the Second Affiliated Hospital of Guangzhou Medical University from March 2016 to April 2017 were randomly divided into experimental group （ n=18 ） and control group （ n=18 ） .The experimental group received 10 Hz rTMS of the left dorsolateral prefrontal cortex （ DLPFC ） and cognitive functional training , while the control group received sham rTMS and cognitive functional training , for four weeks.Mini-Mental State Examination（MMSE）, Wisconsin Card Classification Test（WCST）, Digit Symbol Test（ DST） and Digital Span （ DS） were used for cognitive assessment at baseline and therapy completed . Results After a four weeks therapy , the total number of responses showed no significant difference in WCST between two groups.But the control group after treatment showed that MMSE score （17.44 ±4.73） and DST score （4.50 （2.75, 8.25）） were improved compared with that before treatment （MMSE score 15.28 ±4.61, t=-8.371, P=0.000;DST score 4.00 （2.75, 7.25）, Z=-2.122, P=0.049）, and the DS score and the numbers of correction , classification and continuous errors of WCST showed no significant difference compared with that before treatment .The experimental group after treatment showed that MMSE score （20.67 ±4.59）, DST score （7.50（4.75, 12.50））, DS score （recite in order 7.00 （7.00, 8.00）, recite in reverse order 3.00 （2.00, 4.00））, the numbers of correction of WCST （24.61 ± 8.30）, the numbers of continuous errors （12.17 ±5.08）, the numbers of classification （2.00 （2.00, 3.00） were improved compared with that before treatment （ MMSE score 15.50 ±5.24, t=-21.013, P=0.000;DST score 3.00（1.00, 7.00）, Z=-3.757, P=0.000; DS score recited in order 6.00（5.00, 6.00）, Z=-3.703, P=0.000;DS score recited in reverse order 2.00（1.00, 3.00）, Z=-3.494, P=0.000;The numbers of correction of WCST （16.50 ±9.34）, t=-6.544, P=0.000）; The numbers of continuous errors （18.06 ±5.63, t=9.744, P=0.000）; The numbers of classification （1.00 （1.00, 2.00）, Z=-3.900, P=0.000 ）.And the curative effect was better than that of control group . Conclusion High frequency rTMS combined with cognitive function training can improve the executive dysfunction of stroke patients , and the improvement is better than cognitive functional training alone .
出处
《中华神经科杂志》
CAS
CSCD
北大核心
2017年第10期745-750,共6页
Chinese Journal of Neurology
基金
2014年广东省学位与研究生教改项目（52010107-168）
关键词
脑卒中
执行功能
重复经颅磁刺激
认知功能训练
Stroke
Executive function
Repetitive transcranial magnetic stimulation
Cognitive functional training
