摘要
目的:观察高频重复经颅磁刺激(rTMS)对脑梗死后抑郁患者抑郁、认知功能及日常生活活动能力的影响。方法:选择2018年7月—2020年2月在重庆医科大学附属第二医院神经内科、康复科治疗的脑梗死后抑郁患者50例,采用随机数字表法分为对照组和观察组,每组25例。2组均进行常规药物治疗、康复训练和盐酸帕罗西汀抗抑郁治疗。在此基础上,对照组接受假刺激,将磁刺激线圈与头皮表面垂直呈90°放置,刺激频率为10.0 Hz,刺激强度为80%~90%静息运动阈值(RMT),根据患者的耐受性调节,先低后高,每次刺激2 s,间隔20 s,总脉冲数为1200,1次/d,5次/周,持续治疗6周,共30次。观察组接受高频rTMS治疗,刺激部位为左侧前额叶背外侧皮质(DLPFC),线圈中心点与患者头皮表面相切,治疗参数与时间同对照组。分别于治疗前、治疗6周后,采用蒙特利尔认知评估量表(MoCA)评估患者的总体认知功能;采用汉密尔顿抑郁量表17项(HAMD-17)评估患者的抑郁情况;采用改良Barthel指数(MBI)评估患者的日常生活活动能力;采用听觉事件相关电位P300评估患者认知功能;比较2组不良反应。结果:2组治疗前MoCA、HAMD、MBI评分及听觉事件相关电位P300无明显区别,差异无统计学意义(P>0.05)。与治疗前比较,2组治疗后MoCA评分、视空间/执行和注意/计算等MoCA子项评分、MBI评分均明显提高(P<0.05),HAMD评分、P300潜伏期均明显降低,差异具有统计学意义(P<0.05)。与对照组比较,观察组治疗后MoCA评分、注意/计算和延迟记忆等MoCA子项评分均明显更高,HAMD评分、P300潜伏期均明显更低,差异具有统计学意义(P<0.05)。2组MBI评分和不良反应无明显区别,差异无统计学意义(P>0.05)。结论:高频rTMS可有效改善脑梗死后抑郁患者的抑郁状态、认知功能,值得临床推广应用。
Objective:To explore the effect of high-frequency repetitive transcranial magnetic stimulation(rTMS)on depres‐sion,cognitive function and activities of daily living in patients with depression after cerebral infarction.Methods:A total of 50 pa‐tients with depression after cerebral infarction from the departments of neurology and rehabilitation of the Second Affiliated Hospital of Chongqing Medical University from July 2018 to February 2020,which were randomly divided into the control group and the ob‐servation group,with 25 cases in each group.All of the patients received conventional drug therapy,rehabilitation training,and par‐oxetine antidepressant treatment.On this basis,the control group was given sham stimulation,the coil of magnetic stimulation was placed at 90 degrees perpendicular to the scalp,the stimulation frequency was 10.0 Hz,the stimulation intensity was 80%-90%rest‐ing motor threshold(RMT),and the stimulation intensity was adjusted from low to high according to the patient's tolerance,two sec‐onds per stimulus,20 seconds interval,total pulses 1200,once a day,five days a week,continous treatment for six weeks.The obser‐vation group was given high-frequency rTMS treatment,the stimulation site was the left dorsolateral prefrontal cortex(DLPFC),the center point of the coil was tangent to the patient's scalp surface,and the treatment parameters and time were the same as those in the control group.Before treatment and after treatment for six weeks,the Montreal cognitive assessment scale(MoCA)was used to eval‐uate the overall cognitive function of patients;the Hamilton depression scale(HAMD)was used to evaluate the depression of pa‐tients;the modified Barthel index(MBI)was used to evaluate the activities of daily living of patients;the auditory event-related po‐tential P300 was used to evaluate cognitive function and the adverse reactions of the two groups were compared.Results:There were no significant differences in MoCA,HAMD,MBI scores and P300 between the two groups before treatment(P>0.05).Com‐pared with before treatment,MoCA scores,subitem scores of MoCA(such as visuospatial/executive function,attention/calculation)and MBI score of both groups after treatment for six weeks were significantly higher(P<0.05),HAMD score and P300 latency of both groups were significantly lower,the difference was statistically significant(P<0.05).Compared with the control group,the Mo‐CA scores and subitem scores of MoCA(such as attention/calculation and delayed memory)of the observation group were signifi‐cantly higher(P<0.05),and HAMD score and P300 latency were significantly lower,the difference was statistically significant(P<0.05).There were no significant differences in MBI score and occurrence of adverse events between the two groups(P>0.05).Con‐clusion:High frequency rTMS can effectively improve the depressive state and cognitive function of patients with post-stroke de‐pression,which is worthy of clinical application.
作者
姜霖霖
牛陵川
王愉乐
杨宝童
李豪
李佳妮
JIANG Linlin;NIU Lingchuan;WANG Yule;YANG Baotong;LI Hao;LI Jiani(The Second Affiliated Hospital of Chongqing Medical University,Chongqing 400010,China)
出处
《康复学报》
CSCD
2021年第6期455-460,共6页
Rehabilitation Medicine
基金
国家自然科学基金项目(81201506)
重庆市科卫联合医学科研项目(2019MSXM017)。
关键词
缺血性脑卒中
脑梗死
抑郁
高频重复经颅磁刺激
认知功能
日常生活活动能力
ischemic stroke
cerebral infarction
depression
high frequency repetitive transcranial magnetic stimulation
cogni‐tive function
activities of daily living
