自我效能训练联合高频重复经颅磁刺激治疗脑梗死后认知障碍的随机对照研究

Self-efficacy training combined with high-frequency repeated transcranial magnetic stimulation in the treatment of cognitive dysfunction after cerebral infarction:a randomized controlled study

目的:探讨自我效能训练联合高频重复经颅磁刺激(repeated transcranial magnetic stimulation,rTMS)对脑梗死后认知障碍患者的认知功能、自我效能水平和心理状况的改善作用。方法:80例脑梗死后认知障碍患者随机分为自我效能训练联合rTMS组和rTMS组(对照组),每组均为40例。2组患者均接受常规治疗(药物治疗和认知康复训练),rTMS组同时接受高频rTMS治疗,自我效能训练联合rTMS组同时接受自我效能训练联合高频rTMS治疗,共治疗4周。治疗前及治疗4周后,采用蒙特利尔认知评估量表(Montreal Cognitive Assessment,MoCA)、一般自我效能感量表(General Self-Efficacy Scale)、Zung抑郁自评量表和Zung焦虑自评量表对患者的认知功能、自我效能水平和心理状况进行评估和比较。结果:2组患者的性别、年龄、病程、病灶侧别、受教育年限以及治疗前的MoCA评分、一般自我效能感量表评分、Zung抑郁自评量表评分和Zung焦虑自评量表评分的差异均无统计学意义(P>0.05)。治疗4周后,2组患者的MoCA评分、自我效能水平、Zung抑郁自评量表评分和Zung焦虑自评量表评分与本组治疗前相比,均有显著改善(P<0.05)。与rTMS组相比,自我效能训练联合rTMS组患者治疗4周后的MoCA评分、自我效能水平、Zung抑郁自评量表评分和Zung焦虑自评量表评分的改善均较rTMS组更为显著(P<0.05)。结论:自我效能训练联合高频rTMS治疗能够改善脑梗死后认知障碍患者的认知功能、自我效能水平和心理状况,且安全性高,有助于提高患者的生活质量。

Objective:To explore the effect of self-efficacy training combined with repetitive transcranial magnetic stimulation(rTMS)on cognitive function,self-efficacy level and psychological status of patients with cognitive dysfunction after cerebral infarction.Methods:A total of 80 eligible patients were randomly divided into two groups:self-efficacy training combined with rTMS group and rTMS group(control group).Both groups received routine treatment(drug treatment and cognitive rehabilitation training).rTMS group received high-frequency rTMS treatment and the self-efficacy training combined with rTMS group received self-efficacy training combined with high-frequency rTMS treatment for 4 weeks.Before and 4 weeks after treatment,the cognitive function,self-efficacy level and psychological status of the patients were assessed and compared by using the Montreal Cognitive Assessment(MoCA),General Self-Efficacy Scale,Zung Self-Rating Depression Scale and Zung Self-Rating Anxiety Scale.Results:There were no significant differences between the two groups in gender,age,course of disease,lesion side,years of education and MoCA,General Self-Efficacy Scale,Zung Self-Rating Depression Scale and Zung Self-Rating Anxiety Scale scores before treatment(P>0.05).After 4 weeks of treatment,the MoCA score,self-efficacy level and Zung Self-Rating Depression Scale and Zung Self-Rating Anxiety Scale scores of the two groups were significantly improved(P<0.05).Compared with rTMS group,the improvement of MoCA score,self-efficacy level and Zung Self-Rating Depression Scale and Zung Self-Rating Anxiety Scale scores in self-efficacy training combined with rTMS group was more significant(P<0.05).Conclusion:Self-efficacy training combined with high-frequency rTMS has better curative effects in cognitive function,self-efficacy level and psychological status of patients with cognitive dysfunction after cerebral infarction,and it is safe and helpful to improve the quality of life.