低频重复经颅磁刺激对急性期脑梗死患者焦虑抑郁状态的影响

The effect of low-frequency r-TMS to anxiety-depression in patients with acute phase of cerebral infarction

目的:探讨低频重复经颅磁刺激(r-TMS)对急性期脑梗死患者焦虑抑郁状态及日常生活活动能力(ADL)的影响。方法:65例急性期脑梗死患者随机分成对照组(32例)和治疗组(33例),对照组给予常规治疗,治疗组除常规治疗外,同时给予r-TMS治疗,疗程8周。治疗前后用汉密尔顿焦虑量表(HAMA)和汉密尔顿抑郁量表(HAMD)进行精神心理评定,以中国脑卒中神经功能评分量表(CSS)行神经功能缺损程度评定,用改良Barthel指数(BI)量表进行日常生活活动能力评定。结果:对照组治疗后HAMA、HAMD及CSS评分分别下降13.33%、13.13%及20.62%,其中,精神性焦虑和躯体性焦虑评分分别下降11.71%和15.30%,MBI评分提高40.85%,差异均有显著性意义(P<0.05);治疗组治疗后HAMA、HAMD及CSS评分分别下降33.60%、35.66%及26.23%,其中,精神性焦虑和躯体性焦虑评分分别下降34.64%和20.26%,MBI评分提高40.10%,差异均有显著性意义(P<0.05)。另外,治疗后治疗组较对照组HAMA、精神性焦虑、HAMD及CSS评分均明显下降,差异有显著性意义(P<0.05),但两组间躯体性焦虑评分下降及MBI评分提高差异并不明显,无显著性意义(P>0.05)。治疗组与对照组间焦虑状态改善总有效率分别为78.95%和12.00%,抑郁状态改善总有效率分别为86.96%和9.52%,两组间焦虑抑郁状态改善率差异均有显著性意义(P<0.05)。结论:低频r-TMS能改善急性期脑梗死患者焦虑抑郁状态,尤其是精神性焦虑症状,促进神经功能恢复,但对日常生活活动能力的影响可能不大。

Objective： To study the effect of low-frequency r-TMS to anxiety-depression and ability of activities of daily living（ADL） in patients with acute cerebral infarction. Method＇According to be selected standard,65 acute cerebral infarction patients were divided randomly into 2 groups：control group （32 cases） treated with routine therapy only,and therapy group（33cases） received routine therapy and r-TMS for 8 weeks.Patients were evaluated with scores of Hamilton anxiety rating scale（HAMA）,Hamihon depression（HAMD） and Chinese stroke scale（CSS） and modified Barthel index（MBI） before and after treatment. Result： After treatment, in control group the scores of HAMA, HAMD and CSS decreased by 13.33%, 13.13% and 20.62% respectively, of which the scores of psycho-anxiety and somato-anxiety decreased by 11.71% and 15.30%, and the scores of MBI elevated by 40.85% （all P 〈 0.05）; in therapy group the scores of HAMA, HAMD and CSS decreased by 33.60%, 35.66% and 26.23% respectively,of which the scores of psycho-anxiety and so--mato-anxiety decreased by 34.64% and 20.26%, and the scores of MBI elevated 40.10% （all P〈0.05）. Otherwise, after treatment the scores of HAMA, psycho-anxiety, HAMD and CSS in therapy group decreased more significantly than those in control group（〈 0.05）, but the decrease of somato-anxiety and rise of MBI had no significant difference in two groups （P 〉 0.05）. The total effective rate of anxiety in therapy group （78.95%） was higher than （P〈 0.05） that in control group （12.00%）, and for depression were 86.96% to 9.52% respectively （/9〈 0.05）. Conclusion：Low-frequency r-TMS applied in patients with acute cerebral infarction could improve anxiety-depression, especially psycho-anxiety symptom and decrease neurologic impairment, but it had less impact on ability of ADL. Author＇s address Department of Neurological Rehabilitation, Mawangdui Hospital of Hunan Province, The Center of Cerebrovaseular Disease Rehabilitation Management of Hunan Province, Changsha, 410016