重复经颅磁刺激结合经络电刺激治疗颅脑损伤性抑郁症的临床应用

Clinical application of RTMS combined with meridian electrical stimulation in treatment of the depression after craniocerebral trauma

目的 探讨重复经颅磁刺激（RTMS）结合经络电刺激治疗颅脑损伤性抑郁症的可行性。方法 选取2006～2010年北京中医药大学东方医院神经外科颅脑损伤患者40例为研究对象，其中轻型闭合性颅脑损伤19例，中型闭合性颅脑损伤13例，重型颅脑损伤术后恢复期患者8例。所有患者均具有明显的精神抑郁症表现。按入院顺序将其分为两组，RTMS结合经络电刺激组20例（实验组），单独应用RTMS治疗组20例（对照组）。对所有研究病例适时进行治疗前后汉密尔顿抑郁量表（HAMD）评分、巴氏指数评分、血浆去甲肾上腺素（NE）含量测定，观察两组病例治疗前后抑郁症临床症状改善情况，对两组进行疗效比较。结果 治疗后实验组及对照组HAMD评分分别为（13．43±2．35）、（15．16±3．02）分，均较治疗前[（31．90±3．72）、（30．27±3．86）分]降低，实验组及对照组巴氏指数分别为（67．26±3．53）、（63．43±3．24），均较治疗前（51．25±6．51、52．37±6．73）升高，差异均有统计学意义（均P〈0．05）；两组治疗后HAMD评分及巴氏指数比较，差异均有统计学意义（均P〈0．05）。治疗后实验组及对照组去甲肾上腺素水平分别为（0.42±0．02）、（0．36±0．03）μmol／L，均高于治疗前[（0．29±0．03）、（0．27±0．02）μmol／L]，差异有统计学意义（P〈0．05）；两组治疗后NE水平比较，差异有统计学意义（P〈0．05）。实验组治愈6例，显效8例；对照组治愈2例，显效9例，两组比较差异有统计学意义（P〈0．05）。结论 RTMS结合经络电刺激是治疗颅脑损伤性抑郁症的有效手段。

Objective To research the feasibility Of repetitive transcranial magnetic stimulation （RTMS） combined with the meridian electrical stimulation in the treatment of the depression after craniocerebral trauma. Methods The 40 patients with craniocerebral injury in Orient Hospital of Beijing University of Chinese Medicine from 2006 to 2010 were chosen as study objects, including 19 cases of light closed craniocerebral injury, 13 cases of medium closed craniocerebral injury, 8 cases of postoperative recovering patients with severe craniocerebral injury. The 40 depression patients after craniocerebral trauma were assigned randomly for the experiment group （n=20） and control group （n=20）. The patients in experiment group were given the treatment of RTMS and meridian electrical stimulation. Control group were only given the treatment of RTMS. The Hamilton depression scale （HAMD） grades, barthel index, plasma form amine neurotransmitter （NE） before and after treatment of two groups were compared, the clinical effect of two groups were compared. Results The HAMD grades of experiment group and control group after treatment were （18.47±1.61） and （15.16±3.02） scores respectively, which were lower than before treatment [（31.90±3.72）, （30.27±3.86） scores], the barthel index of experiment group and control group after treatment were （67.26±3.53） and （63.43±3.24）, which were higher than before treatment [（51.25±6.51）, （52.37±6.73）], the differences were statistically significant （all P 〈 0.05 ）; the HAMD grades and barthel index in the two groups had statistically significant differences （all P 〈 0.05）. Norepinephrine of experiment group and control group after treatment were （0.42±0.02）, （0.36±0.03） μ mol/L respectively, which were higher than before treatment [（0.29±0.03）, （0.27±0.02） μ mol/L], the differences were statistically significant （P 〈 0.05）, norepinephrine in the two groups had statistically significant differences （P 〈 0.05）. There were 6 cases with cure, 8 cases with excellent in the experiment group, and there were 2 cases with cure, 9 cases with excellent, the difference of two were statistically significant （P 〈 0.05）. Conclusion RTMS combined with the meridian electrical stimulation is a effective method in the treatment of the depression after craniocerebral injury.