重复经颅磁刺激对脑卒中后抑郁患者抑郁情绪、睡眠障碍及日常生活活动能力的影响

Effects of repetitive transcranial magnetic stimulation on post-stroke depression, sleep quality and activities of daily living

目的探讨重复经颅磁刺激（rTMS）对脑卒中后抑郁（PSD）患者抑郁情绪、睡眠障碍及日常生活活动（ADL）能力的影响。方法选取PSD患者90例，按随机数字表法将其分为对照组、治疗组和联合治疗组，每组30例。3组患者均给予基础治疗及综合康复训练，对照组在此基础上给予艾司西酞普兰治疗，治疗组给予rTMS治疗，联合治疗组在对照组基础上辅以rTMS治疗，疗程8周。治疗前及治疗8周后（治疗后），采用汉密尔顿抑郁量表（HAMD）、匹斯堡睡眠质量指数量表（PSQI）、中国脑卒中量表（CSS）及改良Barthel指数（MBI）对患者的抑郁情绪、睡眠质量、神经功能缺损情况及ADL能力进行评定。结果治疗前，3组患者HAMD、CSS、PSQI、MBI评分之间比较。差异无统计学意义（P〉0．05）。治疗8周后（治疗后），3组患者HAMD评分、PSQI评分、css评分均较治疗前明显下降（P〈0．05），MBI评分较治疗前明显增高（P〈0．05）。与对照组治疗后比较，治疗组及联合治疗组治疗后HAMD、CSS、PSQI、MBI评分均无显著变化，差异无统计学意义（P〉0．05）。与联合治疗组治疗后比较，治疗组治疗后HAMD[（9．76±4．59）分]、CSS[（7．65±2．35）分]、PSQI[（16．13±4．12）分]、MBI评分[（52．61±9．26）分]无显著变化，差异无统计学意义（P〉0．05）。结论rTMS可显著改善PSD患者的抑郁症状、睡眠障碍及神经功能缺损状况，有效提高其ADL能力。

Objective To explore the effects of repetitive transeraninal magnetic stimulation （rTMS） on de- pression, sleep disorder and activities of daily life （ADL） in post-stroke depression （PSD） patients. Methods A total of 90 PSD patients were divided into a control group, a treatment group and a combined treatment group accord- ing to a random number table, 30 cases in each group. All patients were given basic treatment and comprehensive re- habilitation training. Moreover, the control group was additionally received eseitalopram treatment, the treatment group rTMS treatment, the combined treatment group the above both, lasting 8 weeks. Before and after the treatment, the Hamilton depression （HAMD） scale, the Pittsburgh sleep quality index （PQSI） ,the Chinese stroke scale （CSS） and the modified Barthel index （MBI） were employed to evaluate depression, quality of sleep, neurological impair- ment and the activities of daily living （ADL） of patients in three groups. Results Before treatment, there was no significant difference in the HAMD, CSS, PSQI and MBI score among the 3 groups. After 8 weeks＇ treatment, the HAMD, PSQI and CSS scores of three groups had significantly decreased, but their MBI scores had significantly in- creased. Compared with the control group, no significant differences were observed in HAMD, CSS, PSQI and MBI scores of the treatment group and the combined treatment group （ P 〉 0.05 ）. After treatment, there was no significant difference in the above four values between the combined treatment group, and the treatment group. Conclusion The rTMS can significantly improve PSD patient＇s depressive symptoms, relieve sleep disorders and neurological defi- cit situation, and effectively improve their ADL.