rTMS对创伤后康复期PTSD患者核心症状、正负性情绪和心理弹性的影响

Effect of repetitive transcranial magnetic stimulation on core symptoms,positive and negative affects and resilience in rehabilitation patients with post-traumatic stress disorder after traumatic injury

目的研究高频重复经颅磁刺激(repetitive transcranial magnetic stimulation,r TMS)对创伤后应激障碍(post traumatic stress disorder,PTSD)患者核心症状、正负性情绪和心理弹性的影响。方法将40例伴有创伤后应激障碍症状(PTSD评分≥38分)的康复科住院患者分为治疗组20例,接受20 Hz高频r TMS右侧前额叶背外侧区域(DLPFC);对照组20例,采用假性r TMS,刺激部位同治疗组。两组被试分别接受10次,共2周的治疗。在刺激前后分别对两组患者进行创伤后应激障碍症状、心理弹性以及正负性情绪的评定,比较两组患者治疗前后创伤后应激障碍、心理弹性和正负性情绪水平的变化。结果治疗组的创伤后应激障碍总分及各因子分、正负性情绪得分在刺激前后差异有统计学意义(P<0.01),但心理弹性得分在刺激前后没有统计学差异(P>0.05)。对照组假刺激前后在各项评分上均没有统计学差异(P>0.05)。结论 20 Hz高频重复经颅磁刺激可提高患者的积极情绪,减少负性情绪,有效缓解创伤后应激障碍核心症状。

Objective To explore the effect of high-frequency repetitive transcranial magnetic stimulation （rTMS） on the core symptoms, positive and negative affects, and resilience in rehabilitation patients with post-tranmatic stress disorder （PTSD） after traumatic injury. Methods Forty patients with PTSD scores~〉 38 were assigned to a treatment group （n = 20） receiving 20 Hz rTMS at the right dorsolateral prefrontal cortex （DLPFC） area, and a control group （n =20） receiving sham rTMS at the same area. Treatment was performed in total 10 sessions （once per day, for 15 rain, 5 day＇s treatment followed by 2 day＇s resting） for 2 weeks. The 2 groups were assessed before and after treatment according to the PTSD checklist-civilian version （PCL-C）, Connor-Davidson resilience scale （CD-RISC） and positive and negative affect scale （PANAS）. The PTSD core symptoms （flashback, avoidance, hyperarousal, etc. ）, resilience, and positive and negative affects of the 2 groups before and after treatment were compared. Results The treatment of 20Hz rTMS at the right DLPFC significantly alleviated the PTSD core symptoms and improved the positive and negative affects （P 〈 0.01 ）, but resilience was no markedly improved （P 〉0.05）. No statistically significant improvements were found in the control group （P 〉 0.05）. Conclusions 20Hz rTMS at the right DLPFC can enhance positive affect, reduce negative affect, and alleviate the core symptoms of PTSD, and it can be used as the optimal treatment strategy for PTSD.