低频重复经颅磁刺激治疗对卒中后抑郁患者认知和日常生活能力的影响

Effects of Low-frequency Repetitive Transcranial Magnetic Stimulation on Cognitive Function and Daily Life Ability in Patients with Post Stroke Depression

目的:探讨低频重复经颅磁刺激(r TMS)治疗对卒中后抑郁(PSD)患者认知和日常生活能力的影响。方法:PSD伴轻度认知障碍患者128例随机分为对照组和r-TMS组,各64例。对照组给予常规药物治疗及早期肢体功能康复、心理疏导和抗抑郁治疗;r-TMS组在对照组治疗基础上加用低频r-TMS治疗。疗程均为8周。分别于治疗前和治疗后4、8周,采用汉密顿抑郁量表(HAMD)-17评定患者抑郁程度,简易精神状态检查量表(MMSE)评定患者认知功能,巴塞尔指数(BI)评定患者的日常生活能力。结果:治疗前2组患者HAMD、MMSE评分及BI差异无统计学差异(P>0.05);治疗后2组HAMD评分均低于治疗前,MMSE评分及BI指数高于治疗前(P<0.05),r-TMS组改善程度优于对照组(P<0.05或0.01)。r-TMS组未发生严重不良反应。结论:低频r-TMS治疗PSD患者的抑郁症状的效果明显,能够提高患者的认知功能及日常生活能力,且不良反应少。

Objective： To explore the effects of low-frequency repetitive transcranial magnetic stimulation （r-TMS） on cognitive function and daily life ability of patients with post stroke depression （PSD）. Methods： One-hundred and twenty-eight patients with PSD and mild cognitive impairment were enrolled and randomly divided into control group and r-TMS group with 64 cases in each group. Foundation treatment such as nerve nutrition, dilate blood ves-sels, early limb function rehabilitation, psychological counseling and antidepressant treatment were implemented in the control group. Cases in r-TMS group were treated with low-frequency r-TMS on the basis of foundation treat-ment for 8 weeks. The degree of depression were evaluated by using Hamilton depression scale （HAMD）-17; the cognitive function were evaluated by using mini-mental state examination （MMSE）, and daily life ability were eval-uated by using Barthel index （BI） before and 4 and 8 weeks after treatment in two groups. Results： There were no difference in HAMD and MMSE scores and BI between two the groups （P〉0.05） before treatment. After treatment, both groups showed lower HAMD scores as well as higher MMSE scores and BI than those before treatment （P〈0.05）. The scores of HAMD, MMSE and BI were improved more significantly in r-TMS group than those in control group （P〈0.05 or 0.01）. No serious adverse event was found in r-TMS group. Conclusion： Low-frequency r-TMS is an effective and safe therapy for patients with PSD, which can relieve depression and improve the cognitive func-tion and daily life ability.