生物反馈对脑卒中后抑郁患者的情绪及压力测试参数的影响

The effects of biofeedback therapy on mood and stress test parameters in patients with post-stroke depression

目的研究心率变异性生物反馈对脑卒中后抑郁患者情绪改善、自主神经功能的影响,同时观察反馈在压力应激刺激下心率变异性指标的变化规律。方法住院脑卒中后抑郁患者48例,随机数字表法分为反馈组24例和对照组24例,反馈组在常规康复治疗基础上给予心率变异性生物反馈治疗,在治疗前后采用汉密尔顿抑郁量表(HAMD)、改良巴氏指数(MBI)测试,比较2组的分值变化。并在治疗前后以认知能力测试作为压力应激源,在安静基线状态、压力应激状态及结束休息状态下,了解HRV指标变化规律,并比较2组的疗效。结果反馈组经过治疗后HAMD阻滞因子、睡眠障碍因子与对照组比较有明显改善(t=-2.10,P=0.04;t=7.88,P=0.01)。压力应激源刺激下,反馈组低频段(LF)和心率(HR)比对照组升高缓慢(t=36.13,P=0.02;t=14.88,P=0.02),在休息结束时反馈组的HR恢复速度较快(t=27.16,P=0.05)。结论 HRV生物反馈可以提高脑卒中后抑郁患者的HRV指标并改善情绪。应对压力应激刺激时,通过降低交感神经敏感性,强化迷走神经活动,使个体的交感神经和副交感神经达到动态的平衡,增强了应对各种变化的适应性能力。但HRV生物反馈长期效应的理论有待进一步研究。

Objective To investigate the effects of biofeedback therapy on mood and autonomic nervous function im-provement in patients with post-stroke depression, and meanwhile observe the variation of heart rate variability （ HRV） param-eters under stress.Methods Forty-eight patients with post-stroke depression were randomly divided into feedback and control groups.Besides conventional rehabilitation, feedback patients received additional HRV biofeedback therapy.Hamilton De-pression Scale （ HAMD） and Modified Barthel Index （ MBI） were used to compare the efficacy differences of the two groups before and after treatment.We also conducted cognitive stress tests as stressors before and after treatment, and observed HRV variation of the two groups in quiet baseline state, cognitive stress state, and resting state were tracked to compare the thera-peutic effects.Results Compared with the control group, the HAMD retardarce score （ t =-2.10, P =0.04） and HAMD sleep disturbance score （ t =7.88, P =0.01） of the feedback group were significantly improved after treatment;the low fre-quecncy （LF） and heart rate （HR） of the feedback group increased slowly（ t =36.13, P =0.02, t =14.88, P =0.01）. under the stress conditions; and the HR recovery of the feedback group was faster than the feedback group after rest （ t =27.16, P =0.05）.Conclusion HRV biofeedback can improve the HRV parameters and mood in patients with post-stroke depression.Under stress conditions, patients that have received HRV biofeedback therapy can achieve a dynamic balance be-tween sympathetic and parasympathetic nerves,which improved patients’ adaptive capacity to various changes.