重复经颅磁刺激对脑卒中后认知功能障碍的影响

Effects of repetitive transcranial magnetic stimulation on post stroke cognitive impairment

目的观察重复经颅磁刺激（rTMS）对脑卒中后认知功能障碍（PSCI）的影响。方法选取PSCI患者30例，采用随机数字表法将其分为对照组（15例）和观察组（15例）。对照组仅给予常规康复训练，观察组给予常规康复训练和rTMS治疗，2组患者分别于治疗前进行蒙特利尔认知评估量表（MoCA）筛查，治疗前后进行洛文斯顿作业疗法认知评定量表（LOTCA）评定。结果治疗前2组患者的LOTCA、MoCA量表评分的差异无统计学意义（P〉0．05）。观察组治疗后LOTCA量表总分与治疗前比较差异有统计学意义（P〈0．05）；观察组治疗后LOT—CA量表中的定向、视知觉、空间知觉、动作运用、视运动组织时间及思维操作的评分与治疗前的差异均有统计学意义（P〈0．05）。对照组患者的LOTCA量表总分以及量表中的各项评分在治疗前后的差异均有统计学意义（P〈0．05）。观察组患者治疗后LOTCA量表总分以及量表中的各项评分较对照组明显提高，组间差异均有统计学意义（P〈0．05）。结论rTMS可有效改善PSCI。LOTCA可较全面地评定PSCI患者的治疗效果。

Objective To observe the effects of repetitive transcranial magnetic stimulation （rTMS） on post stroke cognitive impairment （PSCI）. Methods A total of 30 PSCI patients were randomly divided into a treatment group and a control group （n = 15 ）. The control group was treated with routine therapy, while the treatment group was given rTMS in addition to routine therapy. Both groups were subjected to the Montreal Cognitive Assessment （MoCA） and the Loewenstein Occupational Therapy Cognitive Assessment before and after treatment. Results No statistical differences were found in the scores of LOTCA and MoCA between the two groups before treatment （ P 〈 0.05 ）. The observation group produced a total score of LOTCA after treatment, which was statistically different from the score before treatment （ P 〈 0.05）. Meanwhile, the observation group produced scores of orientation, visual and spatial perceptions, use of action, the movement of organizational time and thinking procedures, which were statistically different from the scores before treatment （P 〈 0.05）. The control group produced a total score of LOTCA and each assessment index mentioned above after treatment, which were statistically different from the scores before treatment （ P 〈 0.05 ）. Compared with the control group, the observation group produced a statistically different total score of LOTCA and each assessment index mentioned above after treatment （P 〈 0.05）. Conclusions rTMS can effectively improve PSCI. The therapeutic efficacy of PSCI patients can be comprehensively assessed by LOTCA.