不同频率重复经颅磁刺激治疗脑卒中后抑郁的对照研究

A comparative study on the treatment of post-stroke depression by repetitive transcranial magnetic stimulation with different frequencies

目的探讨不同频率重复经颅磁刺激(repetitive transcranial magnetic stimulation,r TMS)治疗卒中后抑郁(poststroke depression,PSD)患者的临床疗效。方法选取不伴有认知功能受损的PSD患者共120例,按随机数字表法分为低频组、高频组、对照组各40例,分别接受1 Hz低频r TMS治疗、5 Hz高频r TMS治疗及假刺激治疗,三组同时均予以脑卒中常规药物治疗、心理疏导及综合康复训练,于治疗前、治疗第2周末、治疗第4周末分别用汉密尔顿抑郁量表(HAMD-17)评定抑郁程度、改良巴塞尔指数(MBI)评定日常生活能力。结果治疗前,三组HAMD及MBI评分组间比较差异无统计学意义(P>0.05);治疗第2周末,高频组与低频组HAMD及MBI评分优于对照组(P<0.05),但低频组与高频组比较,差异无统计学意义(P>0.05);治疗第4周末,高频组HAMD及MBI评分优于低频组及对照组(P<0.05)。治疗过程中仅有3例出现轻微不良反应。结论 r TMS治疗PSD安全有效,在疗程为4周时,高频r TMS较低频r TMS对改善PSD程度以及日常生活能力效果更明显。

To investigate the curative effect of low or high frequency repetitive transcranial magnetic stimulation(rTMS)on patients with post-stroke depression(PSD).One hundred and twenty patients with PSD were randomly divided into low-frequency,high-frequency or control group,40 in each group.The three groups received 1 HZ rTMS,5 HZ rTMS or sham stimulation treatment,respectively.At the same time,they were also given conventional treatment of cerebral infarction,psychological counseling and comprehensive rehabilitation training.The HAMD-17 for depression and the MBI for daily life ability were used to evaluate the condition of three groups before treatment,and at the 2 nd and the 4 th week during the treatment.There were no significant differences in HAMD-17 and MBI among the three groups before treatment(P>0.05).However,the HAMD-17 and MBI in the low frequency and the high frequency groups were better than those in the control group at the end of the second week of treatment(P>0.05),but there were no differences between the two rTMS groups(P>0.05).Moreover,the high frequency group of HAMD-17 and MBI were better than the low frequency group and the control group at the end of the fourth week of treatment(P<0.05).Mild adverse reactions occurred in only 3 cases during the course of treatment.The rTMS is safe and effective in the treatment of PSD.It is obviously that high frequency rTMS is better than low frequency rTMS in improving PSD and daily life ability after four weeks of treatment.