高频重复经颅磁刺激治疗脑梗死后患者注意障碍的疗效分析

Effect of high frequency repetitive transcranial magnetic stimulation on patients with attention disorder after ischemic stroke

目的探讨高频5~8 Hz重复经颅磁刺激治疗脑梗死后患者注意障碍的疗效。方法采用随机对照实验设计,将82例脑梗死后注意障碍患者随机分为真刺激组和假刺激组。2组患者均常规给予一般康复治疗和认知康复训练,真刺激组在一般康复治疗和认知康复训练的基础上给予5~8 Hz高频rTMS治疗,假刺激组则给予假刺激治疗,均每日1次,每周连续5 d,共治疗3周。所有患者在进行高频经颅磁刺激治疗前1 d和治疗3周后即刻进行蒙特利尔认知评估量表(MoCA)、数字广度测验、Stroop色词测验进行注意功能的评定,同时评估2组患者事件相关电位P300潜伏期和波幅的改善情况。结果治疗15次后,真刺激组和假刺激组MoCA量表评分均高于治疗前,且真刺激组提高更明显(P<0.01);真刺激组和假刺激组P300潜伏期均较治疗前缩短,且真刺激组缩短更明显(P<0.01),真刺激组和假刺激组P300波幅均较治疗前增高,真刺激组增高幅度更大(P<0.05);真刺激组和假刺激组数字广度测验中顺背、倒背得分均明显升高,且真刺激组升高更为显著(P<0.05);真刺激组和假刺激组Stroop色词测验中完成卡片A、B、C耗时均较治疗前缩短,真刺激组耗时缩短更明显(卡片A、C P<0.01,卡片B P<0.05),卡片C错词个数均较治疗前减少,真刺激组减少更明显(P<0.05)。结论5~8 Hz的高频重复经颅磁刺激治疗能显著改善脑梗死后患者的注意障碍。

Objective To explore the effect of high frequency 5-8 Hz repetitive transcranial magnetic stimulation on attention disorder in patients with cerebral infarction.Methods Eighty-two patients with attention disorder after cerebral infarction were randomly divided into the true stimulation group and the sham stimulation group.Both groups were received routine rehabilitation treatment and cognitive training.For the true stimulation group,5-8 Hz rTMS was given at the diseased side of the dorsolateral prefrontal cortex for three weeks and for the sham stimulation group,a sham treatment was given.All patients were assessed with the Montreal cognitive assessment scale(MoCA),digit span test and Stroop color word test one day before and three weeks after the high-frequency transcranial magnetic stimulation treatment.Meanwhile,the improvement of P300 latency and amplitude of event-related potential was evaluated.Results The scores of MoCA were higher either in the real stimulation or in the sham stimulation,and the increase was more obvious in the real stimulation(P<0.01).The latency of P300 were shorter either in the real stimulation or in the sham stimulation,and in the real stimulation group the shortening was obvious(P<0.01).The amplitude of P300 were higher either in the real stimulation or in the sham stimulation,and that in the real stimulation group the was more significant(P<0.05).Forward and backward in digit span test were higher either in the real stimulation or in the sham stimulation,and the increase was more obvious in the real stimulation(P<0.05).The average time of CWT-card A/B/C were significantly decreased in the both groups,and that decrease was more obvious in the real stimulation(card A/C P<0.01,card B P<0.05).The wrong words of CWT-card C were decreased in both groups,and the decrease was more obvious in the real stimulation group(P 0.05).Conclusion 5-8 Hz high frequency repetitive transcranial magnetic stimulation can significantly improve the attention disorder of patients with cerebral infarction.