重复经颅磁刺激联合康复训练对脑卒中患者神经功能缺损程度及心理障碍的影响

Observation on the effect of transcranial magnetic stimulation combined with rehabilitation training on the neurological deficit and psychological disorders in patients with stroke

目的观察重复经颅磁刺激联合康复训练治疗对脑卒中患者神经功能缺损程度及心理障碍的影响。方法将2017年10月—2018年12月河北医科大学第一医院收治的60例脑卒中患者采用随机数字表法分为对照组和治疗组各30例,2组患者均给予常规基础药物治疗及患侧肢体的康复干预,治疗组在此基础上给予重复经颅磁刺激(rTMS)治疗,共治疗4周。比较2组治疗前后汉密尔顿焦虑量表(HAMA)评分、汉密尔顿抑郁量表(HAMD)评分、美国国立卫生研究院卒中量表(NIHSS)评分以及运动诱发电位(MEP)波幅及中枢运动传导时间(CMCT)。结果治疗后2组患者的HAMA、HAMD、NIHSS评分均较治疗前明显降低,且治疗组各评分明显低于对照组,差异均有统计学意义(P均<0.05)。治疗后2组患者MEP波幅均较治疗前显著提高,CMCT均较治疗前显著缩短,且治疗组MEP波幅、CMCT改善更为明显,差异均有统计学意义(P均<0.05)。结论重复经颅磁刺激联合康复训练不但可以改善患者的神经功能缺损程度,还能够改善患者的心理障碍状况。

Objective It is to observe the effect of transcranial magnetic stimulation combined with rehabilitation training on the neurological deficit and psychological disorders in patients with stroke.Methods Sixty stroke patients admitted to the First Hospital of Hebei Medical University from October 2017 to December 2018 were divided into a control group(n=30)and a treatment group(n=30)according to a random number table,30 cases in each group.All patients in both groups were given conventional basic medical treatment and rehabilitation intervention for affected limb.The treatment group was additionally given repeated transcranial magnetic stimulation(rTMS),both groups were treated for a total of 4 weeks.The scores of Hamilton Anxiety Scale(HAMA),Hamilton Depression Scale(HAMD),National Institutes of Health Stroke Scale(NIHSS),motor evoked potential(MEP)amplitude and central motor conduction time(CMCT)before and after treatment were compared between the two groups.Results After 4 weeks of treatment,the scores of HAMA,HAMD,and NIHSS were significantly lower than those before treatment in the two groups,and the scores of the treatment group were significantly lower than those of the control group,and the differences were statistically significant(P<0.05).After treatment,the amplitude of MEP was significantly higher than that before treatment,and the value of CMCT was significantly shorter than that before treatment in the two groups,the improvement of MEP amplitude and CMCT in the treatment group was better than that of the control group,and the differences were statistically significant(P<0.05).Conclusion Repetitive transcranial magnetic stimulation combined with rehabilitation training can not only improve the patient's neurological deficit,but also improve the patient's psychological disorder.