多靶点重复经颅磁刺激联合针刺在中老年主观性耳鸣中的应用效果

Effect of multi-target repetitive transcranial magnetic stimulation combined with acupuncture on subjective tinnitus in middle-aged and elderly patients

目的探讨多靶点重复经颅磁刺激(rTMS)联合针刺在中老年主观性耳鸣中的应用效果。方法选取2020年6月至2021年5月的就诊于大连市第三人民医院耳鼻喉科的60例中老年重度主观性耳鸣的患者作为研究对象,采用随机数字表法分组发将其分为多靶点磁刺激治疗组、单靶点磁刺激治疗组和针刺组,每组各20例。多靶点磁刺激治疗组患者采用双侧颞顶叶皮质及右侧前额叶背外侧皮质多靶点磁刺激治疗+针刺治疗,单靶点磁刺激治疗组患者采用双侧颞顶叶皮质磁刺激治疗+针刺治疗,针刺组患者采用单针刺治疗。比较三组患者治疗前后的耳鸣残疾量表(THI)、视觉模拟评分法(VAS)评分及不良反应。结果三组患者治疗后的THI和VAS评分均低于治疗前,差异有统计学意义(P<0.05)。治疗后多靶点磁刺激治疗组的THI和VAS评分均低于单靶点磁刺激治疗组及针刺组,差异有统计学意义(P<0.05)。三组患者治疗后不良反应总发生率比较,差异无统计学意义(P>0.05)。结论多靶点重复经颅磁刺激治疗联合针刺治疗中老年中度主观性耳鸣具有明显的治疗效果,可以更有效降低患者耳鸣的严重程度,明显改善患者不适感受。

Objective To explore the clinical efficacy of multi-target repetitive transcranial magnetic stimulation(rTMS)combined with acupuncture in the treatment of subjective tinnitus in the elderly.Methods A total of 60 middle-aged and elderly patients with severe subjective tinnitus admitted to the Department of Otolaryngology of Dalian Third People′s Hospital from June 2020 to May 2021 were selected as the research objects.They were divided into multi-target magnetic stimulation group,single-target magnetic stimulation group and acupuncture group by random number table method,with 20 patients in each group.Patients in the multi-target magnetic stimulation treatment group were treated with multi-target magnetic stimulation plus acupuncture in bilateral temporal parietal cortex and the right dorsolateral prefrontal cortex,patients in the single-target magnetic stimulation treatment group were treated with magnetic stimulation plus acupuncture in bilateral temporal parietal cortex,patients in the acupuncture group were treated with single acupuncture.Tinnitus disability scale(THI),visual analogue scale(VAS)scores and adverse reactions were compared before and after treatment among the three groups.Results THI and VAS scores in the three groups after treatment were lower than before,the differences were statistically significant(P<0.05).Compared with before treatment,the THI and VAS scores in the three groups were decreased after treatment,the differences were statistically significant(P<0.05).After treatment,the THI and VAS scores of multi-target rTMS combined group were lower than those of rTMS group and acupuncture group,the differences were statistically significant(P<0.05).There was no significant difference in the total incidence of adverse reactions between the three groups after treatment(P>0.05).Conclusion Multi-target repetitive transcranial magnetic stimulation combined with acupuncture has obvious therapeutic effect on middle-aged and elderly patients with moderate subjective tinnitus,which can more effectively reduce the severity of tinnitus and significantly improve the discomfort of patients.