间歇性θ短阵脉冲刺激治疗缺血性脑卒中后重度抑郁的临床研究

A Clinical Study of Intermittent θ Short Burst Stimulation of Rapid Pulses in the Treatment of Severe Depression after Ischemic Stroke

目的:探讨间歇性θ短阵脉冲刺激(iTBS)治疗缺血性脑卒中后重度抑郁的临床研究。方法:选取2020年6月-2021年8月赣州市第三人民医院就诊的105例卒中后抑郁(PSD)(重度)患者,根据随机数字表法分为三组,各35例。A组口服草酸艾司西酞普兰片+iTBS模式重复经颅磁刺激治疗。B组口服草酸艾司西酞普兰片+常规模式重复经颅磁刺激治疗。C组仅口服草酸艾司西酞普兰片。三组患者均连续治疗6周。比较三组疗效、汉密尔顿抑郁量表17项版(HAMD-17)、蒙特利尔认知评估量表(MoCA)、治疗副反应量表(TESS)评分,椎基底动脉的平均血流速度(Vm)、搏动指数(PI)、收缩期峰值血流速度(Vs)、舒张末期血流速度(Vd)、阻力指数(RI)。结果:治疗前,三组HAMD-17、MoCA评分和Vm、PI、Vs、Vd和RI水平比较,差异均无统计学意义(P>0.05)。治疗6周,A组HAMD-17评分低于B组和C组,且B组低于C组,差异均有统计学意义(P<0.05)。治疗后,A组MoCA评分高于B组和C组,且B组高于C组,差异均有统计学意义(P<0.01)。治疗后,A组Vm、Vs与Vd均高于B组和C组,PI、RI均低于B组和C组,且B组Vm、Vs与Vd均高于C组,PI低于C组,差异均有统计学意义(P<0.05)。治疗后,A组TESS评分低于B组和C组,且B组低于C组,差异均有统计学意义(P<0.05)。A组总有效率高于B组和C组,差异均有统计学意义(P<0.05)。结论:iTBS治疗PSD效果确切,可有效改善患者的抑郁症状和认知功能,提高脑血流量供应,值得临床借鉴。

Objective:To investigate the clinical study of intermittentθshort burst stimulation of rapid pulses(iTBS)in the treatment of severe depression after ischemic stroke.Method:A total of 105 post stroke depression(PSD)(severe)patients treated in the Third People’s Hospital of Ganzhou from June 2020 to August 2021 were selected,they were divided into three groups according to random number table method,with 35 patients in each group.Group A was treated with oral Escitalopram Oxalate Tablets and repeated transcranial magnetic stimulation in iTBS mode.Group B was treated with oral Escitalopram Oxalate Tablets and conventional repeated transcranial magnetic stimulation(TMS).Group C only took Escitalopram Oxalate Tablets orally.Patients in three groups were treated for 6 weeks.The efficacy,17-item Hamilton depression scale(HAMD-17),Montreal cognitive assessment scale(MoCA),treatment emergent symptom scale(TESS)scores,mean blood flow velocity(Vm),pulse index(PI),peak systolic blood flow velocity(Vs),end diastolic blood flow velocity(Vd)and resistance index(RI)in vertebrobasilar artery were compared among three groups.Result:Before treatment,there were no significant differences in HAMD-17,MoCA scores,Vm,PI,Vs,Vd and RI levels among three groups(P>0.05).After 6 weeks of treatment,HAMD-17 score of the group A were lower than those of the group B and group C,and that of the group B was lower than that of the group C,the differences were statistically significant(P<0.05).After treatment,MoCA score of the group A was higher than those of the group B and C,and that of the group B was higher than that of the group C,the differences were statistically significant(P<0.01).After treatment,Vm,Vs and Vd of the group A were higher than those of the group B and group C,while PI and RI of the group A were lower than those of the group B and group C,Vm,Vs and Vd of the group B were higher than those of the group C,while PI of the group B was lower than that of the group C,the differences were statistically significant(P<0.05).After treatment,the TESS scores of the group A was lower than that of the group B and C,and that of the group B was lower than that of the group C,the differences were statistically significant(P<0.05).The total effective rate of the group A were higher than those of the group B and group C,the differences were statistically significant(P<0.05).Conclusion:iTBS has a definite curative effect in the treatment of PSD(severe),can effectively improve the depressive symptoms and cognitive function of patients,and improve the supply of cerebral blood flow,which is worthy of clinical reference.