高频重复经颅磁刺激联合认知行为治疗对脑卒中后焦虑和抑郁共病状态患者的影响

Effects of high-frequency repetitive transcranial magnetic stimulation combined with cognitive behavioral therapy on patients with anxiety and depression comorbidities after stroke

目的观察高频重复经颅磁刺激(rTMS)联合认知行为治疗对脑卒中后焦虑(PSA)、脑卒中后抑郁(PSD)共病状态患者的影响。方法采用随机数字表法将160例脑卒中后焦虑抑郁状态患者分为对照组和观察组。两组患者均给予脑卒中常规治疗、抗抑郁药物治疗和认知行为治疗,对照组同时给予高频rTMS假刺激治疗,观察组则给予高频rTMS真刺激治疗。观察4周后2组患者抑郁症状、焦虑症状、睡眠质量、日常生活能力改善情况。结果两组患者汉密尔顿抑郁量表(HAMD)评分、汉密尔顿焦虑量表(HAMA)评分、匹兹堡睡眠指数量表(PSQI)、改良Barthel指数(MBI)在治疗前差异无统计学意义(P均>0.05)。治疗4周后,对照组和观察组的HAMD评分、HAMA评分、PSQI较治疗前下降,差异有统计学意义(P均<0.05),其中观察组下降更为明显,与对照组相比,差异有统计学意义(P<0.05)。对照组和观察组MBI与治疗前相比,均有明显提高,差异有统计学意义(P<0.05),而观察组和对照组相比,观察组分数提高更显著,差异有统计学意义(P<0.05)。观察组治疗有效率为87.50%,高于对照组的71.25%。两组之间差异有统计学意义(Uc=-3.45,P<0.001)。结论高频rTMS治疗联合认知行为治疗和认知行为治疗均能有效改善PSA+PSD患者的焦虑抑郁症状、睡眠质量及日常生活能力,但高频rTMS治疗联合认知行为治疗的效果更加明显。

Objective To observe the effect of high-frequency repeated transcranial magnetic stimulation(rTMS)and cognitive behavioral treatment on patients with comorbid post-stroke anxiety(PSA)and post-stroke depression(PSD).Methods A total of 160 patients with anxiety and depression after stroke were divided into control group and observation group by random number table method.All patients in 2 groups were given routine treatment for stroke,antidepressant therapy and cognitive behavioral therapy.The control group was also given high-frequency repetitive transcranial magnetic stimulation sham stimulation,and the observation group was given high-frequency repetitive transcranial magnetic stimulation true stimulation.After 4 weeks,the improvement of depression symptoms,anxiety symptoms,sleep quality,and daily life ability in group 2 patients were observed.Results At baseline,there were no significant differences in the Hamilton depression scale(HAMD)score,Hamilton anxiety scale(HAMA)score,Pittsburgh sleep index number scale(PSQI)score,and modified Barthel index(MBI score)(P>0.05).After 4 weeks of treatment,HAMD score,HAMA score and PSQI score all decreased compared with the treatment before.The difference was statistically significant(P<0.05).The MBI score of the control group and the observation group was significantly improved compared with that before treatment,with statistical significance(P<0.05),while the score of the observation group was significantly improved compared with that of the control group,with statistical significance(P<0.05).The treatment effective rate of the observation group was 87.50%,which was higher than that of the control group(71.25%).There was a significant difference between the two groups(Uc=-3.45,P=0.001).Conclusion High frequency repetition and cognitive behavior therapy can effectively improve the anxiety and depression,but the quality of repeated TMS treatment and cognitive behavior treatment is more obvious,and cognitive behavior treatment may take longer time and is related to the patient’s own comprehension ability.