重复经颅磁刺激联合曲唑酮治疗脑卒中后抑郁伴睡眠障碍患者的临床效果观察

Observation of clinical effect of repetitive transcranial magnetic stimulation combined with trazodone in the treatment of post-stroke depression patients with sleep disorders

目的 探讨重复经颅磁刺激(rTMS)+曲唑酮治疗脑卒中后抑郁(PSD)伴睡眠障碍的临床效果。方法 收集2019年8月至2021年8月我院收治的PSD伴睡眠障碍者107例,其中曲唑酮治疗48例(对照组),曲唑酮+rTMS59例(联合组)。治疗6周,比较两组治疗前后睡眠状况、认知水平、生活能力、抑郁情况、脑源性神经营养因子(BDNF)水平变化以及不良反应。结果 治疗后联合组觉醒次数(AT)、睡眠潜伏期(SL)均低于对照组,总睡眠时间(TST)、睡眠效率(SE)高于对照组(P<0.05);两组简易智力状态检查量表(MMSE)、蒙特利尔认知评估量表(MoCA)及日常生活能力量表(ADL)评分均较治疗前升高,且联合组高于对照组(P<0.05);治疗后两组抑郁量表(HAMD)评分降低,BDNF升高,且联合组HAMD评分低于于对照组,BDNF水平高于对照组(P<0.05);两组患者不良反应发生情况比较差异无统计学意义(P>0.05)。结论 rTMS联合曲唑酮可明显改善PDS伴睡眠障碍者睡眠者抑郁情况及睡眠质量,提高认知功能,不增加不良反应,有良好的耐受性。

Objective To investigate the clinical effect of repetitive transcranial magnetic stimulation(rTMS) + trazodone in the treatment of post-stroke depression(PSD) patients with sleep disorders.Methods One hundred and seven patients with PSD and sleep disorder treated in our hospital from August 2019 to August 2021 were collected. Among these patients, 48 patients were treated with trazodone(control group) and 59 patients were treated with trazodone + rTMS(combination group). After 6 weeks of treatment, the sleep status, cognitive level, living ability, depression, changes in levels of brain-derived neurotrophic factor(BDNF) and adverse reactions were compared before and after treatment between the two groups.Results After treatment, the number of awakenings(AT) and sleep latency(SL) in the combined group were lower than those in the control group, while the total sleep time(TST) and sleep efficiency(SE) in the combined group were higher than those in the control group(P<0.05). After treatment, the scores of Mini-mental State Examination(MMSE) score, Montreal Cognitive Assessment(MoCA) score, and Activities of Daily Living(ADL) were all increased when compared with those before treatment, and the combined group was higher than the control group(P<0.05). After treatment, the HAMD score was decreased and BDNF was increased in the two groups, and the HAMD score was lower, and the level of BDNF was higher in the combined group than those in the control group(P<0.05). There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusions rTMS combined with trazodone can significantly improve the depression and sleep quality of patients with PDS and sleep disorders, and increase the cognitive function. It does not increase the adverse reactions and has a good tolerance.