重复经颅磁刺激治疗缺血性脑卒中后认知功能障碍的效果

Effect of repetitive transcranial magnetic stimulation in the treatment of cognitive dysfunction after ischemic stroke

目的探究重复经颅磁刺激(rTMS)治疗缺血性脑卒中后认知功能障碍的效果。方法选取2018年3月至2021年3月江苏省无锡市第五人民医院接收的82例缺血性脑卒中后认知功能障碍患者。按照随机数字表法将其分为单一组(尼莫地平,连续4周)和联合组(rTMS+尼莫地平,连续4周),各41例。统计两组治疗前及治疗4周后蒙特利尔认知评估(MoCA)评分、脑循环动力学指标、改良Barthel指数(MBI)与脑卒中专用生活质量(SS-QOL)量表评分。结果82例患者中途有5例退出,剩余77例,其中单一组剩余40例,联合组剩余37例。治疗4周后,两组MoCA、MBI、SS-QOL评分及脑部平均血流量、平均流速均高于治疗前,血管阻力低于治疗前,且联合组MoCA、MBI、SS-QOL评分及脑部平均血流量、平均流速均高于单一组,血管阻力低于单一组(P<0.05)。两组不良反应总发生率比较,差异无统计学意义(P>0.05)。结论rTMS治疗缺血性脑卒中后认知功能障碍的效果确切,能有效改善患者认知功能,促进脑血流量增加,安全性较好,可以在临床中推广。

Objective To investigate the effect of repetitive transcranial magnetic stimulation(rTMS)in the treatment of cognitive dysfunction after ischemic stroke.Methods A total of 82 patients with cognitive dysfunction after ischemic stroke admitted to the Fifth People’s Hospital of Wuxi,Jiangsu Province from March 2018 to March 2021 were selected.According to the random number table method,they were divided into single group(Nimodipine,four consecutive weeks)and combined group(rTMS+Nimodipine,four consecutive weeks),with 41 cases in each group.The Montreal cognitive assessment(MoCA)score,cerebral circulation dynamics index,modified Barthel index(MBI),and stroke specific quality of life(SS-QOL)scale score before and after four weeks of treatment were analyzed.Results Among the 82 patients,five dropped out and the remaining 77 cases were included,including 40 cases in the single group and 37 cases in the combined group.After four weeks of treatment,the scores of MoCA,MBI,SS-QOL,mean cerebral blood flow,and mean cerebral flow velocity in the two groups were higher than those before treatment,and the vascular resistance was lower than that before treatment;the scores of MoCA,MBI,SS-QOL,mean cerebral blood flow,and mean velocity in the combined group were higher than those in the single group,and the vascular resistance was lower than that in the single group(P<0.05).There was no significant difference in the total incidence of adverse reactions between the two groups(P>0.05).Conclusion rTMS is effective in the treatment of cognitive dysfunction after ischemic stroke,which can effectively improve the cognitive function of patients and promote the increase of cerebral blood flow,with good safety,and can be popularized in clinical practice.