重复经颅磁刺激联合帕罗西汀治疗创伤后应激障碍的临床效果

Clinical effect of repetitive transcranial magnetic stimulation combined with paroxetine in the treatment of posttraumatic stress disorder

目的探讨重复经颅磁刺激(rTMS)联合帕罗西汀治疗创伤后应激障碍(PTSD)的临床效果。方法采用随机数字表法将2020年9月至2021年7月就诊于石河子市某三级甲等医院的63例PTSD患者分为对照组及试验组,其中3例患者因个人原因未能完成后期随访而退出本研究,最终两组各纳入30例。对照组给予帕罗西汀联合虚拟rTMS刺激,试验组给予帕罗西汀联合真实rTMS治疗。比较两组干预前及干预后第20、40、60天的第五版创伤后应激障碍测评量表(PCL-5)、汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD)评分。结果干预后第20、40天,试验组的PCL-5、HAMA及HAMD评分低于对照组,差异具有统计学意义(P<0.05);干预后第60天,两组的PCL-5、HAMA评分无显著差异(P>0.05);干预后第60天,试验组的HAMD评分低于对照组,差异具有统计学意义(P<0.05);两组干预后第20、40、60天的PCL-5、HAMA及HAMD评分低于干预前,差异具有统计学意义(P<0.05)。结论rTMS联合帕罗西汀可快速缓解PTSD患者的核心症状及伴随症状,真实rTMS刺激效果更佳,但其远期疗效及最佳治疗参数、治疗疗程的设置等仍需大样本、多中心的随机对照研究去进一步求证。

Objective To investigate the clinical effect of repetitive transcranial magnetic stimulation(rTMS)combined with paroxetine in the treatment of posttraumatic stress disorder(PTSD).Methods A total of 63 patients with PTSD diagnosed in a third class A hospital in Shihezi from September 2020 to July 2021 were divided into control group and experimental group by random number table method,three patients withdrew from the study because they failed to complete follow-up due to personal reasons,finally,30 case were included in each group.The control group was given paroxetine combined with virtual rTMS stimulation,and the experimental group was given paroxetine combined with real rTMS stimulation.The scores of PTSD Checklist for DSM-5(PCL-5),Hamilton Anxiety Scale(HAMA)and Hamilton Depression Scale(HAMD)were compared between the two groups before intervention and at the 20th,40th and 60th days after intervention.Results At the 20th and 40th days after intervention,the scores of PCL-5,HAMA and HAMD in the experimental group were lower than those in the control group,and the differences were statistically significant(P<0.05);at the 60th day after intervention,there were no significant differences in PCL-5 and HAMA scores between the two groups(P>0.05);at the 60th day after intervention,the HAMD score in the experimental group was lower than that in the control group,and the difference was statistically significant(P<0.05);at the 20th,40th and 60th days after intervention,the scores of PCL-5,HAMA and HAMD in the two groups were lower than those before intervention,and the differences were statistically significant(P<0.05).Conclusion The rTMS combined with paroxetine can rapidly relieve the core symptoms and concomitant symptoms of PTSD patients,and the effect of real rTMS stimulation is better,but its long-term efficacy,the best treatment parameters,and the setting of treatment course still need to be further verified by a large sample,multicenter randomized controlled study.