高压氧同步舱内经颅直流电刺激治疗卒中后疲劳的临床研究

Clinical study on synchronized transcranial direct current stimulation in hyperbaric oxygen chamber in the treatment of post-stroke fatigue

目的:评估高压氧同步舱内经颅直流电刺激治疗卒中后疲劳的临床疗效及对血清炎性因子的影响。方法:收集2021年6月~2022年11月在我院住院的90例出现卒中后疲劳的缺血性脑卒中患者,将其随机分为3组,每组30例。A组给予常规治疗,B组在A组治疗基础上加用高压氧同步舱内经颅直流电刺激治疗,C组在A组治疗基础上加用高压氧同步舱内经颅直流电假刺激治疗。评估3组治疗前及治疗4周后疲劳严重程度量表(FSS)、多维疲劳量表(MFI-20)评分变化,并检测血清C反应蛋白(CRP)、血清白细胞介素-1β(IL-1β)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)浓度变化。结果:治疗后,A组FSS及MFI-20评分与治疗前相比有下降趋势,但差异无统计学意义,B组和C组的FSS及MFI-20评分均较治疗前及A组下降(均P<0.05),且B组低于C组(P<0.05)。治疗后,3组血清CRP、IL-1β、IL-6、TNF-α浓度均较治疗前降低(P<0.05)。治疗后,3组血清CRP浓度比较差异无统计学意义;B组和C组的IL-1β、IL-6、TNF-α浓度均低于A组(均P<0.05),且B组低于C组(P<0.05)。B组治疗4周后血清IL-1β、TNF-α、IL-6浓度与FSS评分、MFI-20评分均成正相关(P<0.05)。结论:高压氧同步舱内经颅直流电刺激能有效改善卒中后疲劳患者的疲劳程度,其机制可能与血清炎性因子浓度降低有关。

Objective:To evaluate the clinical effect of synchronized transcranial direct current stimulation(tDCS)in hyperbaric oxygen chamber on post-stroke fatigue and its impact on serum inflammatory factors.Methods:A total of 90 patients with post-stroke fatigue hospitalized in our hospital from June 2021 to November 2022 were randomly divided into three groups:A,B and C,with 30 patients in each group.Group A was given routine treatment,group B was treated with hyperbaric oxygen combined with synchronized tDCS on the basis of group A,and group C was treated with hyperbaric oxygen combined with Sham synchronized tDCS on the basis of group A.The changes in the scores of fatigue severity scale(FSS)and multidimensional fatigue scale(MFI-20)in three groups before and 4 weeks after treatment were evaluated,and the serum levels of C-reactive protein(CRP),interleukin-1β(IL-1β),IL-6 and tumor necrosis factor-α(TNF-α)were detected.Results:For comparison before and after treatment in each group,and among groups after treatment,FSS score and MFI-20 score in group A showed a downward trend,but the difference was not statistically significant;The FSS score and MFI-20 score in group B and group C decreased significantly(P<0.05);In three groups,serum levels of CRP,IL-1β,IL-6 and TNF-αwere all decreased with statistically significant difference(P<0.05).After 4 weeks of treatment,the FSS score and MFI-20 score in group B and group C were lower than those in the group A,and those in group B were the lowest(P<0.05).There was no significant difference in serum CRP concentration among the three groups.IL-1β,IL-6 and TNF-αconcentrations in groups B and C were lower than those in the group A,and those in the group B was the lowest(P<0.05).IL-1β,TNF-αand IL-6 concentrations were positively correlated with FSS score and MFI-20 score in group B at 4th week after treatment.Conclusion:Synchronized tDCS in hyperbaric oxygen chamber can effectively improve the degree of fatigue in patients with post-stroke fatigue,and its mechanism may be related to the reduction of the concentration of serum proinflammatory cytokines.