高频重复经颅磁刺激及高压氧对脑卒中后认知功能障碍患者的影响

Effects of high-frequency repetitive transcranial magnetic stimulation and hyperbaric oxygen in patients with post-stroke cognitive impairment

目的分析高频重复经颅磁刺激(rTMS)联合高压氧对脑卒中后认知功能障碍(PSCI)患者的影响。方法选取118例PSCI患者,随机分为观察组(n=59)和对照组(n=59)。对照组接受常规药物治疗联合高压氧干预,观察组在对照组基础上另加用高频rTMS进行治疗。比较2组治疗前后蒙特利尔认知评估量表(MoCA)、洛文斯顿作业疗法认知评定量表(LOTCA)及改良Barthel指数(MBI)评分。结果观察组干预期间无脱组病例,剩余59例有效病例,对照组自主退出1例,剩余58例有效病例。治疗后,2组的MoCA各维度评分及总分高于治疗前,且观察组注意与集中、延迟记忆、语言、视空间/执行以及抽象思维维度评分均高于对照组,差异有统计学意义(P<0.05);2组的LOTCA各维度评分及总分高于治疗前,且观察组高于对照组,差异有统计学意义(P<0.05);2组MBI评分高于治疗前,且观察组高于对照组,差异有统计学意义(P<0.05)。结论与高压氧单独治疗相比,高频rTMS联合高压氧治疗在改善脑卒中患者认知障碍和日常生活能力方面具有显著优势。

Objective To analyze the effects of high-frequency repetitive transcranial magnetic stimulation(rTMS)combined with hyperbaric oxygen in patients with post-stroke cognitive impairment(PSCI).Methods A total of 118 patients with PSCI were randomly divided into observation group(n=59)and control group(n=59).The control group received conventional drug therapy combined with hyperbaric oxygen intervention,and the observation group was treated with high-frequency rTMS on the basis of the control group.Montreal Cognitive Assessment Scale(MoCA),Lovingston Occupational Therapy Cognitive Assessment(LOTCA)and Modified Barthel Index(MBI)score were compared between the two groups before and after treatment.Results During the intervention period,there were no drop-out cases in the observation group,remaining 59 effective cases,and one case in the control group withdrew voluntarily,remaining 58 effective cases.After treatment,the item scores and total scores of MoCA in the two groups were significantly higher than before treatment,and the scores of attention and concentration,delayed memory,language,visuospatial/executive and abstract thinking in the observation group were significantly higher than those in the control group(P<0.05);the item scores and total scores of LOTCA Scale in the two groups were significantly higher than before treatment,and the observation group was significantly higher than the control group(P<0.05);the MBI scores in the two groups were significantly higher than before treatment,and the observation group was significantly higher than the control group(P<0.05).Conclusion Compared with hyperbaric oxygen therapy alone,high-frequency rTMS combined with hyperbaric oxygen has significant advantages in improving cognitive impairment and daily living ability in patients with stroke.