不同rTMS模式对精神分裂症幻听患者的应用效果研究

The research study on the application effects of different rTMS modes on auditory hallucinations in patients with schizophrenia

目的探讨不同重复经颅刺激模式(rTMS)对精神分裂症幻听患者的应用效果。方法将2021年1月至2022年6月本院收治的100例精神分裂症伴幻听患者按照随机双盲法分组,rTMS组给予常规1 Hz rTMS模式,连续性Theta节律刺激(cTBS)组给予丛内脉冲50 Hz,丛间脉冲5 Hz的cTBS模式刺激,评估两组临床疗效[阳性与阴性症状量表(PANSS)、幻听症状评估量表(AHRS)]和安全性(副反应量表)。Logistic多因素回归分析影响幻听消失的影响因素。结果治疗后,两组治疗有效率(80.00%VS.92.00%)、副反应发生率(22.00%VS.16.00%)比较无显著差异(P>0.05)。不同时间点、组间PANSS评分、AHRS评分有显著差异(P<0.05),但治疗前、治疗2周后PANSS、AHRS评分组间比较无显著差异(P>0.05),cTBS组治疗4周后及治疗结束1个月后的PANSS评分和AHRS评分均低于rTMS组(P<0.05)。治疗结束1个月后,rTMS组头痛、头皮发麻、嗜睡、头晕评分高于cTBS组(P<0.05)。与幻听未消失组比较,幻听消失组采用cTBS模式治疗的临床有效患者比例较高,出现不良反应患者较少,治疗前至治疗4周后PANSS、AHRS评分差值较高,治疗前至治疗结束1个月后TESS评分差值较低(P<0.05)。Logistic多因素回归分析发现,是否采用cTBS模式治疗是影响幻听治疗效果的影响因素。结论rTMS模式和cTBS模式均有助于改善精神分裂症患者的幻听症状,安全性高,但cTBS模式作用效果较优。

Objective To investigate the effects of different repetitive transcranial stimulation patterns(rTMS)in patients with schizophrenia auditory hallucinations.Methods 100 patients with schizophrenia and auditory hallucinations admitted to our hospital from January 2021 to June 2022 were divided into two groups according to random double-blind method.The rTMS group was given conventional 1 Hz rTMS mode,and the continuous Theta rhythm stimulation(cTBS)group was given cTBS mode stimulation with intrasplexus pulse of 50 Hz and interplexus pulse of 5 Hz.Clinical efficacy[positive and negative symptom scale(PANSS),auditory hallucination symptom assessment scale(AHRS)]and safety indicators[Toronto side effects scale(TESS)]were evaluated.Logistic multivariate regression analyzed the influencing factors affecting auditory hallucinations.Results After treatment,there was no significant difference in the effective rate(80.00%VS.92.00%)and incidence of side effects(22.00%VS.16.00%)between two groups(P>0.05).There were significant differences in PANSS score and AHRS score between groups at different time points(P<0.05),but there were no significant differences in PANSS score and AHRS score between groups before treatment and 2 weeks after treatment(P>0.05).PANSS scores and AHRS scores in the cTBS group were lower than those in the rTMS group after 4 weeks of treatment and 1 month after treatment(P<0.05).One month after treatment,the scores of headache,scalp numbness,lethargy and dizziness in the rTMS group were higher than those in the cTBS group(P<0.05).Compared with the group without disappearance of auditory hallucinations,the proportion of clinically effective patients treated with cTBS mode was higher in the disappearance of auditory hallucinations group,and fewer patients had adverse reactions.The difference of PANSS and AHRS scores was higher from before treatment to 4 weeks after treatment,and the difference of TESS scores was lower from before treatment to 1 month after treatment(P<0.05).Logistic multivariate regression analysis showed that whether cTBS mode was used was an influential factor in the treatment of auditory hallucinations.Conclusion Both rTMS mode and cTBS mode can improve the auditory hallucinations of schizophrenia patients with high safety,but cTBS mode has better effect.