早期丹佛康复训练模式联合rTMS、针灸对孤独症谱系障碍患儿的临床疗效、孤独症状严重程度、意志控制力及综合协调能力的影响

Effects of early early start Denver model combined with rTMS and acupuncture on clinical efficacy,severity of loneliness symptoms,will control and comprehensive coordination in children with autism spectrum disorder

目的:探讨早期丹佛康复训练模式(Early start Denver model,ESDM)联合重复经颅磁刺激(Repetitive transcranial magnetic stimulation,rTMS)、针灸对孤独症谱系障碍(Autism spectrum disorder,ASD)患儿的临床疗效、孤独症状严重程度、意志控制力及综合协调能力的影响.方法:选取2020年2月至2022年5月平顶山市第一人民医院收治的96例ASD患儿作为研究对象,采用随机数字表法分为常规治疗组和ESDM联合组,各48例.常规治疗组采取rTMS和针灸治疗,ESDM联合组在常规治疗组基础上采用ESDM治疗.比较两组临床疗效、治疗前及治疗6 w、12 w后两组儿童孤独症评定量表(Child autism rating scale,CARS)、孤独症儿童行为检查表(Autism behavior checklist,ABC)、儿童孤独症治疗评定量表(Autism treatment evaluation checklist,ATEC)、视听整合连续性测试(Integrated visual and auditory continuous performance test,IVA-CPT)结果、事件相关电位P3波幅和潜伏期.结果:ESDM联合组临床总有效率明显高于常规治疗组(P<0.05).治疗6 w、12 w后,两组CARS、ABC、ATEC评分均降低,IVA-CPT综合注意力评分和综合反应控制评分均升高,且ESDM联合组CARS、ABC、ATEC评分低于常规治疗组,IVA-CPT综合注意力评分、IVA-CPT综合反应控制评分高于常规治疗组(P<0.05);治疗6 w、12 w后,两组P3波幅均增大,P3潜伏期均缩短,且ESDM联合组变化幅度大于常规治疗组(P<0.05).结论:采用ESDM联合rTMS、针灸及可有效改善ASD患儿的临床症状、意志控制力及综合协调能力、异常脑电活动,进而提高临床疗效.

Objective:To explore the effects of early early start Denver model(ESDM)combined with repetitive transcranial magnetic stimulation(rTMS)and acupuncture on clinical efficacy,severity of loneliness symptoms,will control and comprehensive coordination in children with autism spectrum disorder(ASD).Methods:A total of 96 children with ASD admitted to the First People's Hospital of Pingdingshan City from February 2020 to May 2022 were collected and divided into conventional treatment group and ESDM combined group by random number table method,with 48 cases in each group.The conventional treatment group was treated with rTMS and acupuncture,and the ESDM combined group was treated with ESDM based on the conventional treatment group.The clinical efficacy,child autism rating scale(CARS),autism behavior checklist(ABC),autism treatment evaluation checklist(ATEC),integrated visual and auditory continuous performance test(IVA-CPT)results,event-related potential P3 amplitude and latency before and after 6 weeks and 12 weeks of treatment were compared between the two groups.Results:The total effective rate of ESDM combined group was higher than that of conventional treatment group(P<0.05).After 6 and 12 weeks of treatment,CARS,ABC and ATEC scores were decreased in both groups,comprehensive attention score and comprehensive response control score of IVA-CPT were increased,and CARS,ABC and ATEC scores in ESDM combined group were lower than those in conventional treatment group.comprehensive attention score and comprehensive response control score of IVA-CPT were higher than those in conventional treatment group(P<0.05).After 6 and 12 weeks of treatment,P3 amplitude increased and P3 latency were decreased in both groups,and the change range in ESDM combined group were greater than those in conventional treatment group(P<0.05).Conclusion:ESDM combined with rTMS and acupuncture can effectively improve the clinical symptoms,volitional control,comprehensive coordination ability and abnormal brain electrical activity in children with ASD,so as to improve the clinical efficacy.