重复经颅磁刺激联合虚拟现实技术对脑卒中后认知障碍的影响

Effect of repetitive transcranial magnetic stimulation combined with virtual reality technology on post-stroke cognitive impairment

目的观察重复经颅磁刺激(rTMS)联合虚拟现实技术(VR)对卒中后认知障碍的影响。方法选择中国五冶集团有限公司医院康复医学科自2021年4月至2022年8月收治的153例PSCI患者为研究对象,采用随机数字表法分为联用组、rTMS组和对照组,根据纳排标准最终得到联用组49例,rTMS组和对照组各48例。对照组采用常规认知康复训练+假磁刺激,rTMS组在对照组基础上改用真实的rTMS刺激,联用组在rTMS组基础上加用VR技术,3组均干预8周。在治疗前和治疗8周后,观察3组患者的蒙特利尔认知评估量表(MoCA)量表、Stroop色词试验(SCWT)、美国国立卫生研究院卒中量表(NIHSS),并检测超敏C反应蛋白(hs-CRP)、脑源性神经营养因子(BDNF)、血清神经元特异性醇化酶(NSE)、同型半胱氨酸(HCY)、超氧化物歧化酶(SOD)的水平。结果联用组的MoCA评分和SCWT结果均高于rTMS组和对照组,NIHSS评分低于对照组,差异有统计学意义(P<0.05)。联用组的BDNF水平高于rTMS组和对照组,NSE、HCY水平低于rTMS组和对照组,hs-CRP水平低于对照组,SOD水平高于对照组,差异有统计学意义(P<0.05)。结论rTMS联合VR技术能够改善PSCI患者的认知障碍,促进神经功能恢复,改善相关生化指标。

Objective To observe the effect of repetitive transcranial magnetic stimulation(rTMS)combined with virtual reality(VR)technology on cognitive impairment after stroke.Methods One hundred and fifty-three PSCI patients admitted to the Rehabilitation Medicine Department of China MCC5 Group Corp.Ltd.Hospital from April 2021 to August 2022 were selected as the research subjects.They were divided into a combination group,rTMS group,and control group using a random number table method.According to the inclusion and exclusion criteria,49 cases were obtained in the combination group,48 cases in the rTMS group,and 48 cases in the control group.The control group received routine cognitive rehabilitation training and false magnetic stimulation,the rTMS group switched to real rTMS stimulation on top of the control group,while the combination group added VR technology on top of the rTMS group.All three groups were intervened for 8 weeks.Before and after 8 weeks of treatment,the Montreal cognitive assessment scale(MoCA),Stroop color word test(SCWT),and National Institutes of Health stroke scale(NIHSS)were observed in three groups of patients,and the levels of hypersensitive C-reactive protein(hs-CRP),brain derived neurotrophic factor(BDNF),serum neuron specific enolase(NSE),homocysteine(HCY),and superoxide dismutase(SOD)were measured.Results The MoCA score and SCWT results of the combination group were higher than those of the rTMS group and the control group,while the NIHSS score was lower than that of the control group,and the difference was statistically significant(P<0.05).The BDNF level in the combination group was higher than that in the rTMS group and control group,while the NSE and HCY levels were lower than those in the rTMS group and control group,the hs-CRP level was lower than that in the control group,and the SOD level was higher than that in the control group,with statistical significance(P<0.05).Conclusion rTMS combined with VR technology can improve cognitive impairment,promote neural function recovery,and improve related biochemical indicators in PSCI patients.