高频重复经颅磁刺激联合心理疗法对颅脑创伤住院患者创伤应激障碍症状、心理健康的影响

Effect of high-frequency repetitive transcranial magnetic stimulation combined with psychotherapy on symptoms of traumatic stress disorders and mental health of patients with craniocerebral trauma

目的:探讨高频重复经颅刺激(repetitive transcranial magnetic stimulation,rTMS)联合心理疗法对颅脑外伤住院患者创伤应激障碍症状及心理健康的影响。方法:选取我院70例颅脑外伤后发生创伤应激障碍(post traumatic stress disorder,PTSD)患者为研究对象,根据住院单双号随机分为常规组与联合组,患者均予以常规脑外科干预,并予以舍曲林等抗精神药治疗,常规组予以rTMS治疗,每7d为1个周期,共治疗2个周期,观察组在常规组治疗基础上联合心理疗法,干预2周。干预前后采用创伤后应激障碍症状检查表-平民版(PTSD,ChecklistCivilian Version,PCL-C)问卷调查评估其临床症状改善情况,心理弹性量表(connor-Davidson Resilience Scale,CD-RISC)及正负性情绪量表(Positive and Negative Affect Scale,PANAS)评估其心理状态。结果:干预后常规组反复重现体验、回避症状评分、警觉症状评分,均显著高于观察组(t=2.183,2.492,2.226;P<0.05);观察组坚韧、力量、乐观评分均显著高于常规组(t=4.273,2.689,5.839;P<0.05),但常规组坚韧、乐观评分与干预前比较无显著差异(P>0.05);观察组正性情绪评分显著高于常规组(t=4.331,P<0.05);负性情绪显著低于常规组(t=-2.988,P<0.05),但常规组正性情绪与干预前无显著差异(P>0.05)。结论:rTMS联合心理疗法可有效改善颅脑外伤后PTSD患者创伤应激反应,避免负性情绪,促进患者树立良好的心态。

Objective:To explore the effect of high-frequency repetitive transcranial magnetic stimulation(rTMS)combined with psychotherapy on symptoms of traumatic stress disorders and mental health of hospitalized patientswith craniocerebral trauma.Methods:A total of 70patients with post traumatic stress disorder(PTSD)after craniocerebral trauma were selected as the subjects,and they were randomly divided into the routine group and the observation group,All patients were given routine nursing in the department of cerebral surgery,and treated with antipsychotic drugs,The routine group were treated with rTMS while the observation group were treated with rTMS combined with psychotherapy,The relief of clinical symptoms and the mental status were evaluated with the PTSDChecklist-Civilian Version(PCL-C),the connor-Davidson Resilience Scale(CD-RISC)and Positive and NegativeAffect Scale(PANAS)respectively,Adverse reactions were statistically analyzed.Results:After the intervention,scores of recurrent experience,avoidance and alertness in the routine group were significantly higher than those inthe observation group(t=2.183,2.492,2.226;P<0.05),while scores of tenacity,strength and optimism in the observation group were significantly higher than those in the routine group(t=4.273,2.689,5.839,P<0.05),Therewas no significant change in scores of tenacity and optimism in the routine group before and after the intervention(P>0.05),The score of positive emotions of observation group was significantly higher than that of the routine group(t=4.331,P<0.05),while the score of negative emotions was significantly lower than that of the routine group(t=2.988,P<0.05),There was no significant change in the score of positive emotions of the routine group before andafter intervention(P>0.05).Conclusion:RTMS combined with psychotherapy can effectively relieve post-traumatic stress response in patients with PTSD after craniocerebral trauma,avoid negative emotions and help patients establish a good mental state.