高压氧联合重复经颅磁刺激治疗血管性认知功能障碍的临床研究

目的 探讨高压氧（HBO）联合重复经颅磁刺激（rTMS）治疗血管性认知功能障碍（VCI）的临床疗效。 方法 将52例VCI患者按随机数字表法分为HBO+rTMS组(25例)和rTMS组(27例)。2组患者均给予药物、常规康复治疗和rTMS治疗，HBO+rTMS组在此基础上增加HBO治疗。治疗前和治疗4周后（治疗后），采用简易精神状态量表(MMSE)、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)评估2组患者的认知功能及恢复情况。 结果 治疗前，两组患者MMSE、MoCA、LOTCA、MBI评分比较，差异无统计学意义(P>0.05)。治疗后，两组患者MMSE、MBI评分均较组内治疗前改善，且HBO+rTMS组MMSE、MBI评分优于rTMS组，差异有统计学意义（P<0.05）。rTMS组除命名外，其他项目及总分均较治疗前提高（P<0.05）。HBO+rTMS组各项分值及总分均较治疗前提高（P<0.05）。rTMS组知觉、思维、视运动和总分较治疗前改善（P<0.05）；HBO+rTMS组各项评分及总分均较治疗前改善（P<0.05）。组间治疗后比较，HBO+rTMS组的视空间执行［(2.48±0.78)分］、抽象［(1.91±0.78)分］、延迟回忆［(2.67±0.90)分］、定向分值［(3.46±1.05)分］及总分［(17.52±2.53)分］均高于对照组（P<0.05），HBO+rTMS组患者的定向［(5.20±1.26)分］、知觉［(20.02±1.65)分］、思维能力［(18.59±2.81)分］和总分［(62.33±8.13)分］均高于rTMS组（P<0.05）。 结论 HBO联合rTMS可显著提高非痴呆型VCI患者的认知功能，提高日常生活活动能力，改善患者生存质量。

Treating vascular cognitive impairment using hyperbaric oxygen combined with repeated transcranial magnetic stimulation

Objective To observe the clinical effect of combining hyperbaric oxygen (HBO) with repeated transcranial magnetic stimulation (rTMS) in the treatment of vascular cognitive impairment (VCI). Methods A total of 56 hospitalized VCI patients were randomly divided into an HBO+rTMS group (n=25) and an rTMS group (n=27). The patients of both groups were given routine medication, rehabilitation and rTMS treatment, while the HBO+rTMS group was additionally provided with HBO. The mini mental state examination (MMSE), the Montreal cognitive assessment (MoCA), the Lo Winston occupational therapy cognitive assessment (LOTCA) and the modified Barthel index (MBI) were used to evaluate the cognitive function of both groups before and after 4 weeks of treatment. Results Before the treatment there were no significant differences between the two groups in any of the average measurements. After the treatment, significant improvement was observed in the average MMSE and MBI scores in both groups, with significantly greater improvement in the HBO+rTMS group. After the treatment, all the average sub-scores except that of naming and the total MMSE score of the rTMS group had improved significantly, together with all the average sub-scores and total scores of the HBO+rTMS group. After the treatment the average visual space and execution, abstraction, delayed recall, orientation and the total MoCA score of the HBO+rTMS group were all significantly higher than those of the control group. Conclusion HBO combined with rTMS can improve cognitive function and the life quality of VCI patients.