重复经颅磁刺激改善脑卒中后抑郁的临床观察

目的:探讨重复经颅磁刺激(rTMS)治疗脑卒中后抑郁患者的临床疗效。方法:脑卒中后抑郁患者150例,随机分为观察组和对照组各75例。2组均给予脑卒中常规药物治疗并针对性给予康复训练和心理疏导治疗,观察组同时给予左前额叶背外侧区rTMS治疗。治疗前后分别采用汉密尔顿抑郁量表(HAMD-17)、Barthel指数、脑卒中影响量表(SIS)进行评定。结果:治疗6周后,2组HAMD-17评分较治疗前明显降低(P<0.05),且观察组更低于对照组(P<0.05);2组Barthel指数评分和SIS评分均较治疗前明显上升(P<0.05),且观察组更高于对照组(P<0.05)。治疗12周后比较,对照组HAMD-17评分较治疗6周时稍下降,但差异无统计学意义,观察组较治疗6周时及对照组均明显下降(P<0.05);对照组Barthel指数评分和SIS评分较治疗6周时均稍有所上升,但差异无统计学意义,观察组较治疗6周时及对照组均明显提高(P<0.05)。结论:脑卒中并发抑郁的程度与患者的日常生活自理能力以及生活质量呈负相关。rTMS对脑卒中后抑郁患者有明显疗效。

The clinical observation of post-stroke depression improvement by repetitive transcranial magnetic stimulation

Objective: To investigate the clinical curative effect of the repetitive transcranial magnetic stimulation (rTMS) in the treatment of post-stroke depression. Methods: 150 cases of post-stroke depression were randomly and equally divided into two groups: observation group and control group. The two groups were given conventional drugs, rehabilitation training and psychological counseling therapy. The observation group was subjected to rTMS in the dorsolateral prefrontal cortex (DLPFC). The Hamilton depression scale (HAMD-17), Barthel index, and stroke impact scale (SIS) score were used to evaluate the effect. Results: After the treatment for 6 weeks, HAMD-17 scores were significantly lower than those before treatment in two groups(P<0.05), more significantly in the observation group than in the control group (P<0.05). Barthel index and SIS scores were significantly increased in two groups (P<0.05), which were higher in the observation group than in the control group (P<0.05). At 12th week, the HAMD-17 scores in the control group were decreased slightly as compared with those at 6th week, but there was no statistically significant difference between two groups. On the contrary, the HAMD-17 scores after treatment for 12 weeks were decreased obviously in the observation group as compared those at 6th week and in the control group (P<0.05). The Barthel index and SIS scores were increased slightly at 12th week in the control group as compared with those at 6th week, but there was no statistically significant difference between two groups. On the contrary, the Barthel index and SIS scores were increased obviously after treatment for 12 weeks in the observation group as compared with those at 6th week and in the control group (P<0.05). Conclusion: The degree in patients with post-stroke depression was negatively correlated with the self-care ability of daily life and quality of life. rTMS in post-stroke depression patients has satisfactory effectiveness.