重复经颅磁刺激对精神障碍患者听力功能的影响

目的 评价重复经颅磁刺激（rTMS）治疗精神分裂症幻听及双相情感障碍抑郁发作时对患者听力功能的影响.方法 30例精神分裂症和30例双相情感障碍抑郁发作（以下简称双相抑郁）患者均给予rTMS治疗,精神分裂症幻听组的刺激选择部位为左侧颞顶叶皮质（1 Hz,80％MT）,双相抑郁发作患者选择左侧前额叶背外侧皮质（10 Hz,80％ MT）;在治疗前和治疗后均采用纯音听力测试分别测试患者左右耳气导听力,纯音频率在125～8 000 Hz之间选择8个点进行测试,强度＜30dB视为正常.结果 60例患者治疗后听力阈值强度下降,与治疗前比较差异有统计学意义[（18.22±12.24）比（16.41±12.25）,t=2.71,P＜0.01],表明rTMS对听力有一定的改善作用;在60例患者中有听力功能障碍者23例,其中精神分裂症患者13例,双相抑郁患者10例;23例中在6 000 Hz,8 000 Hz两个频率段存在异常者13例,占听力异常总人数的56.5％;虽然刺激部位及治疗强度均不相同,但rTMS对精神分裂症患者及双相抑郁患者的听力功能均有改善作用,两组之间差异无统计学意义（t=0.3,P＞0.05）;rTMS治疗后精神分裂症患者幻听症状减轻或消失,双相抑郁发作者的情绪改善.结论 rTMS在改善精神障碍患者临床症状的同时对听力功能有一定改善作用.

Impact of repetitive transcranial magnetic stimulation on audition function of patients with mental disorders

Objective To evaluate the impact of repetitive transcranial magnetic stimulation on audition function of the patients with mental disorders （schizophrenia or bipolar depression）.Methods Both 30 patients with schizophrenia and auditory hallucination and 30 patients with bipolar depression were given the treatment of repetitive transcranial magnetic stimulation （rTMS）,left temporalparietal cortex （1 Hz,80 ％ MT）was the place of stimulation in the schizophrenia group,and left prefrontal dorsolateral cortex（10 Hz,80％ MT） was chosen in patients with bipolar depression,both of them adopted the pure tone audiometry to test patients＇ left and right air conduction hearing whatever before or after the treatment.Pure tone frequency was chosen eight points from 125 Hz to 8000 Hz,and the intension was less than 30 db as normal.Results There were statistically significant differences？ of the variation of hearing threshold before and after the treatment[（18.22±12.24）vs（16.41 ± 12.25）,t =2.71,P ＜ 0.01],it showed that rTMS could improve the audition function.There were 23 cases of 60 patients with hearing impairment,of which 13 cases with schizophrenia,10 cases with bipolar depression.There were existing 13 abnormal cases in 23 patients,they were both on the frequency bands of 6 000 Hz and 8 000 Hz,accounting for 56.5 percent of the total abnormal patients.Though there were existing a different position and intensity of the treatment,rTMS on the audition function of patients with schizophrenia and bipolar depression were improved,and no statistically significant difference was found between the two groups （t =0.3,P ＞ 0.05）.The Symptom of auditory hallucination was alleviated or disappeared,except that,the emotion of patients with bipolar depressive episode was improved.Conclusions In addition to improving clinical symptoms of patients with mental disorders,repetitive transcranial magnetic stimulation have a certain improvement on the audition function.