低频重复经颅磁刺激对急性期脑梗死患者焦虑抑郁状态的影响

关键词：低频重复经颅磁刺激  脑梗死  焦虑  抑郁  日常生活活动

Keywords:low-frequency repetitive transcranial magnetic stimulation  cerebral infarction  anxiety  depression  activities of daily living

摘要：

      摘要 目的：探讨低频重复经颅磁刺激（r-TMS）对急性期脑梗死患者焦虑抑郁状态及日常生活活动能力（ADL）的影响。 方法：65例急性期脑梗死患者随机分成对照组（32例）和治疗组（33例），对照组给予常规治疗，治疗组除常规治疗外，同时给予r-TMS治疗，疗程8周。治疗前后用汉密尔顿焦虑量表（HAMA）和汉密尔顿抑郁量表（HAMD）进行精神心理评定，以中国脑卒中神经功能评分量表（CSS）行神经功能缺损程度评定，用改良Barthel指数（BI）量表进行日常生活活动能力评定。 结果：对照组治疗后HAMA、HAMD及CSS评分分别下降13.33%、13.13%及20.62%，其中，精神性焦虑和躯体性焦虑评分分别下降11.71%和15.30%，MBI评分提高40.85%，差异均有显著性意义（P＜0.05）；治疗组治疗后HAMA、HAMD及CSS评分分别下降33.60%、35.66%及26.23%，其中，精神性焦虑和躯体性焦虑评分分别下降34.64%和20.26%，MBI评分提高40.10%，差异均有显著性意义（P＜0.05）。另外，治疗后治疗组较对照组HAMA、精神性焦虑、HAMD及CSS评分均明显下降，差异有显著性意义（P＜0.05），但两组间躯体性焦虑评分下降及MBI评分提高差异并不明显，无显著性意义（P＞0.05）。治疗组与对照组间焦虑状态改善总有效率分别为78.95%和12.00%，抑郁状态改善总有效率分别为86.96%和9.52%，两组间焦虑抑郁状态改善率差异均有显著性意义（P＜0.05）。 结论：低频r-TMS能改善急性期脑梗死患者焦虑抑郁状态，尤其是精神性焦虑症状，促进神经功能恢复，但对日常生活活动能力的影响可能不大。

Abstract:

      Abstract Objective: To study the effect of low-frequency r-TMS to anxiety-depression and ability of activities of daily living（ADL） in patients with acute cerebral infarction. Method:According to be selected standard,65 acute cerebral infarction patients were divided randomly into 2 groups:control group (32 cases) treated with routine therapy only,and therapy group(33cases) received routine therapy and r-TMS for 8 weeks.Patients were evaluated with scores of Hamilton anxiety rating scale（HAMA）,Hamilton depression（HAMD） and Chinese stroke scale（CSS） and modified Barthel index（MBI） before and after treatment. Result: After treatment, in control group the scores of HAMA, HAMD and CSS decreased by 13.33%, 13.13% and 20.62% respectively， of which the scores of psycho-anxiety and somato-anxiety decreased by 11.71% and 15.30%, and the scores of MBI elevated by 40.85% (all P＜0.05); in therapy group the scores of HAMA, HAMD and CSS decreased by 33.60%, 35.66% and 26.23% respectively，of which the scores of psycho-anxiety and somato-anxiety decreased by 34.64% and 20.26%, and the scores of MBI elevated 40.10% (all P＜0.05). Otherwise, after treatment the scores of HAMA, psycho-anxiety, HAMD and CSS in therapy group decreased more significantly than those in control group(P＜0.05), but the decrease of somato-anxiety and rise of MBI had no significant difference in two groups (P＞0.05). The total effective rate of anxiety in therapy group (78.95%) was higher than (P＜0.05) that in control group (12.00%), and for depression were 86.96% to 9.52% respectively (P＜0.05). Conclusion:Low-frequency r-TMS applied in patients with acute cerebral infarction could improve anxiety-depression, especially psycho-anxiety symptom and decrease neurologic impairment, but it had less impact on ability of ADL.