经颅直流电刺激改善维持性血液透析患者注意力和执行力的临床观察

关键词：维持性血液透析  经颅直流电刺激  认知功能  转弯角度  转弯峰值角速度

Keywords:maintenance hemodialysis  transcranial direct current stimulation  cognitive function  turning angle  turning peak velocity

摘要：

      摘要 目的：探索经颅直流电刺激（transcranial direct current stimulation， tDCS）改善维持性血液透析（maintenance hemodialysis，MHD）患者注意力和执行力，降低跌倒风险的作用。 方法：本研究招募MHD患者36例，采用随机数字表法将患者随机分为对照组（n=18）和治疗组（n=18）。治疗组患者在每次透析期间使用tDCS治疗20min，每周3次，共2周的治疗，对照组进行假刺激。两组患者在治疗前后均采用蒙特利尔认知评估量表（Montreal Cognitive Assessment， MoCA）评估认知功能，使用无线APDM运动监测惯性传感器系统采集步态时空参数（步速、步幅、转弯时间、转弯角度及转弯峰值角速度）观察行为学的变化。 结果：治疗前两组患者各项测试得分均无显著差异（P>0.05）。治疗后治疗组患者的MoCA总分显著提高（P<0.05），其中MoCA量表的视空间与执行力、注意力、定向得分显著升高（P<0.05）。治疗组转弯角度和转弯峰值角速度的差值较对照组显著提高（P<0.05）。多元线性逐步回归分析结果表明，MHD患者治疗后的转弯峰值角速度与MoCA总分和tDCS干预有关，标准回归系数分别为0.581、0.402（P<0.05）。 结论：tDCS显著改善了MHD患者的注意力和执行力，步行中转弯角度及转弯峰值角速度的提高与认知功能的改善有关。

Abstract:

      Abstract Objective：To investigate the effect of transcranial direct current stimulation （tDCS） on the improvement of attention and executive function which reduced the risk of falls in the patients with maintenance hemodialysis （MHD）. Method：Thirty-six patients with MHD were randomized into the control group （CG， n=18） and the treatment group （TG， n=18）. The patients in the TG were treated with tDCS for 20min at each dialysis session three times a week for 2 weeks. The patients with CG were treated with sham-tDCS. The scale of Montreal Cognitive Assessment scale（MoCA） was assessed before and after treatment. The wireless APDM motion monitoring inertial sensor system was used to collect the temporal and spatial parameters of the gait （gait speed， stride length， turning time， turning angle and peak angular velocity） for observing the changes of the gait behavior. Result：There was no significant difference in the scores of MoCA between the two groups before treatment （P>0.05）. After treatment， the total score of MoCA in the TG was significantly higher than that in the CG （P<0.05）. The factor scores of visuospatial executive function， attention and orientation in MoCA increased significantly in the TG after treatment （P<0.05）. The difference values of the turning angle and turning peak velocity before and after treatment in the TG were significantly higher than that in the CG （P<0.05）. The results of stepwise multiple linear regression showed that the total score of MoCA and tDCS were significantly correlated to turning peak velocity with the standard partial regression coefficients of 0.581 and 0.402 respectively （P<0.05）. Conclusion：The treatment of tDCS can significantly improve the attention and executive function in the patients with MHD. The increases in turning angle and peak angular velocity during walking are concerned with the improvement of cognitive function.