重复经颅磁刺激对创伤后应激障碍患者疗效及执行功能的影响  

A comparative study of repetitive transcranial magnetic stimulation to improve clinical symptoms and executive function in patients with post-traumatic stress disorder

作　　者：孙润珠[1] 陈怡环[1] 郭力[1] 彭正午[1] 谭庆荣[1] 

机构地区：[1]第四军医大学西京医院,陕西西安710032

出　　处：《精神医学杂志》2017年第1期5-7,共3页Journal of Psychiatry

基　　金：国家自然科学基金项目(编号:81371478)

摘　　要：目的探讨重复经颅磁刺激(r TMS)对创伤后应激障碍(PTSD)患者疗效和执行功能的影响。方法将38例创伤后应激障碍患者随机分为r TMS组(20例)及假刺激组(18例),r TMS组采用高频r TMS联合盐酸帕罗西汀治疗,假刺激组采用给予假刺激联合盐酸帕罗西汀治疗,共4周。在治疗前后采用创伤后应激障碍检查表(PCL)评定临床疗效,采用威斯康星卡片分类测验(WCST)评估执行功能。结果两组患者治疗后第4周末PCL总分及重现、警觉性增高因子分均较各自治疗前降低(P<0.05),并低于假刺激组(P<0.05);PCL回避因子分较治疗前升高(P<0.05),并高于假刺激组(P<0.05)。治疗后第4周末,r TMS组WCST总应答数、错误应答数均较治疗前降低(P<0.05),正确应答数、完成分类数均较治疗前升高(P<0.05)。治疗后第4周末,假刺激组WCST总应答数较治疗前降低(P<0.05),正确应答数、持续错误数较治疗前升高(P<0.05)。治疗后第4周末,r TMS组WCST总应答数、正确应答数高于假刺激组(P<0.05),错误应答数、持续错误数低于假刺激组(P<0.05)。结论重复经颅磁刺激合并帕罗西汀能改善PTSD患者的核心症状及执行功能。Objective To explore the efficacy of repetitive transcranial magnetic stimulation（r TMS） to improve clinical symptoms and executive function in patients with post-traumatic stress disorder（PTSD）.Methods A total of 38 patients with PTSD were randomly divided into r TMS group（n = 20） with paroxetine combined with r TMS and control group（n = 18） with paroxetine combined with sham stimulation for 4 weeks of treatment.They were assessed with Post-traumatic Stress Disorder Checklist（PCL） and Wisconsin Card Sorting Test（WCST） before and after treatment.Results In both groups,the total score and factor scores of ceurrence and alerthess of PCL after treatment were all significantly lower than those before treatment（P〈0.05）.and also lower than those in control group（P〈0.05）：the factor score of avoidance of PCL after treatment was higher than that before treatment（P〈0.05）,and also higher than that in control group（P〈0.05）.In r TMS group,the total numbers of responses,error responses of WCST after treatment were all significantly less than those before treatment（P〈0.05）,and the numbers of correct responses,completed classifications after treatment were significantly more than those before treatment（P〈0.05）.In control group,the total number of responses of WCST after treatment was significantly less than that before treatment（P〈0.05）,and the numbers of correct responses,continuous error responses after treatment were significantly more than those before treatment（P〈0.05）.After treatment,the total numbers of responses,correct responses of WCST in r TMS group were all significantly more than those in control group（P〈0.05）,and the numbers of error responses,continuous error responses in r TMS group were significantly less than those in control group（P〈0.05）.Conclusion It＇s effective for paroxetine combined with r TMS to improve the core symptoms and executive function in patients with PTSD.

关 键 词：经颅磁刺激创伤后应激障碍 帕罗西汀执行功能 

分 类 号：R749.5[医药卫生—神经病学与精神病学]