经颅直流电刺激前扣带回对卒中后无动性缄默症的疗效观察  

Clinical observation of transcranial direct current stimulation over anterior cingulate cortex on post-stroke akinetic mutism

作　　者：张甜甜[1] 杨晓龙 张晔[1] 赵钰婷[1] 宋为群[1] Zhang Tiantian;Yang Xiaolong;Zhang Ye;Zhao Yuting;Song Weiqun(Department of Rehabilitation Medicine,Xuanwu Hospital,Capital Medical University,Beijing 100053,China)

机构地区：[1]首都医科大学宣武医院康复医学科,北京100053

出　　处：《中国脑血管病杂志》2022年第5期331-338,共8页Chinese Journal of Cerebrovascular Diseases

基　　金：国家自然科学基金(81873723、82102658);北京市自然科学基金(7204267)。

摘　　要：目的观察经颅直流电刺激前扣带回对卒中后无动性缄默症的应用疗效。方法回顾性连续纳入2016年7月至2021年9月在首都医科大学宣武医院康复医学科收治的18例卒中后无动性缄默症患者,均为首次卒中发病。根据治疗方式的不同,将18例卒中后无动性缄默症患者分为观察组和对照组,每组各9例。两组均接受常规康复治疗,包括视、听、触、嗅和味觉的多重感官刺激,同时给予言语训练、关节活动度训练及神经肌肉电刺激;观察组则在常规康复治疗基础上接受经颅直流电刺激治疗,阳极刺激部位为前扣带回,参考电极则置于前后矢状线枕点。两组治疗频次为2次/d,30 min/次,每周连续5 d,治疗总时间为2周。收集并对比分析两组患者的基线资料(年龄、卒中类型、性别、病程)和疗效指标[改良昏迷恢复量表(CRS-R)、行为反应量表评分]。结果(1)两组患者年龄、性别、卒中类型、病程的差异均无统计学意义(均P>0.05)。(2)CRS-R评分显示,观察组治疗前及治疗后分别为(7.89±2.67)、(15.44±3.94)分,对照组治疗前及治疗后分别为(8.11±2.37)、(9.33±2.87)分。两组患者治疗前后CRS-R评分比较,观察组与对照组的组间及时间的交互效应差异有统计学意义(F=80.72,P<0.01)。观察组与对照组的组间主效应差异有统计学意义(F=4.56,P=0.04),治疗前,组间CRS-R评分的差异无统计学意义(P=0.85);治疗后,观察组CRS-R评分较对照组提高,组间差异有统计学意义(P<0.01)。不同时间点的时间主效应差异有统计学意义(F=14.14,P<0.01),两组治疗后的CRS-R评分较治疗前均有提高,差异均有统计学意义(均P<0.05)。(3)行为反应量表总分显示,观察组治疗前及治疗后分别为(6.89±4.26)、(26.22±8.82)分,对照组治疗前及治疗后分别为(7.56±4.61)、(9.44±4.95)分。两组治疗前后行为反应量表总分比较,观察组与对照组的组间及时间交互效应差异有统计Objective To observe the effect of transcranial direct current stimulation(tDCS)of anterior cingulate cortex on post-stroke akinetic mutism(AM).Methods The study retrospectively included 18 stroke patients who were treated in the Department of Rehabilitation Medicine of Xuanwu Hospital,Capital Medical University from July 2016 to September 2021.All patients had the onset of stroke for the first time.According to treatment methods,they were divided into observation group and control group,with 9 cases in each group.Both groups were received routine rehabilitation,including multi-sensory stimulation of sight,hearing,touch,smell and taste,speech training,range of motion training and neuromuscular electrical stimulation.The observation group were received tDCS on the basis of routine rehabilitation therapy,with the anodic stimulation site was located at the anterior cingulate cortex and the reference electrode was placed at the occipital point of the anterior and posterior sagittal lines.Both groups received routine rehabilitation treatment(2 times/d,30 min/time,5 consecutive days a week for 2 weeks).Baseline data(age,stroke type,gender and course of disease)and outcome measures(modified Coma Recovery Scale[CRS-R]and behavioral response scale scores)in both groups were collected and compared.Results(1)There was no statistically significant difference in age,stroke type,gender and course of disease between the two groups(all P>0.05).(2)The CRS-R scores before and after treatment were(7.89±2.67)and(15.44±3.94)in the observation group and(8.11±2.37)and(9.33±2.87)in the control group,respectively.There were significant differences in the interaction of group and time when comparing the CRS-R scores before and after treatment between the two groups(F=80.72,P<0.01).There was statistically significant difference in the main effect between the observation group and the control group(F=4.56,P=0.04).There was no significant difference between the CRS-R scores between the two groups before treatment(P=0.85);after treatment,

关 键 词：卒中 无动性缄默症 经颅直流电刺激 前扣带回 

分 类 号：R743.3[医药卫生—神经病学与精神病学]