θ爆发刺激治疗卒中相关失眠的疗效分析  

Efficacy of theta burst stimulation in treatment of stroke-related insomnia

作　　者：李国华[1] 唐吉友 任永霞[1] LI Guohua;TANG Jiyou;REN Yongxia(Department of Rehabilitation Medicine,The Third Hospital of Jinan,Jinan 250132,China)

机构地区：[1]济南市第三人民医院康复医学科,山东济南250132 [2]山东省第一医科大学第一附属医院,山东济南250014

出　　处：《中风与神经疾病杂志》2023年第3期207-211,共5页Journal of Apoplexy and Nervous Diseases

基　　金：济南市卫生健康委员会科技计划项目(2020-4-38)。

摘　　要：目的观察连续性θ爆发刺激(cTBS)治疗卒中相关失眠的疗效。方法纳入亚急性期脑梗死患者60例,采用匹兹堡睡眠质量指数(PSQI)进行测评,以PSQI量表总分>7分作为判断睡眠障碍的标准。随机分为药物治疗组、联合治疗组,各30例。药物治疗组给予唑吡坦10 mg口服、联合治疗组给予唑吡坦5 mg口服+cTBS模式刺激右侧背外侧前额叶和顶枕区域,分别比较两组患者抗失眠药物停药时间和2周停药率、PSQI减分率、NIHSS评分、HAMD和HAMA评分的变化,以观察cTBS治疗卒中相关失眠的临床疗效。结果联合治疗组平均停药时间短于药物治疗组,2周停药率均高于药物治疗组(P<0.05);两组患者NIHSS评分、HAMD及HAMA评分随治疗时间呈现好转趋势,同一随访时间组间比较无明显差异。由于两组患者HAMD、HAMA评分交互P有统计学意义,说明随着时间的变化,两组间的HAMD、HAMA评分会出现差异。结论cTBS对于卒中相关失眠的治疗具有明显作用,且一定程度上改善了患者的焦虑抑郁状态。Objective To investigate the therapeutic effect of continuous theta burst stimulation(cTBS)for stroke-related insomnia.Methods Sixty patients with subacute cerebral infarction were evaluated for sleep disorders using the Pittsburgh Sleep Quality Index(PSQI,global score>7 indicating sleep disturbances).They were divided randomly into drug therapy group and combined treatment group.The drug treatment group was given zolpidem 10 mg orally,and the combined treatment group was given oral zolpidem 5 mg plus cTBS to the right dorsolateral prefrontal lobe and parieto-occipital region.The efficacy of cTBS for stroke-related insomnia was determined by comparing the two groups in terms of time to zolpidem withdrawal,zolpidem withdrawal rate within two weeks,PSQI score reduction rate,and the changes of National Institutes of Health Stroke Scale(NIHSS)score,Hamilton Depression Scale(HAMD)score,and Hamilton Anxiety Scale(HAMA)score.Results Compared with the drug treatment group,the combined treatment group showed a significantly shorter time to zolpidem withdrawal and a significantly higher zolpidem withdrawal rate within two weeks(P<0.05).For both groups,NIHSS,HAMD,and HAMA scores improved with the course of treatment,without significant differences between the two groups at the same follow-up time.However,the interaction P-value was statistically significant,which indicated that HAMD and HAMA scores of the two groups would differ over time.Conclusion cTBS has significant benefits in the treatment of stroke-related insomnia,moderately improving patients'anxiety and depression.

关 键 词：连续性θ爆发刺激 卒中 失眠 右侧背外侧前额叶 顶枕区 

分 类 号：R338.63[医药卫生—人体生理学]