重复经颅磁刺激结合平衡针疗法对脑卒中后患者睡眠质量与心理的影响  

Effects of Repetitive Transcranial Magnetic Stimulation Combined with Balance Acupuncture Treatment on Sleep Quality and Psychology in Patients after Stroke

作　　者：杨华中 崔金龙 范鹤馨 熊中慧 姚沅勉 周莎莎 崔文秀 孙天宝 YANG Huazhong;CUI Jinlong;FAN Hexin;XIONG Zhonghui;YAO Yuanmian;ZHOU Shasha;CUI Wenxiu;SUN Tianbao(Xiangya Boai Rehabilitation Hospital,Changsha,Hunan,410010,China;The First Rehabilitation Hospital of Shanghai,Shanghai,200090,China)

机构地区：[1]湘雅博爱康复医院,湖南长沙410100 [2]上海市第一康复医院,上海200090

出　　处：《康复学报》2024年第1期69-75,共7页Rehabilitation Medicine

基　　金：湖南省卫生健康委科研计划项目(20200101)。

摘　　要：目的观察重复经颅磁刺激(rTMS)结合平衡针疗法对脑卒中后患者睡眠质量与心理的影响。方法选取湘雅博爱康复医院的脑卒中后睡眠障碍(SD)患者60例,采用随机数字表法分为rTMS组(心理治疗+rTMS)、平衡针组(心理治疗+平衡针疗法)和联合组(心理治疗+rTMS+平衡针疗法)3组,每组20例,疗程均为4周。在疗程结束后评价总体临床疗效的同时,对所有患者治疗前后匹兹堡睡眠指数量表(PSQI)、汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD)等指标进行观察,以及血清γ-氨基丁酸(GABA)、5-羟色胺(5-HT)进行检测。结果rTMS组总有效率为75%(15/20),平衡针组为73.68%(14/19),联合组为100%(20/20);联合组总有效率均高于平衡针组和rTMS组(P<0.05);平衡针组总有效率与rTMS组比较,差异无统计学意义(P>0.05)。治疗4周后3组患者PSQI评分明显下降(P<0.05);与平衡针组、rTMS组比较,联合组PSQI评分明显更低(P<0.05);平衡针组PSQI评分与rTMS组比较,差异无统计学意义(P>0.05)。治疗4周后3组患者HAMA评分明显下降(P<0.05);与平衡针组、rTMS组比较,联合组HAMA评分明显更低(P<0.05);平衡针组与rTMS组HAMD评分比较,差异无统计学意义(P>0.05);平衡针组与rTMS组HAMD评分比较,差异无统计学意义(P>0.05)。治疗4周后3组患者HAMD评分明显下降(P<0.05);与平衡针组、rTMS组比较,联合组HAMD评分明显更低(P<0.05)。治疗4周后3组患者GABA评分明显上升(P<0.05);与平衡针组、rTMS组比较,联合组GABA评分明显更高(P<0.05);平衡针组GABA评分与rTMS组比较,差异无统计学意义(P>0.05)。治疗4周后3组患者5-HT明显上升(P<0.05);与平衡针组、rTMS组比较,联合组5-HT明显更高(P<0.05);平衡针组与rTMS组5-HT比较,差异无统计学意义(P>0.05)。结论rTMS和平衡针疗法均可改善脑卒中后患者的睡眠质量与心理;联合组疗效更优于平衡针组和rTMS组,有利于协同增效,值得推广应用。Objective To observe the clinical effects of repetitive transcranial magnetic stimulation(rTMS)combined with balance acupuncture treatment on sleep quality and psychology in patients after stroke.Methods A total of 60 patients with poststroke sleep disorder admitted at Xiangya Boai Rehabilitation Hospital were selected and randomly divided into three groups:rTMS group(psychotherapy+rTMS),balance acupuncture group(psychotherapy+balance acupuncture treatment),and combination group(psychotherapy+rTMS+balance acupuncture),with 20 cases in each group.All patients were treated for 4 weeks.The overall clinical efficacy was assessed at the end of the treatment course.The Pittsburgh sleep quality index(PSQI),Hamilton anxiety scale(HAMA),Hamilton depression rating scale(HAMD)and other indicators before and after treatment were observed as well as serumγ-aminobutyric acid(GABA),5-hydroxytryptamine(5-HT)level were detected in all patients.Results The total effective rate was 75%(15/20)in the rTMS group,73.68%(14/19)in the balance acupuncture group,and 100%(20/20)in the combination group.The total effective rate of the combination group was higher than that of the balance acupuncture group or the rTMS group(P<0.05),while there were no significant differences in the total effective rate between the balance acupuncture group and the rTMS group(P>0.05).After 4 weeks of treatment,the PSQI score of the three groups decreased significantly(P<0.05);compared with the balance acupuncture group and the rTMS group,the PSQI score of the combination group was significantly lower(P<0.05);and there were no significant differences in PSQI score between the balance acupuncture group and the rTMS group(P>0.05).After 4 weeks of treatment,the HAMA score of the three groups decreased significantly(P<0.05);compared with the balance acupuncture group and the rTMS group,the HAMA score of the combination group was significantly lower(P<0.05);and there were no significant differences in HAMA score between the balance acupuncture group and the rTMS gr

关 键 词：脑卒中 重复经颅磁刺激 平衡针疗法 睡眠质量 心理 

分 类 号：R743.3[医药卫生—神经病学与精神病学]