低频经颅磁刺激联合佐匹克隆片治疗脑卒中后失眠的临床观察  

Clinical study on treatment of post-stroke insomnia with low-frequency rTMS combined with zolpidem tablet

作　　者：代美玲 胡雪艳[2] DAI Meiling;HU Xueyan(Department of Rehabilitation Medicine,Electric Power Teaching Hospital,Capital Medical University,Beijing 100073,China;Department of Neurorehabilitation,School of Rehabilitation Medicine,Capital Medical University/China Rehabilitation Research Center,Beijing Bo'ai Hospital,Beijing 100068,China)

机构地区：[1]首都医科大学电力教学医院康复医学科,北京100073 [2]首都医科大学康复医学院/中国康复研究中心北京博爱医院神经康复一科,北京100068

出　　处：《新疆医科大学学报》2024年第11期1476-1480,1485,共6页Journal of Xinjiang Medical University

基　　金：国家电网公司科技项目(Y2018002)。

摘　　要：目的探究低频经颅磁刺激(rTMS)治疗联合佐匹克隆片对脑卒中后失眠患者的临床疗效以及对血清炎症因子、神经递质、脑血流动力学指标水平的影响。方法回顾性分析2022年7月至2023年11月本院收治的126例脑卒中后失眠患者的临床资料,按照治疗方式将其分成研究组(低频rTMS联合佐匹克隆片治疗,63例)和对照组(口服佐匹克隆片治疗,63例),比较两组患者的睡眠质量、日常生活能力评分、神经递质水平、炎性因子指标、脑血流动力学指标变化情况。结果治疗前,两组患者入睡时间、睡眠时间、觉醒次数、日间功能障碍评分、运动功能(FMA)评分、Barthel指数(BI)评分、神经递质P物质(SP)、神经肽Y(NPY)、5-羟色胺(5-HT)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、白细胞介素-2(IL-2)、平均血流速度(Vm)、收缩期血流速度(Vs)、阻力指数(RI)水平差异无统计学意义(P>0.05);治疗后,与对照组相比,研究组入睡时间、觉醒次数、日间功能障碍评分、SP、NPY、IL-6、TNF-α、IL-2、RI水平更少或更低,FMA、BI评分、5-HT、Vm、Vs水平、睡眠时间更高或更多,差异有统计学意义(P<0.05)。结论低频rTMS联合佐匹克隆片治疗脑卒中后失眠患者,可改善其神经递质水平,减轻炎性反应,改善脑血流动力学指标,进而提升患者睡眠质量和日常生活能力。Objective To exploring the clinical efficacy of low-frequency transcranial magnetic stimulation therapy(rTMS)combined with zopiclone tablets in post-stroke insomnia patients and its effects on serum inflammatory factors,neurotransmitters and cerebral hemodynamic indicators.Methods A retrospective analysis was conducted on the clinical data of 126 patients with post-stroke insomnia admitted to the hospital from July 2022 to November 2023.The patients were divided into study group(treated with low-fre-quency rTMS combined with zopiclone tablets,63 cases)and acontrol group(treated with oral zopiclone tablets,63 cases)according to the treatment method.The changes in sleep quality,daily living ability scores,neurotransmitter levels,inflammatory factor indicators and cerebral hemodynamic indicators were compared between the two groups of the patients.Results Before the treatment,there was no statistically significant difference in the levels of sleep onset time,sleep time,number of awakenings,daytime func-tional impairment score,motor function(FMA)score,Barthel index(BI)score,neurotransmitter sub-stance P(SP),neuropeptide Y(NPY),serotonin(5-HT),interleukin-6(IL-6),tumor necrosis factor-α(TNF-α),interleukin-2(IL-2),mean blood flow velocity(Vm),systolic blood flow velocity(Vs)and re-sistance index(RI)between the 2 groups of the patients(P>0.05).After the treatment,compared with control group,the study group had less or lower sleep onset time,awakening frequency,daytime dysfunc-tion score,SP,NPY,IL-6,TNF-α,IL-2,RI levels and higher or more FMA,BI scores,5-HT,Vm,Vs levels and sleep time,with statistically significant differences(P<0.05).Conclusion The combination of low-frequency rTMS and zopiclone tablets in the treatment of post-stroke insomnia patients can improve their neurotransmitter levels,reduce inflammatory reactions,improve cerebral hemodynamic indicators,and thereby enhance their sleep quality and daily living abilities.

关 键 词：低频经颅磁刺激治疗(rTMS)治疗 佐匹克隆片 脑卒中 失眠 神经递质P物质(SP) 神经肽Y(NPY) 

分 类 号：R749.4[医药卫生—神经病学与精神病学]