重复经颅磁刺激联合改良呼吸训练对脑卒中抑郁患者的临床疗效及机制研究  

Clinical efficacy and mechanism of repeated transcranial magnetic stimulation combined with modified breathing training in patients with stroke depression

作　　者：刘加美 张保国 刘立芝 付娟娟 张园园 LIU Jia-mei;ZHANG Bao-guo;LIU Li-zhi;FU Juan-juan;ZHANG Yuan-yuan(Rehabilitation Medicine Center,the Affiliated Jiangning Hospital of Nanjing Medical University,Nanjing 211199,Jiangsu,China)

机构地区：[1]南京医科大学附属江宁医院康复医学中心,江苏南京211199

出　　处：《川北医学院学报》2024年第12期1692-1695,共4页Journal of North Sichuan Medical College

基　　金：江苏省南京市卫生科技发展专项资金项目(YKK20190);南京医科大学科技发展基金项目(NMUB2020163)。

摘　　要：目的:探究重复经颅磁刺激(rTMS)联合改良呼吸训练对脑卒中抑郁(PSD)患者的治疗效果及作用机制。方法:选取101例PSD患者为研究对象,按照不同的训练方法分为观察组(n=47)和对照组(n=54)。对照组采用改良呼吸训练;观察组患者采用rTMS联合改良呼吸训练。记录并比较两组患者的抑郁改善疗效、血清炎症指标[C反应蛋白(Hs-CRP)、白细胞介素6(IL-6)]及神经元特异性烯醇化酶(NSE)、皮质醇(COR)的变化情况。评估所有患者治疗前后匹兹堡睡眠质量指数(PSQI)量表、汉密顿抑郁量表17项(HAMD-17)和改良Barthel指数(MBI)的得分情况。比较两组患者不良反应发生情况。结果:观察组患者治疗总有效率为95.74%,高于对照组总有效率83.33%(P<0.05)。治疗后,观察组患者血清NSE、COR、IL-6和Hs-CRP浓度均低于对照组(P<0.05),MBI评分高于对照组(P<0.05),PSQI量表、HAMD评分低于对照组(P<0.05)。两组患者不良反应总发生率无统计学差异(P>0.05)。结论:rTMS联合改良呼吸训练能够改善PSD患者的抑郁状态,提高患者的睡眠质量以及生活自理能力,这可能与患者炎症神经功能改善有关。Objective:To explore the therapeutic effect and mechanism of repeated transcranial magnetic stimulation(rTMS)combined with modified breathing training in patients with post-stroke depression(PSD)Methods:Among the PSD patients,101 patients meeting the inclusion and exclusion criteria were selected and divided into two groups by different training methods:47 patients in the observation group and 54 patients in the control group.The control group received improved breathing training,and the observation group received rTMS combined with improved breathing training.The therapeutic effect of depression improvement,serum inflammatory index[High-sensitivity C-reactive protein(Hs-CRP),Interleukin-6(IL-6)],neuronal specific enolase(NSE)and cortisol(COR)were recorded and compared between the two groups.The Pittsburgh sleep quality index(PSQI)and Hamilton Depression Scale(HAMD-17)and the Modified Barthel Index(MBI)were evaluated before and after treatment.The occurrence of adverse reactions was compared between the two groups.Results:The total effective rate of observation group was higher than that of control group(95.74%vs.83.33%,P<0.05).After treatment,serum concentrations of NSE,COR,IL-6 and Hs-CRP in observation group were lower than those in control group(P<0.05),MBI score was higher than that in control group(P<0.05),PSQI scale and HAMD score were lower than that in control group(P<0.05).There was no difference in the total incidence of adverse reactions between the two groups(P>0.05).Conclusion:rTMS combined with modified breathing training can significantly improve the depressive state,sleep quality and self-care ability of patients with PSD,which may be related to the improvement of inflammation and neurological function of patients.

关 键 词：经颅磁刺激 呼吸训练 脑卒中抑郁 临床效果 作用机制 神经功能 炎症 

分 类 号：R743.3[医药卫生—神经病学与精神病学]