经颅磁刺激联合认知疗法治疗卒中后抑郁的疗效分析

Therapeutic Effect of Transcranial Magnetic Stimulation Combined with Cognitive Therapy on Post-Stroke Depression

摘要: 目的：探究经颅磁刺激联合认知疗法治疗卒中后抑郁(post stroke depression PSD)的疗效。方法：选取延大附院神经内科确诊为卒中后抑郁的患者82例分为实验组和对照组，对照组给予常规治疗 + 认知疗法，实验组给予常规治疗 + 认知疗法 + 经颅重复磁刺激(Repetitive transcranial magnetic stimulation rTMS)，分别于初次治疗时、第4周采用美国国立卫生院脑卒中量表(NIHSS)、汉密顿抑郁量表(Hamilton Depression Scale, HAMD)、蒙哥马利抑郁评定量表(Montgomery Asberg Depression Rating Scale MADRS)和改良Rankin量表(mRS)进行综合分析评估神经功能恢复、抑郁改善情况。结果：参与82例卒中后抑郁患者有2人因依从性差退出实验，随着进程随访评估完成了98%，各量表依基线水平治疗4周后HAMD和MADRS抑郁评分值明显低于对照组(tHADM = 19.37**, p < 0.05, tMADRE = 25.23, p < 0.05)，于治疗4周后NIHSS和mRS神经功能恢复评分因子显著低于对照组(tNIHSS = 11.39**, p < 0.05, tmRS = 4.13*, p < 0.05)。结论：采用经颅磁刺激联合认知疗法治疗卒中后抑郁发现，rTMS联合认知疗法有助于患者神经功能恢复，改善抑郁状况，降低住院率、致残率，提高患者生活及社会参与度。

Abstract: Objective: To investigate the efficacy of transcranial magnetic stimulation combined with cognitive therapy in the treatment of post stroke depression (PSD). Methods: Eighty-two patients with post-stroke depression diagnosed by the Department of Neurology of Yanda Affiliated Hospital were divided into experimental group and control group. The control group received conventional therapy + cognitive therapy. The experimental group received conventional therapy + cognitive therapy + transcranial repetitive magnetic stimulation (Repetitive transcranial magnetic stimulation rTMS). National institutes of health stroke scale (NIHSS), Hamilton Depression Scale (HAMD), Montgomery Asberg Depression Rating Scale MADRS and modified Rankin Scale (mRS) were used for comprehensive analysis and evaluation of neurological function recovery and depression improvement at the first treatment and the fourth week respectively. Results: Two of the 82 post-stroke depression patients withdrew from the study due to poor compliance. 98% of the patients were followed up by the follow-up evaluation. The HAMD and MADRS depression scores were significantly lower than the control group after 4 weeks of treatment (tHADM = 19.37**, p < 0.05, tMADRE = 25.23, p < 0.05), the NIHSS and mRS neurological recovery scoring factors were significantly lower than the control group after 4 weeks of treatment (tNIHSS = 11.39**, p < 0.05, tmRS = 4.13*, p < 0.05). Conclusion: Using transcranial magnetic stimulation combined with cognitive therapy to treat post-stroke depression, rTMS combined with cognitive therapy can help patients with neurological recovery, improve depression, reduce hospitalization rate, disability rate, and improve patient life and social participation.