间歇性Theta脉冲刺激对卒中后抑郁患者的临床疗效研究

Clinical Efficacy of Intermittent Theta Pulse Stimulation in Patients with Post-Stroke Depression

摘要: 目的：探讨间歇性Theta脉冲刺激对卒中后抑郁患者的临床疗效。方法：采用随机数字表法将32例符合纳入标准的PSD患者分为试验组及对照组，每组16例。试验组给予常规康复训练、抗抑郁药物盐酸舍曲林50 mg每日一次、左侧背外侧前额叶皮层iTBS模式经颅磁刺激；对照组给予常规康复训练、抗抑郁药物盐酸舍曲林50 mg每日一次、左侧背外侧前额叶皮层假iTBS模式经颅磁刺激。每位患者于治疗前、治疗3周后进行汉密尔顿抑郁评定量表24项(HAMD-24)、蒙哥马利抑郁评定量表(MADRS)及事件相关诱发电位P300潜伏期测定指标，评定两组患者的卒中后抑郁程度以及治疗后改善情况。结果：治疗前两组患者的HAMD-24、MADRS评分及P300潜伏期比较均无显著性差异(P > 0.05)；经过3周治疗后，两组患者HAMD-24、MADRS评分与组内治疗前相比均有明显下降、P300潜伏期较治疗前缩短(P < 0.05)；且试验组较对照组有更明显的下降，两组间有统计学意义(P < 0.05)。结论：iTBS在改善PSD患者抑郁情绪方面有良好效果，且较单纯药物治疗效果更佳。

Abstract: Objective: To investigate the clinical effect of intermittent Theta pulse stimulation on patients with post-stroke depression. Methods: 32 patients with PSD who met the inclusion criteria were divided into experimental group and control group by random number table method, with 16 cases in each group. The experimental group was given routine rehabilitation training, the antidepressant Ser-traline hydrochloride 50 mg once a day, the left dorsolateral prefrontal cortex iTBS mode transcra-nial magnetic stimulation; The control group was given routine rehabilitation training, the antide-pressant Sertraline 50 mg once a day, and left dorsolateral prefrontal cortex pseudo-iTBS mode transcranial magnetic stimulation. Hamilton Depression Rating Scale 24 (HAMD-24), Montgomery Depression Rating Scale (MADRS) and event related evoked potential P300 latency were performed before and 3 weeks after treatment for each patient, and the degree of post-stroke depression and the improvement after treatment were assessed. Results: There were no significant differences in HAMD-24, MADRS scores and P300 latency between the two groups before treatment (P > 0.05). After 3 weeks of treatment, HAMD-24 and MADRS scores were significantly decreased in both groups compared with before treatment, and P300 latency was shorter than before treatment (P < 0.05). The experimental group had a more significant decrease than the control group, and there was statistical significance between the two groups (P < 0.05). Conclusion: iTBS had a good effect on improving the depressive mood of PSD patients, and the effect was better than that of drug therapy alone.