低频重复经颅磁刺激对卒中后记忆障碍患者认知和P300的影响
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江苏省卫生健康委科研项目(K2019012);徐州市科技项目(KC19156)


Effects of low-frequency rTMS on cognitive of post-stroke memory disorders patients and P300
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    摘要:

    目的 研究低频重复经颅磁刺激(rTMS)对卒中后记忆障碍(PSMD)患者认知及事件相关 电位P300 的影响。方法 前瞻性连续纳入2019 年9 月至2020 年6 月于徐州市中心医院康复科门诊或 住院诊疗的PSMD 患者50 例,采用随机数字表法分为刺激组和假刺激组各25 例。两组在常规药物及康 复治疗的基础上,刺激组予低频(1 Hz)rTMS 治疗,假刺激组予假rTMS 治疗,治疗4 周。治疗前及治疗 4 周后均对患者进行简易精神状态检查(MMSE)、蒙特利尔认知评估量表(MoCA)、Rivermead 行为记忆量 表(RBMT- Ⅱ)、改良Barthel 指数(MBI)及P300 的评定并进行组间治疗前后的比较。结果 治疗前两组 的MMSE、MoCA、RBMT- Ⅱ和MBI 之间的差异均无统计学意义(均P > 0.05),治疗4 周后刺激组MMSE 评分[(21.52±4.51)分]、MoCA 评分[(16.80±3.88)分]、RBMT- Ⅱ评分[(17.28±3.30)分]、MBI 评分 [(64.60±14.21)分]、P300 潜伏期[(346.04±40.25)ms],波幅[(10.76±3.44)μV]均优于假刺激组[分 别为MMSE 评分(18.28±4.56)分、MoCA 评分(13.92±4.58)分、RBMT- Ⅱ评分(14.52±3.81)分和MBI 评 分(52.80±13.93)分、P300 潜伏期(383.39±51.23)ms、波幅(7.28±3.00)μV],治疗前后各量表及P300 参数的差值刺激组均优于假刺激组[MMSE、MoCA、RBMT- Ⅱ、MBI、P300 潜伏期和P300波幅差值分别 为:(4.68±1.63)分比(2.40±1.61)分,(4.82±1.56)分比(1.82±1.33)分,(5.04±1.21)分比(2.44±1.85)分, (21.80±7.62)比(13.20±6.60),-45.52(-121.69,-0.67)ms比-21.10(-60.61,29.31)ms,5.36(2.08,8.21)μV 比1.18(0.12,2.08)μV;均P< 0.05]。结论 低频rTMS 可提高PSMD患者的记忆功能,更有助于日常生 活能力的恢复,P300 更客观地体现低频rTMS 改进记忆功能效果。

    Abstract:

    Objective To explore the effects of low-frequency repetitive transcranial magnetic stimulation( rTMS) on cognitive of patients with post-stroke memory disorders( PSMD) and the event-related potential P300. Methods A total of 50 patients with PSMD, who were hospitalized in the rehabilitation department of Xuzhou Central Hospital from September 2019 to June 2020, were prospectively and continuously enrolled, and divided into stimulation group and sham stimulation group with 25 cases each by random number table method. Both groups were given drugs and routine rehabilitation training. The stimulation group was given low-frequency( 1 Hz) rTMS treatment, and the sham stimulation group was given sham rTMS treatment for 4 weeks. Before and after treatment, evaluations were performed on the Mini Mental State Assessment Scale( MMSE), Montreal Cognitive Assessment Scale( MoCA), Rivermead Behavioral Memory Scale( RBMT- Ⅱ), Modified Barthel Index( MBI) and P300. Comparison of treatment was made between different groups. Rusults There was no statistically significant difference in MMSE, MoCA, RBMT-Ⅱ and MBI between the two groups before treatment( all P>0.05). After 4 weeks treatment, the scores in stimulation group[ MMSE score (21.52±4.51), MOCA score( 16.80±3.88), RBMT-Ⅱ score( 17.28±3.30), MBI score( 64.60±14.21), P300 latency period( 346.04±40.25) ms, amplitude( 10.76±3.44) μV] were better than those in sham stimulation group[ MMSE score( 18.28±4.56), MOCA score( 13.92±4.58), RBMT- Ⅱ score( 14.52±3.81), MBI score (52.80±13.93), P300 latency period( 383.39±51.23) ms, and amplitude( 7.28±3.00) μV]. Before and after treatment, the differences of scales results and P300 parameter of the simulation group were all better than those of the sham simulation group[ MMSE score( 4.68±1.63) vs.( 2.40±1.61), MOCA score( 4.82±1.56) vs. (1.82±1.33), RBMT-Ⅱ score( 5.04±1.21) vs(. 2.44±1.85), MBI score( 21.80±7.62) vs(. 13.20±6.60), P300 latency period -45.52(-121.69,-0.67) ms vs. -21.10(-60.61,29.31)ms, and amplitude 5.36(2.08,8.21) μV vs. 1.18(0.12,2.08) μV; all P< 0.05]. Conclusions Low-frequency rTMS can improve memory function of PSMD patients, and is more helpful to recovery of daily living ability. P300 can objectively reflect the effect of low-frequency rTMS more on improving memory function.

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温炜婷 巩尊科 马喆喆 苏彩霞 陈姣姣 王聪 王世雁.低频重复经颅磁刺激对卒中后记忆障碍患者认知和P300的影响[J].神经疾病与精神卫生,2020,20(10):
DOI :10.3969/j. issn.1009-6574.2020.10.002.

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  • 在线发布日期: 2021-01-06