经颅直流电刺激治疗脑卒中后认知功能障碍患者的效果
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摘要
目的探讨经颅直流电刺激(tDCS)对脑卒中后认知功能障碍疗效及预后的影响。方法选取2016年6月～2018年6月于江门市中心医院住院治疗的80例脑卒中合并认知功能障碍患者,采用随机数字表法分为对照组和观察组,每组各40例。对照组予以神经内科常规药物治疗及康复训练,观察组在此基础上加用tDCS治疗,比较两组患者治疗前后的认知功能状态(LOTCA评分)、工作记忆(WM评分)、疗效及预后情况。结果两组患者治疗后的LOTCA评分均有提高(P<0.05),且观察组LOTCA评分中的定向、视知觉、空间知觉、动作运用、视运动组织、思维操作评分高于对照组,差异有统计学意义(P<0.05);观察组患者治疗后的工作记忆准确度和识别准确度高于对照组,反应时间短于对照组,差异均有统计学意义(P<0.05);观察组患者的治疗总有效率高于对照组,差异有统计学意义(P<0.05);观察组患者治疗后的预后良好率高于对照组,差异有统计学意义(P<0.05)。结论使用tDCS治疗脑卒中合并认知障碍,可有效提高患者认知功能、工作记忆水平,提升疗效、改善预后,值得临床应用推广。
Objective To explore the effect of transcranial direct current stimulation(tDCS) on the efficacy and prognosis of patients with cognitive dysfunction after stroke. Methods A total of 80 cases of patients with stroke and cognitive dysfunction who were hospitalized in Central Hospital of Jiangmen City from June 2016 to June 2018 were selected and divided into the control group and the observation group according to the random number table method, with 40 cases in each group. The control group was given neurological routine drugs and rehabilitation training, and the observation group was given tDCS on this basis. The cognitive functional state(LOTCA score), working memory(WM score), efficacy and prognosis were compared between the two groups before and after treatment. Results After treatment, the LOTCA score in the two groups was improved(P<0.05), and the scores of orientation, visual perception, spatial perception,movement application, visual motor organization and thinking operation of LOTCA score in the observation group were higher than those in the control group, with significant difference(P<0.05). After treatment, the accuracy of working memory and the recognition accuracy in the observation group were significantly higher than those in the control group,while the reaction time in the observation group was significantly shorter than that in the control group, with significant difference(P<0.05). The total effective rate of treatment in the observation group was higher than that in the control group, with significant difference(P<0.05). After treatment, the good prognosis rate in the observation group was higher than that in the control group, with significant difference(P<0.05). Conclusion The tDCS in the treatment of stroke patients with cognitive dysfunction can effectively improve the cognitive function and working memory level, enhance the efficacy and improve the prognosis. Thus tDCS is worthy of clinical application and promotion.
Objective To explore the effect of transcranial direct current stimulation(tDCS) on the efficacy and prognosis of patients with cognitive dysfunction after stroke. Methods A total of 80 cases of patients with stroke and cognitive dysfunction who were hospitalized in Central Hospital of Jiangmen City from June 2016 to June 2018 were selected and divided into the control group and the observation group according to the random number table method, with 40 cases in each group. The control group was given neurological routine drugs and rehabilitation training, and the observation group was given tDCS on this basis. The cognitive functional state(LOTCA score), working memory(WM score), efficacy and prognosis were compared between the two groups before and after treatment. Results After treatment, the LOTCA score in the two groups was improved(P<0.05), and the scores of orientation, visual perception, spatial perception,movement application, visual motor organization and thinking operation of LOTCA score in the observation group were higher than those in the control group, with significant difference(P<0.05). After treatment, the accuracy of working memory and the recognition accuracy in the observation group were significantly higher than those in the control group,while the reaction time in the observation group was significantly shorter than that in the control group, with significant difference(P<0.05). The total effective rate of treatment in the observation group was higher than that in the control group, with significant difference(P<0.05). After treatment, the good prognosis rate in the observation group was higher than that in the control group, with significant difference(P<0.05). Conclusion The tDCS in the treatment of stroke patients with cognitive dysfunction can effectively improve the cognitive function and working memory level, enhance the efficacy and improve the prognosis. Thus tDCS is worthy of clinical application and promotion.
引文
[1]曲艳吉,卓琳,詹思延.中国脑卒中后认知障碍流行病学特征的系统评价[J].中华老年心脑血管病杂志,2013,15(12):1294-1301.
[2]汪洁,吴东宇,宋为群,等.双额叶在线经颅直流电刺激对失语症图命名的作用[J].中国康复医学杂志,2014,29(1):31-35.
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[4]李小旋,安金,任艳艳,等.无创性经颅刺激与认知功能障碍治疗现状[J].中国全科医学,2017,20(15):1804-1808.
[5]刘畅,吴东宇,敖纯利,等.经颅直流电刺激对基底核区病变后失语症合并认知障碍患者的1例报告[J].中国康复医学杂志,2015,30(9):954-956.
[6]蔡天燕,冉春风,钞强,等.计算机辅助工作记忆训练对脑卒中后认知障碍的影响[J].中国康复,2016,31(5):377-379.
[7]陈正威,张璞,恽晓平.工作记忆训练对脑卒中患者大脑功能激活的影响[J].中国康复理论与实践,2015,21(8):929-933.
[8]李松泽,胡金生,李骋诗,等.孤独症谱系障碍者的视觉-空间工作记忆缺陷及脑机制[J].心理科学进展,2016,24(7):1050-1064.
[9]出江绅一,唐志明.非侵入性脑刺激技术在脑卒中吞咽障碍治疗中的应用[J].中华物理医学与康复杂志,2013,35(12):945-948.
[10]Tremblay S,Lepage JF,Latulipe-Loiselle A,et al.The uncertain outcome of prefrontal tDCS[J].Brain Stimul,2014,7(6):773-783.
[11]Jo JM,Yun HK,Ko MH,et al.Enhancing the working memory of stroke patients using tDCS[J].Am J Phys Med Rehab,2009,88(5):404-409.
[12]Oliveira JF,Zanao TA,Valiengo L,et al.Acute working memory improvement after tDCS in antidepressant-free patients with major depressive disorder[J].Neurosci Lett,2013,537(6):60-64.
[13]郑杰,曾云,程攀,等.头针与经颅直流电刺激技术对脑梗死患者认知障碍治疗作用的比较研究[J].辽宁中医药大学学报,2017,19(6):131-133.
[14]刘晶,金香兰,郑宏,等.缺血性脑卒中患者认知功能障碍的影响因素研究[J].中国全科医学,2015,18(12):1361-1365.
[15]Woods AJ,Antal A,Bikson M,et al.A technical guide to tDCS,and related non-invasive brain stimulation tools[J].Clin Neurophysiol,2016,127(2):1031-1048.
[16]方翠霓,方碧兰,刘佳,等.经颅直流电刺激对脑卒中后语言功能障碍的疗效观察[J].中国基层医药,2017,24(17):2603-2606.
[17]Naylor JC,Borckardt JJ,Marx CE,et al.Cathodal and anodal left prefrontal tDCS and the perception of control over pain[J].Clin J Pain,2014,30(8):693-700.
[18]Molerochamizo A,Alameda JB,Garrido TB,et al.Poststimulation time interval-dependent effects of motor cortex anodal tDCS on reaction-time task performance[J].Cogn Affect Behav Ne,2018,18(1):167-175.
[2]汪洁,吴东宇,宋为群,等.双额叶在线经颅直流电刺激对失语症图命名的作用[J].中国康复医学杂志,2014,29(1):31-35.
[3]吴春薇,谢瑛.经颅直流电刺激的研究进展[J].中国康复理论与实践,2015,21(2):171-175.
[4]李小旋,安金,任艳艳,等.无创性经颅刺激与认知功能障碍治疗现状[J].中国全科医学,2017,20(15):1804-1808.
[5]刘畅,吴东宇,敖纯利,等.经颅直流电刺激对基底核区病变后失语症合并认知障碍患者的1例报告[J].中国康复医学杂志,2015,30(9):954-956.
[6]蔡天燕,冉春风,钞强,等.计算机辅助工作记忆训练对脑卒中后认知障碍的影响[J].中国康复,2016,31(5):377-379.
[7]陈正威,张璞,恽晓平.工作记忆训练对脑卒中患者大脑功能激活的影响[J].中国康复理论与实践,2015,21(8):929-933.
[8]李松泽,胡金生,李骋诗,等.孤独症谱系障碍者的视觉-空间工作记忆缺陷及脑机制[J].心理科学进展,2016,24(7):1050-1064.
[9]出江绅一,唐志明.非侵入性脑刺激技术在脑卒中吞咽障碍治疗中的应用[J].中华物理医学与康复杂志,2013,35(12):945-948.
[10]Tremblay S,Lepage JF,Latulipe-Loiselle A,et al.The uncertain outcome of prefrontal tDCS[J].Brain Stimul,2014,7(6):773-783.
[11]Jo JM,Yun HK,Ko MH,et al.Enhancing the working memory of stroke patients using tDCS[J].Am J Phys Med Rehab,2009,88(5):404-409.
[12]Oliveira JF,Zanao TA,Valiengo L,et al.Acute working memory improvement after tDCS in antidepressant-free patients with major depressive disorder[J].Neurosci Lett,2013,537(6):60-64.
[13]郑杰,曾云,程攀,等.头针与经颅直流电刺激技术对脑梗死患者认知障碍治疗作用的比较研究[J].辽宁中医药大学学报,2017,19(6):131-133.
[14]刘晶,金香兰,郑宏,等.缺血性脑卒中患者认知功能障碍的影响因素研究[J].中国全科医学,2015,18(12):1361-1365.
[15]Woods AJ,Antal A,Bikson M,et al.A technical guide to tDCS,and related non-invasive brain stimulation tools[J].Clin Neurophysiol,2016,127(2):1031-1048.
[16]方翠霓,方碧兰,刘佳,等.经颅直流电刺激对脑卒中后语言功能障碍的疗效观察[J].中国基层医药,2017,24(17):2603-2606.
[17]Naylor JC,Borckardt JJ,Marx CE,et al.Cathodal and anodal left prefrontal tDCS and the perception of control over pain[J].Clin J Pain,2014,30(8):693-700.
[18]Molerochamizo A,Alameda JB,Garrido TB,et al.Poststimulation time interval-dependent effects of motor cortex anodal tDCS on reaction-time task performance[J].Cogn Affect Behav Ne,2018,18(1):167-175.