低频重复经颅磁刺激联合高压氧治疗老年患者神经性耳鸣的疗效
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摘要
目的观察低频重复经颅磁刺激(rTMS)联合高压氧治疗对老年神经性耳鸣患者相关症状的治疗效果。方法选取老年神经性耳鸣患者58例,随机分为两组,均进行常规药物治疗,治疗组29例,给予低频rTMS联合高压氧治疗,对照组29例,给予高压氧治疗,低频rTMS患者行耳鸣同侧颞顶叶皮质1 Hz rTMS磁刺激,每天40次×40次,共20 d。两组患者均于治疗前、治疗20 d后,采用耳鸣致残(THI)量表、阿森斯失眠(AIS)量表及目测类比法(VAS)进行评估。对治疗前后两组患者的THI评分、AIS评分和VAS评分进行比较。结果治疗前,两组THI评分、AIS评分和VAS评分比较差异无统计学意义(P>0.05)。治疗20 d后,治疗组的THI、AIS评分和VAS评分显著低于治疗前和对照组(P<0.05)。治疗20 d后,治疗组中有19例患者THI评分降幅≥20分,有效达65.5%;对照组有12例患者THI评分降幅≥20分,有效率为41.4%,组间比较,差异有统计学意义(P<0.05)。结论 rTMS联合高压氧治疗可以显著改善老年神经性耳鸣患者临床症状。
Objective To observe the effect of low-frequency repetitive transcranial magnetic stimulation(rTMS) combined with hyperbaric oxygen therapy on the elderly patients with neurogenic tinnitus. Methods 58 elderly patients with neurogenic tinnitus were randomly divided into treatment and control groups. The treatment group was given rTMS combined with hyperbaric oxygen therapy, and the control group was given hyperbaric oxygen therapy. Before and after treatment for 20 d, tinnitus handicap inventory(THI), Hamilton anxiety(HAMA) scale and visual analogue scale(VAS) of two groups were assessed and compared.Results Before treatment, the scores of THI, AIS and VAS had no significant differences between the two groups(P>0.05). After treatment, the scores of THI, AIS and VAS were significantly different between the two groups(P<0.05). After treatment, the THI score of 19 patients in treatment group was decreased by 20 points, with an effective rate of 65.5%; the THI score of 12 patients in control group was decreased by 20 points, and the effective rate was 41.4%; the difference between the two groups was statistically significant(P<0.05). Conclusions The rTMS with hyperbaric oxygen therapy could significantly improve the clinical symptoms in elderly patients with neurogenic tinnitus.
Objective To observe the effect of low-frequency repetitive transcranial magnetic stimulation(rTMS) combined with hyperbaric oxygen therapy on the elderly patients with neurogenic tinnitus. Methods 58 elderly patients with neurogenic tinnitus were randomly divided into treatment and control groups. The treatment group was given rTMS combined with hyperbaric oxygen therapy, and the control group was given hyperbaric oxygen therapy. Before and after treatment for 20 d, tinnitus handicap inventory(THI), Hamilton anxiety(HAMA) scale and visual analogue scale(VAS) of two groups were assessed and compared.Results Before treatment, the scores of THI, AIS and VAS had no significant differences between the two groups(P>0.05). After treatment, the scores of THI, AIS and VAS were significantly different between the two groups(P<0.05). After treatment, the THI score of 19 patients in treatment group was decreased by 20 points, with an effective rate of 65.5%; the THI score of 12 patients in control group was decreased by 20 points, and the effective rate was 41.4%; the difference between the two groups was statistically significant(P<0.05). Conclusions The rTMS with hyperbaric oxygen therapy could significantly improve the clinical symptoms in elderly patients with neurogenic tinnitus.
引文
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4 石秋兰,卜行宽,王俊国,等.耳鸣致残量表中文版的研译与临床应用[J].南京医科大学学报(自然科学版),2007;27(5):476-9.
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7 Barwood CH,Wilson WJ,Malicka AN,et al.The effect of rTMS on auditory processing in adults with chronic,bilateral tinnitus:a placebo-controlled pilot study[J].Brain Stimul,2013;(6):752-9.
8 Plewnia C,Reimold M,Najib A,et al.Dose-dependent attenuation of auditory phantom perception(tirmitus)by PET-guided repetitive transcranial magnetic stimulation[J].Hum Brain Mapp,2007;28:238-46.
9 Poreisz C,Paulus W,Moser T,et al.Does a single session of theta-burst transcranial magnetic stimulation of inferior temporal cortex affect tinnitus perception[J]?BMC Neurosci,2009;10:54.
10 Lewnia C,Reimold M,Najib A,et al.Moderate therapeutic efficacy of positron emission tomography-navigated repetitive transcranial magnetic stimulation for chronic tinnitus:a randomised,controlled pilot study[J].J Neurol Neurosurg Psychiatry,2007;78:152-6.
11 Khedr EM,Rothwell JC,Ahmed MA,et al.Effect of daily repetitive transcranial magnetic stimulation for treatment of tinnitus:comparison of different stimulus frequencies[J].J Neurol Neurosurg Psychiatry,2008;79:212-5.
12 马跃文,张带,沈艺莲.低频重复经颅磁刺激治疗主观性耳鸣的疗效观察[J].中华物理医学与康复杂志,2014;36(4):299-301.
2 Theodoroff SM,Folmer RL.Repetitive transcranial magnetic stimulation as a treatment for chronic tinnitus:a critical review[J].Otol Neurotol,2013;34(2):199-208.
3 Park S,Park HJ,Kyeong SH,et al.Combined rTMS to the auditory cortex and prefrontal cortex for tinnitus control in patients with depression:a pilot study[J].Acta Otolaryngol,2013;133(6):600-6.
4 石秋兰,卜行宽,王俊国,等.耳鸣致残量表中文版的研译与临床应用[J].南京医科大学学报(自然科学版),2007;27(5):476-9.
5 李建旺,尹素风,殷建勉.阿森斯失眠量表的临床应用[J].健康心理学杂志,2000;8(4):353-5.
6 Siebner HR,Rothwell J.Transcranial magnetic stimulation:new insights into representational cortical plasticity[J].Exp Brain Res,2003;148:1-16.
7 Barwood CH,Wilson WJ,Malicka AN,et al.The effect of rTMS on auditory processing in adults with chronic,bilateral tinnitus:a placebo-controlled pilot study[J].Brain Stimul,2013;(6):752-9.
8 Plewnia C,Reimold M,Najib A,et al.Dose-dependent attenuation of auditory phantom perception(tirmitus)by PET-guided repetitive transcranial magnetic stimulation[J].Hum Brain Mapp,2007;28:238-46.
9 Poreisz C,Paulus W,Moser T,et al.Does a single session of theta-burst transcranial magnetic stimulation of inferior temporal cortex affect tinnitus perception[J]?BMC Neurosci,2009;10:54.
10 Lewnia C,Reimold M,Najib A,et al.Moderate therapeutic efficacy of positron emission tomography-navigated repetitive transcranial magnetic stimulation for chronic tinnitus:a randomised,controlled pilot study[J].J Neurol Neurosurg Psychiatry,2007;78:152-6.
11 Khedr EM,Rothwell JC,Ahmed MA,et al.Effect of daily repetitive transcranial magnetic stimulation for treatment of tinnitus:comparison of different stimulus frequencies[J].J Neurol Neurosurg Psychiatry,2008;79:212-5.
12 马跃文,张带,沈艺莲.低频重复经颅磁刺激治疗主观性耳鸣的疗效观察[J].中华物理医学与康复杂志,2014;36(4):299-301.