目的 探讨重复经颅磁刺激(rTMS)结合眼针治疗脑外伤患者认知功能障碍的效果。方法 2014年5月至2016年6月,脑外伤后认知功能障碍患者90例,随机分为rTMS组(n=30)、眼针组(n=30)和联合组(n=30),分别予rTMS、眼针和rTMS结合眼针治疗,共8周。训练前后采用洛文斯顿作业治疗用认知评定(LOTCA)进行评定。结果 治疗前,各组LOTCA各项评分均无显著性差异(F<0.523, P>0.05),治疗后联合组评分最优(F>3.789, P<0.05)。结论 rTMS和眼针结合治疗能更有效地改善脑外伤后认知功能障碍。
Objective To investigate the effect of repetitive transcranial magnetic stimulation (rTMS) combined with eye-acupuncture on cognitive dysfunction on cognitive dysfunction in patients with traumatic brain injury. Methods From May, 2014 to June, 2016, 90 traumatic brain injury patients with cognitive impairment were randomly divided into eye-acupuncture group (n=30), rTMS group (n=30) and combination group (n=30), who accepted eye-acupuncture, rTMS and combination of eye-acupuncture and rTMS, repectively, for eight weeks. They were assessed with Loewenstein Occupational Therapy Cognitive Assessment (LOTCA) before and after treatment. Results There was no significant difference in scores of LOTCA among three groups before treatment (F<0.523, P>0.05). The scores of LOTCA were the best in the combination group after treatment (F>3.789, P<0.05). Conclusion The combination of eye-acupuncture and rTMS is more effective in improving cognitive function after traumatic brain injury than either alone.
[1] Poulin V, Korner-Bitensky N, Dawson DR, et al. Efficacy of executive function interventions after stroke: a systematic review [J]. Top Stroke Rehabil, 2012, 19(2): 158-171.
[2] 吴在德,吴肇汉. 外科学[M]. 北京:人民卫生出版社, 2008: 244-247.
[3] 王玉龙. 康复功能评定学[M]. 北京:人民卫生出版社, 2010: 295-296.
[4] 彭静山. 眼针疗法[M]. 沈阳:辽宁科学技术出版社, 1990: 11.
[5] 燕铁斌,马超,郭友华,等. Loewenstein认知评定量表(简体中文版)的效度及信度研究[J]. 中华物理医学与康复杂志, 2004, 26(2): 81-84.
[6] Hasadsri L, Wang BH, Lee JV, et al. Omega-3 fatty acids as a putative treatment for traumatic brain injury [J]. J Neurotrauma, 2013, 30(11): 897-906.
[7] Konigs M, Engenhorst PJ, Oosterlaan J. Intelligence after traumatic brain injury: meta-analysis of outcomes and prognosis [J]. Eur J Neurol, 2016, 23(1): 21-29.
[8] 尹义臣,陈卓铭,杜志宏. 卒中后认知功能康复与神经可塑性[J]. 继续医学教育, 2007, 21(15): 16-20.
[9] 宋名杨,朱路文,叶涛,等. 丰富环境促进缺血缺氧性脑损伤修复的研究进展[J]. 中国康复理论与实践, 2016, 22(1): 61-64.
[10] Barker AT, Jalinous R, Freeston IL. Non-invasive magnetic stimulation of human motor cortex [J]. Lancet, 1985, 1(8437): 1106-1107.
[11] 梁雅慧. 重复经颅磁刺激对认知功能影响的研究进展[J]. 中国康复医学杂志, 2015, 30(9): 959-962.
[12] Hellmann J, Juttner R, Roth C, et al. Repetitive magnetic stimulation of human-derived neuron-like cells activates cAMP-CREB pathway [J]. Eur Arch Psychiatry Clin Neurosci, 2012, 262(1): 87-91.
[13] 赵静,易正辉,王继军. 重复经颅磁刺激治疗认知功能障碍的研究进展[J]. 精神医学杂志, 2011, 24(2): 145-147.
[14] Drumond Marra HL, Myczkowski ML, Maia Memoria C, et al. Transcranial magnetic stimulation to address mild cognitive impairment in the elderly: a randomized controlled study [J]. Behav Neurol, 2015, 2015: 8-11.
[15] Wang HL, Xian XH, Wang YY, et al. Chronic high-frequency repetitive transcranial magnetic stimulation improves age-related cognitive impairment in parallel with alterations in neuronal excitability and the voltage-dependent Ca 2+ current in female mice [J]. Neurobiol Learn Mem, 2015, 118: 1-7.
[16] Guse B, Falkai P, Wobrock T. Cognitive effects of high-frequency repetitive transcranial magnetic stimulation: a systematic review [J]. J Neural Transm (Vienna), 2010, 117(1): 105-122.
[17] 黄居科,麦荣康,陈尚杰. 低频重复经颅磁刺激对脑外伤患者认知功能和功能独立的影响[J]. 中华神经医学杂志, 2009, 8(8): 854-856.
[18] Serafini G, Pompili M, Belvederi Murri M, et al. The effects of repetitive transcranial magnetic stimulation on cognitive performance in treatment-resistant depression. A systematic review [J]. Neuropsychobiology, 2015, 71(3): 125-139.
[19] Schafer RJ, Moore T. Selective attention from voluntary control of neurons in prefrontal cortex [J]. Science, 2011, 332: 1568-1571.
[20] 王鹏琴,王丽波,曹凤武,等. 眼针疗法改善实验性血管性痴呆大鼠学习记忆障碍及海马神经元超微结构的变化[J]. 上海针灸杂志, 2004, 23(1): 41-44.
[21] 俞梦瑾,郑学宝,周旋. 针刺与运动疗法对重型颅脑损伤后功能恢复的影响[J]. 中国康复理论与实践, 2012, 18(11): 1049-1051.
[22] 廖亮华,江兴妹,滕新,等. 眼针联合认知训练治疗脑卒中后认知功能障碍的疗效观察[J]. 中华物理医学与康复杂志, 2016, 38(2): 118-121.
[23] 恽晓平.基于研究证据的认知康复[J]. 中国康复理论与实践, 201l, 17(6): 512-514.
[24] Nardone R, Bergmann J, Christova M, et al. Effect of transcranial brain stimulation for the treatment of Alzheimer disease: a review [J]. Int J Alzheimers Dis, 2012, 2012: 687909.
[25] Elder GJ, Taylor JP. Transcranial magnetic stimulation and transcranial direct current stimulation: treatments for cognitive and neuropsychiatric symptoms in the neurodegenerative dementias? [J]. Alzheimers Res Ther, 2014, 6(9): 74.
[26] 李志. 眼针改善慢性脑供血不足患者认知功能障碍[J]. 中国针灸, 2009, 29(10): 791-793.
[27] Hsu WY, Cheng CH, Liao KK, et al. Effects of repetitive transcranial magnetic stimulation on motor functions in patients with stroke: a meta- analysis [J]. Stroke, 2012, 43(7): 1849-1857.
