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超低频经颅磁刺激治疗缺血性脑卒中患者失眠的 临床疗效
朱明跃刘元标黄娟娟宣江慧许光旭
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目的 观察超低频经颅磁刺激(ILF-TMS)治疗缺血性脑卒中后失眠的临床疗效。方法 选 取60例缺血性脑卒中后失眠患者,按照随机数字表法将其分为常规治疗组(30例)和ILF-TMS治疗组(30 例), 两组患者均口服酒石酸唑吡坦片,每晚睡前口服5 mg。ILF-TMS 治疗组在此基础上加用ILF-TMS 治疗, 常规治疗组每日接受伪ILF-TMS治疗,患者治疗前和治疗后(10 d 后)均给予匹兹堡睡眠质量指数(PSQI) 和多导睡眠图(PSG)相关参数评价睡眠情况,PSG 评价参数主要包括总睡眠时间(TST)、睡眠潜伏期(SL) 以及睡眠NREM(S1、S2、S3 +S4 )、REM 的睡眠结构比。结果 治疗前两组患者PSQI、TST、SL、S1、S2、 S3+S4、REM 评分比较,差异无统计学意义(P> 0.05)。常规治疗组患者10 d 后PQSI评分较前明显降低 [(18.03±1.37)分比(12.60±2.43)分];TST 较前明显延长[(251.42±42.42)min 比(288.80±40.32)min]; SL 较治疗前有显著缩短[(39.60±17.62)min 比(34.40±14.89)min],差异均有统计学意义(P < 0.05),睡 眠结构S1、S2、S3+S4、REM 较治疗前均无明显变化。ILF-TMS 治疗组患者10 d 后PQSI评分较前明显降 低[(18.17±1.29)分比(10.40±2.13)分];TST较前明显延长[(241.50±51.75)min 比(353.45±52.20)min]; SL 较治疗前有显著缩短[(40.80±17.47)min 比(26.60±13.22)min],差异均有统计学意义(P < 0.05),而 睡眠结构S1、S2、S3+S4、REM 较治疗前均无明显变化。与常规治疗组比较,ILF-TMS 治疗组患者治疗后 PSQI评分更低,TST更长,SL更短,差异均有统计学意义(P< 0.05)。结论 ILF-TMS 可以改善缺血性脑 卒中后失眠症状,短期(10 d)ILF-TMS 治疗尚不能改善缺血性脑卒中后失眠患者的睡眠结构。
基金项目:南京医科大学科技发展基金一般项目(NMUB2018052)
Clinical study on infra-low frequency transcranial magnetic stimulation in the treatment of insomniaafter ischemic stroke
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Abstract:
Objectives To observe the effects of infra-low frequency transcranial magnetic stimulation (ILF-TMS) in insomnia after ischemic stroke. Methods A total of 60 insomniacs after ischemic stroke were divided into the conventional treatment group( n=30) and the ILF-TMS group( n=30) by random number table method. Zolpidem tartrate was prescribed to patients in both groups, 5mg orally per night before sleep. On this basis, the ILF-TMS group was treated with ILF-TMS, while the conventional treatment group received sham ILF-TMS treatment. Pittsburgh Sleep Quality Index( PSQI) and polysomnography( PSG) were used to evaluate the sleep status before and 10 days after the treatment. PSG was taken to evaluate the sleep state mainly through the percentage of time of total sleep time( TST), sleep latency( SL), non-rapid eye movement( NREM) and rapid eye movement( S1, S2, S3+S4). Results Before the treatment there were no significant differences in the average scores of PSQI, TST, SL, S1, S2, S3+S4, REM between the two groups. In the conventional treatment group, the PQSI score decreased significantly after 10 days' treatment( 18.03±1.37) vs( 12.60±2.43); TST prolonged from( 251.42±42.42) min to( 288.80±40.32) min; SL shortened from( 39.60±17.62) min to( 34.40±14.89), all the differences were statistically significant( P < 0.05). However, REM of sleep structure, S1, S2 and S3+S4 showed no significant changes compared with that before treatment. The PQSI score in the ILF-TMS group was significantly changed after therapy( 18.17±1.29) vs( 10.40±2.13). Both TST and SL were improved (241.50±51.75) vs( 353.45±52.20) and( 40.80±17.47) vs( 26.60±13.22), with statistically significant differences( P < 0.05). However, REM of sleep structure, S1, S2 and S3+S4 showed no significant changes compared with that before treatment. After treatment, the subjective scores of PSQI in the ILF-TMS group was significantly lower than those in the conventional treatment group, TST was significantly better than that in the conventional treatment group, and SL was also improved comparing with the conventional treatment group( P<0.05). Conclusions Although short-term( 10 days) ILF-TMS treatment cannot improve the sleep structure of patients with insomnia after ischemic stroke,ILF-TMS can improve the symptoms of insomnia after ischemic stroke.

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