罗雅丽;陈劲松;白洁;陈莎莎;刘双;

• 1:电子科技大学医学院附属绵阳医院·绵阳市中心医院

摘要(Abstract)：

目的 观察经颅直流电刺激（tDCS）联合重复经颅磁刺激（rTMS）治疗脑卒中后认知障碍（PSCI）的疗效。方法 纳入2020-07—2022-02电子科技大学医学院附属绵阳医院住院的PSCI患者120例，随机分为rTMS组、tDCS组、联用1组和联用2组。rTMS组采用r TMS治疗，tDCS组采用tDCS治疗，联用1组采用先rTMS后tDCS治疗，联用2组采用先tDCS后r TMS治疗，4组均治疗8周。治疗前后观察蒙特利尔认知评估量表（MoCA）、连线测验(TMT)、Stroop色词试验评分，磁共振弥散张量成像(DTI)，实验室指标（hs-CRP、BDNF、SOD）。结果 量表测试方面，治疗后联用2组TMT时长低于其余3组（38.03±3.49比42.96±3.70、43.11±3.58、40.72±4.46）(P<0.05),Stroop色词试验高于其余3组（56.26±4.64比54.29±4.36、52.85±3.69、55.39±4.59）(P<0.05),MoCA评分高于rTMS组和tDCS组（23.05±4.02比21.33±2.64、19.75±2.27），与联用1组比较无统计学差异（P>0.05）。DTI方面，治疗后联用2组在胼胝体压部、矢状层（右侧）、上纵束（双侧）、扣带束（双侧）的FA值高于其余3组（P<0.05），在矢状层（左侧）、下额枕束（双侧）的FA值高于tDCS组，在胼胝体膝部与其他3组比较无统计学差异（P>0.05），且联用2组MoCA评分、Stroop色词试验个数的提高与胼胝体压部、左侧上纵束、双侧扣带束FA值的上升呈正相关（P<0.05），而TMT总时长的减少与胼胝体压部、双侧上纵束、双侧扣带束FA值的上升呈负相关（P<0.05）。实验室指标方面，联用2组BDNF、SOD水平高于其余3组（P<0.05）,hs-CRP水平低于rTMS组和tDCS组（P<0.05），与联用1组比较无统计学差异（P>0.05）。结论 在PSCI治疗上，单独采用r TMS优于单独采用tDCS，先采用tDCS后采用rTMS具有较好的效果，优于单独使用tDCS或rTMS以及先使用rTMS后使用t DCS。

关键词(KeyWords)： 脑卒中;认知障碍;经颅直流电刺激;重复经颅磁刺激;磁共振弥散张量成像

Abstract:

Keywords:

基金项目(Foundation): 四川省医学科研课题计划（编号：S19068）;; 四川省卫生健康委员会科研课题（编号：20PJ261）;; 康复医学四川省重点实验室开放课题（编号：KFYXSZDSYS-06）

作者(Authors): 罗雅丽;陈劲松;白洁;陈莎莎;刘双;

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