重复经颅磁刺激对急性卒中后中枢性疼痛病人疼痛及生活质量的疗效评价

doi:10.3969/j.issn.1003-9198.2024.12.014

摘要/Abstract

摘要： 目的评估重复经颅磁刺激(repetitive transcranial magnetic stimulation, rTMS)改善急性卒中后中枢性疼痛(central poststroke pain,CPSP)病人疼痛及生活质量的效果。方法选取30例年龄≥60岁的急性CPSP病人,采用随机数表法随机分为2组,分别接受3周rTMS干预治疗(rTMS组,n=15)或假性rTMS治疗(对照组,n=15)。分别在基线和干预后采用疼痛数字评估量表(NRS)、汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD)及简明 WHO 生活质量测定量表(WHOQOL-BREF)评分进行评估,比较2组改善效果。结果基线时2组病人一般情况及各项评分差异均无统计学意义(P＞0.05),干预3周后,rTMS组的NRS评分较基线及对照组显著降低(P＜0.05);HAMA和HAMD评分与基线相比显著降低(P＜0.05),但与对照组相比,差异无统计学意义(P＞0.05)。2组病人WHOQOL-BREF评分的前28项之和以及自身总体评分均较基线时显著改善(P＜0.05);与对照组相比,rTMS组改善更加显著(P＜0.05)。结论 rTMS应用于患侧运动皮层可有效缓解急性CPSP,改善与疼痛相关的情绪障碍以及生活质量。

关键词: 重复经颅磁刺激, 卒中后中枢性疼痛, 情绪障碍, 生活质量, 老年人

Abstract: Objective To evaluate the efficacy of repetitive transcranial magnetic stimulation(rTMS) on pain and the quality of life in the patients with acute central poststroke pain(CPSP). Methods A total of 30 patients aged 60 years and over with acute CPSP were selected and randomly divided into two groups using a random number table. The rTMS group received rTMS intervention treatment (n=15),and the control group received sham rTMS treatment (n=15) for 3 weeks, respectively. At baseline and after 3 weeks of intervention, pain Numeric Rating Scale (NRS), Hamilton Anxiety Scale (HAMA), Hamilton Depression Scale (HAMD) and Brief World Health Organization Quality of Life (WHOQOL-BREF) were evaluated and compared between the two groups. Results There were no significant differences in general condition and the scores of above scales between the two groups at baseline (P>0.05). After 3 weeks of treatment, the score of NRS in the rTMS group was significantly lower than that at baseline and that in the control group (P<0.05); The scores of HAMA and HAMD in the rTMS group were significantly lower than those at baseline (P<0.05), but showing no statistical difference from those in the control group (P>0.05). After 3 weeks of treatment, the sum of the first 28 items of WHOQOL-BREF and the overall score of WHOQOL-BREF showed significant improvement in both groups (P<0.05), especially in the rTMS group(P<0.05). Conclusions rTMS applied to the affected motor cortex can effectively alleviate acute CPSP and improve pain-related emotional disorders and quality of life.

Key words: repetitive transcranial magnetic stimulation, central poststroke pain, emotional disorders, quality of life, aged

中图分类号:

张言午, 王海, 高松年, 孙小星, 陈超, 沈媛媛, 丁磊. 重复经颅磁刺激对急性卒中后中枢性疼痛病人疼痛及生活质量的疗效评价[J]. 实用老年医学, 2024, 38(12): 1250-1254.

ZHANG Yanwu, WANG Hai, GAO Songnian, SUN Xiaoxing, CHEN Chao, SHEN Yuanyuan, DING Lei. Efficacy of repetitive transcranial magnetic stimulation in relieving pain and quality of life in patients with acute central poststroke pain[J]. Practical Geriatrics, 2024, 38(12): 1250-1254.

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