经颅磁刺激治疗失眠症的临床研究

·988·

中国实用神经疾病杂志2019年5月第22卷第9期　ChineseJournalofPracticalNervousDiseasesMa019,Vol.22No.9y2

·论著　临床诊治·

经颅磁刺激治疗失眠症的临床研究

冯美娜　杜远敏　李　进

武汉市长江航运总医院脑科医院神经内科,湖北武汉430015

【摘要】　目的　观察重复低频经颅磁刺激治疗失眠症患者的临床疗效。方法　选取武汉市长江航运总医院收治的失眠症

患者3随机分为观察组、对照组各1对照组采用常规治疗,观察组在此基础上给予重复低频经颅磁刺激治疗,0例,5例,14d后观察疗效,入睡困难、睡眠不深、早醒)及1个月后随访。结果　治疗后观察组较治疗前及对照组汉密尔顿抑郁量表睡眠障碍因子(),匹兹堡睡眠量表评分均明显降低(睡眠明显改善。结论　重复低频经颅磁刺激治疗失眠症有明显疗效。P<0.05

【关键词】失眠症;交变磁场;汉密尔顿抑郁量表;睡眠障碍因子;匹兹堡睡眠量表　经颅磁刺激;【()中图分类号】文献标识码】文章编号】　R744.5　　【　A　　【　1673-5110201909-0988-05

FENGMeina,DUYuanmin,LIJinClinicalstudntranscranialmaneticstimulationintreatmentofinsomniayog

DeartmentoeuroloWuhanBrainHostial,GeneralHositaloheYantzeRiverShiinWuhan430015,ChinapfNgy,ppftgppg,

,casesofpatientswithinsomniatreatedinGeneralHositaloftheYantzeRiverShiinereselectedandrandomlividedintopgppgwydvationgrouasgivenreeatedlow-freuencranscranialmaneticstimulation(rTMS)treatment.Theeffectwasobserved14pwpqytg

【】Abstract　Obective　ToexloreclinicaleffectofTranscranialmaneticstimulationintreatmentofinsomnia.Methods　30pgj

:,,2grousobservationgroundcontrolrou15ineach.Thecontrolrousedconventionaltreatment.Onthisbasistheobser-ppagpgpudaslaterandfollowedufteronemonth.Results　ComaredwithComaredwiththethepre-treatmentofobservationgrouypappp

)(),inandPittsburhsleecalescoresweresinificantlreducedP<0.05andsleeasimroved.Conclusion　rTMScaneffec-ggpsgypwptivelimrovesleeualitfpatientswithinsomnia.yppqyo;orderfactorsPittsburhsleecalescoresgps

【】;;;;Keords　TranscranialmaneticstimulationInsomniaAlternatinaneticfieldHamiltonderessionscaleSleeis-ggmgppdyw

,(,,andafterthecontrolroutheHamiltonderessionscalesleeisorderfactorssleeifficultsleeerivationearlwaken-gpppdpdypdpya

/是维持健康重要的生理过　　睡眠占据13的时间,程,而临床上失眠症是常见病之一,因入睡困难或睡眠维持困难等影响正常的生理需求,导致白天社会功能受到影响为主要特征,影响人类健康。失眠治疗主

[1-4]

。要为药物和非药物治疗(心理、认知行为治疗等)

男1女08-2018-01收治的失眠症患者30例,3例,()()年龄3岁。入选标准:失眠17例,0~7556±3.51(自愿参加。排除标准:癫痫发作史、脑器质性疾1)(病,严重躯体疾病,精神疾病,精神发育迟滞;有2)()酒、药物依赖及精神活性药物滥用者;妊娠或哺乳31.2　方法　所有患者进行汉密尔顿抑郁量表(、匹兹堡睡眠量表评价,对照组采用基础治HAMD)

,刺激部位左侧前额叶,设定频率1mH刺激强度z后,比较2组HAMD睡眠障碍因子(入睡困难、睡眠不深、早醒)及匹兹堡睡眠量表评分。

疗,观察组在此基础上加重复低频经颅磁刺激治疗,期妇女。随机分为观察组和对照组各15例。((症状≥3次/周,持续≥2个月;年龄≥12)8岁;3)

多数患者担忧失眠药潜在的不良反应,在接受心理治

5-13]

,疗时依从性又差[故寻求一种安全有效的物理治

,是近年来关注的焦点。maneticstimulationTMS)g本研究采用多种评估方法对低频TMS治疗失眠症的效果进行评价。1　资料与方法

疗更易于让患者接受。而经颅磁刺激(transcranial

,/次,连续治疗2周。疗程结束1.0T,1次/d30min

1.1　临床资料　选取武汉市长江航运总医院2016-:作者简介:冯美娜,Emailnn19860111@126.com

1.3　统计学方法　所有数据采用SPSS15.0统计软件对数据进行统计处理.计量资料以均数±标准差

(表示,组间比较用t检验,x±s)P<0.05为差异有统计学意义。

中国实用神经疾病杂志2019年5月第22卷第9期　ChineseJournalofPracticalNervousDiseasesMa019,Vol.22No.9y2

)可易化神经元的兴奋作用,而低频r则TMS(20-24]

。r对神经元的兴奋性起抑制作用[TMS是一种25]

。因此,连接的大脑区域的功能[rTMS可能具有]26-27

。这些变化的机制尚不完全清楚,段时间[但似乎

·989·

主要依赖于刺激频率的方法,可以瞬间调节受刺激和

2　结果

2.1　2组治疗前后HAMD评分及睡眠障碍因子比较　治疗后观察组HAMD评分及睡眠障碍因子与同组治疗前、对照组治疗后比较,入睡困难、睡眠不2.2　2组治疗前后匹兹堡睡眠量表评分比较　观察组匹兹堡睡眠量表评分与同组治疗前、对照组治疗后)。见表2。比较,差异有统计学意义(P<0.053　讨论

)。见表1。深、早醒均明显改善(P<0.05

治疗和康复作用,因为重复治疗的效果可能会持续一与C和长期抑郁(现NS内突触长期电位(LTP)LTD)

]28-31

。TM象有关[还可能影S除了影响脑电活动外,]3233]34]

、、、响脑血流量[血脑屏障通透性[神经代谢[蛋]35

。TM白信号转导和转录[S和功能影像学

()、正电子发射断层成像(相结合可显示fMRIPET)信息是如何在大脑中处理和传递的,探索大脑网

36-40]

。TM络[S已成为临床和基础研究中常用的调节]41-42

。目前,神经网络和相关脑功能的工具[很多神经

流,进而改变神经细胞的动作电位,以此来影响脑内代谢和神经电活动的生物刺激过程。20世纪90年代,TOFTS证明TMS通过磁场的快速变化在中枢神经系统中诱导循环电流,并优先刺激与线圈在同一

]14-15

。TM平行面上的神经元[S在大脑中产生的电场

TMS是利用时变磁场在大脑皮质中产生感应电

系统疾病(如癫痫、帕金森病、肌张力障碍、抽动症等)和精神系统疾病(如抑郁症、焦虑症等)的发生都可归咎于大脑皮质特定细胞兴奋阈值的改变。某些睡眠障碍性疾病表现为皮质兴奋性升高为主要特征。所以,改变皮质兴奋性有可能是治疗这些神经精神疾病的关键所在。目前,研究将rTMS应用于神经精神疾病的治疗中,如癫痫、帕金森病、肌张力障碍、不宁

]24,43-47

。甚至腿综合征、精神疾病等取得了良好疗效[

取决于许多物理和生物参数,如刺激的频率、强度和模式、磁脉冲波形、在大脑中引起的电流线的方向、线

3,16-19]

。将圈的方向和形状以及可兴奋的神经元件[

)固定频率(和适宜强度的磁刺激连续作1~100Hz用于某一脑区,即称之为rTMS。改变局部大脑皮质兴奋性是磁刺激的独特作用,其刺激强度及频率越高,对大脑皮质功能的影响就越大。不同频率rTMS)对大脑皮质功能的影响也不同,高频rTMS(≥5Hz

国外曾有报道治疗慢性疼痛、耳鸣也有一定的

48-52]

。疗效[

治疗失眠的可能机制,研究显示将低频脉冲磁场发生装置耦合入猫脑内,发现诱导性质的磁刺激具有显著

目前部分动物及临床实验探索了重复低频TMS

Table1　ComarisonofHAMDandsleeisorderfactorsbeforeandaftertreatmentin2grous　(x±s)ppdp

评价指标入睡困难

组别观察组对照组

睡眠不深

观察组对照组

早醒

观察组对照组

表1　2组治疗前后HAMD和睡眠障碍因子比较　(x±s)

n151515151515

治疗前2.5±0.52.5±0.51.5±0.51.4±0.52.5±0.52.3±0.6

治疗后2周0.6±0.32.0±0.50.5±0.41.2±0.31.3±0.62.0±0.5

治疗后1个月0.8±0.52.0±0.50.7±0.51.3±0.51.6±0.51.8±0.4

Table2　ComarisonofPittsburhsleecalescoresbeforeandaftertreatmentin2grous　(x±s)pgpsp组别观察组对照组

表2　2组治疗前后匹兹堡睡眠量表评分比较　(x±s)

治疗前18.20±6.5017.80±7.80

治疗后2周

n1515

10.58±8.6015.63±6.45

治疗后1个月16.95±9.809.05±7.50

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中国实用神经疾病杂志2019年5月第22卷第9期　ChineseJournalofPracticalNervousDiseasesMa019,Vol.22No.9y2

促入眠作用。研究发现,失眠患者的心理生理基础状况、全身代谢率、神经内分泌及神经电生理存在多重

]53

。复杂改变[

内、国外也有相关报道,均证实rTMS治疗失眠的有

54-56]

。效性和安全性[

rTMS治疗原发性或继发性失眠的临床试验国

[],,10　SATEIAMJBUYSSEDJKRYSTALAD,etal.

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本研究中观察组在常规治疗的基础上给予

与同组治疗前、对照组治疗后比较,在入rTMS治疗,睡困难、睡眠不深、早醒等HAMD评分、睡眠障碍因子和匹兹堡睡眠量表评分均明显降低,睡眠较前改[]11　AFOLALUEF,MOOREC,RAMLEEF,etal.Devel-

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善,同时反应,接1受5例患者在接受程度高,证实了rTrTMMS治疗过程中无不适S治疗失眠症的有效性。

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