经颅磁刺激联合高压氧（HBO)治疗脑梗死240 例临床疗效分析

目的:观察经颅磁刺激(transcranial magnetic stimulation,TMS)联合高压氧(hyperbaricoxygen,HBO)治疗脑梗死的临床疗效。方法:采用随机数字表法将240例脑梗死患者分为联合治疗组、HBO组及常规组,每组80例。常规组患者给予常规治疗,HBO组患者在常规干预基础上辅以HBO治疗,联合治疗组患者则在常规干预基础上辅以HBO及TMS联合治疗。上述治疗均以10 d为1个疗程,共治疗2个疗程。于治疗前、治疗2个疗程后比较各组患者神经功能缺损程度,并同时于上述时间点检测各组患者中枢运动传导时间(CMCT)及血清中脑源性神经营养因子(BDNF)、神经生长因子(NGF)表达情况。结果:各组患者分别经2个疗程治疗后,发现联合治疗组NIHSS评分、总有效率均显著优于HBO组及常规组水平(均P0.05);另外联合治疗组血清中BDNF含量与NGF含量均较治疗前明显升高(P0.05),与常规组及HBO组间差异亦具有统计学意义(均P0.05)。结论:TMS联合HBO治疗脑梗死具有协同作用,能进一步改善患者受损神经功能及日常生活质量,其治疗机制可能与增强神经营养因子表达有关。

Effect Analysis of 240 Cases of Cerebral Infarction with Hyperbaric Oxygen Combined with Transcranial Magnetic Stimulation

Objective:To study the effects of repetitive transcranial magnetic stimulation (rTMS) combined with hyperbaric oxygen (HBO) therapy on the recovery of neurological functional after cerebral infarction, and to discuss its possible mechanism.Methods:Forty-five patients with cerebral infarction were randomly divided into a control group, anr TMS group and an rTMS plus HBO group, each group with 15 patients. The patients in the two treatment groups received 1 Hz rTMS to inhibit the unaffected hemisphere and 3 Hz rTMS to stimulate the affected hemisphere. One of the treatment groups also received HBO therapy, 14 daily sessions. The National Institutes of Health stroke scale (NIHSS) and the Barthel index (BI) were evaluated on the 1st, 14th and 30th day of treatment.Results:The neurological function scores of those in the rTMS group and the rTMS&HBO group improved significantly. On the 1st and 14th day, no significant difference in NIHSS or BI scores was observed among the three groups, but by the 30th day the average neurological functional score in the rTMS&HBO group had improved significantly compared with the control group. TherTMS plus HBO group showed significantly better improvement than the rTMS group in terms of BI scores, but no significant difference in average NIHSS and BI scores was observed between the rTMS group and the control group. Fifteen days after the treatments had finished, the follow up results showed the improvements of the patients in the rTMS plus HBO group were significantly better than those in the other groups.Conclusion:For patients with cerebral infarction, rTMS combined with HBO therapy can improve neurological function more significantly than rTMS therapy alone.