乔康熙,张猛,张梦柯,等.间歇性θ脉冲刺激联合高压氧治疗对脑卒中后认知障碍患者认知功能及P300的影响[J].中华物理医学与康复杂志,2026,48(5):411-416
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| 间歇性θ脉冲刺激联合高压氧治疗对脑卒中后认知障碍患者认知功能及P300的影响 |
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| DOI：10.3760/cma.j.cn421666-20251014-00908 |
| 中文关键词: 脑卒中后认知障碍 间歇性θ脉冲刺激 高压氧 事件相关电位 |
| 英文关键词: Cognitive impairment Theta-burst stimulation Hyperbaric oxygen Event-related potentials |
| 基金项目:安徽省教育厅高校科学研究项目（2024AH050788）；2024年度高等学校省级质量工程项目（2024xskc053）；2025年阜阳市科学技术局科研项目（KF20254634） |
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| 中文摘要: |
| 目的 探讨间歇性θ脉冲刺激（iTBS）联合高压氧治疗对脑卒中后认知障碍（PSCI）患者认知功能及事件相关电位P300的影响。 方法 采用随机数字表法将80例PSCI患者分为常规组、高压氧组、iTBS组、联合组，每组20例。4组患者均接受常规认知训练，在此基础上，高压氧组加用2个绝对大气压（ATA）压力的高压氧治疗，iTBS组在左背外侧前额叶皮质（DLPFC）施加iTBS干预，联合组采用2 ATA压力的高压氧治疗及iTBS干预，每日1次，每周5 d。治疗前、治疗4周后（治疗后），采用简易精神状态量表（MMSE）评估4组患者的认知功能，利用事件相关电位仪检测患者的P300潜伏期、波幅及平均反应时间（MRT）。 结果 治疗前，4组患者的MMSE子项评分及总分，P300潜伏期、波幅及MRT比较，差异均无统计学意义（P＞0.05）。与组内治疗前比较，4组患者治疗后除记忆力评分外，MMSE子项（定向力、注意力和计算力、回忆能力、语言能力）评分及总分均增加（P＜0.05），P300潜伏期、波幅及MRT均改善（P＜0.05）。与其余3组比较，联合组治疗后MMSE定向力评分［（7.00±1.45）分］、注意力和计算力评分［（3.80±1.11）分］、语言能力评分［（6.50±1.54）分］及总分［（22.1±2.25）分］较高（P＜0.05），P300潜伏期较短［（342.60±54.56）ms］、波幅较高［（19.42±3.73）μV］、MRT［（607.45±202.60）ms］较短（P＜0.05）。治疗过程中，部分患者在治疗第1周内出现轻度头晕、耳闷、耳鸣等不良反应，休息后自行缓解。 结论 iTBS联合高压氧治疗可有效改善PSCI患者的整体认知功能，优化P300相关神经电生理指标，安全性良好。 |
| 英文摘要: |
| Objective To demonstrate the effect of combining intermittent theta burst stimulation (iTBS) with hyperbaric oxygen (HBO) therapy to improve cognitive functioning and P300 event-related potentials in persons with post-stroke cognitive impairment (PSCI). Methods Eighty PSCI patients were randomly divided into four groups using a random number table: a conventional group, a hyperbaric oxygen group, an iTBS group, and a combination group, each of 20. In addition to conventional cognitive training for all groups, the hyperbaric oxygen group received hyperbaric oxygen therapy at a pressure of 2 atmospheres absolute (ATA). iTBS was applied over the left dorsolateral prefrontal cortex in the iTBS group, and the combination group underwent both. There were daily sessions, five days per week for four weeks. Before and after the treatments, cognitive functioning was assessed using the Mini-mental State Examination (MMSE). P300 latency, amplitude, and the mean reaction times (MRTs) of button responses were measured using an event-related potential device. Results There were no significant differences among the four groups before the experiment. Afterward, a significant improvement was observed in all groups′ average MMSE subitem scores (orientation; attention and calculation; recall ability; language ability) except for the memory scores and total scores. P300 latency, amplitude, and MRT had also improved significantly. Compared with the other three groups, the combination group showed significantly higher MMSE orientation scores, attention and calculation scores, language ability scores, and total scores after the treatment, as well as shorter P300 latency, higher P300 amplitude, and shorter MRT. During the treatment period, some patients experienced mild adverse reactions such as dizziness, aural fullness, and tinnitus within the first week of treatment, which disappeared spontaneously after rest. Conclusions Combining iTBS with hyperbaric oxygen therapy effectively improves global cognitive functioning and optimizes P300-related neuroelectrophysiological parameters in PSCI patients with a favorable safety profile. |
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