摘要
目的探究连续性θ爆发刺激(cTBS)联合低频重复经颅磁刺激(rTMS)治疗主观性耳鸣的临床效果。方法回顾性选择主观性耳鸣患者120例作为研究对象,根据治疗方式将1Hz rTMS刺激双侧颞顶叶皮质+cTBS刺激右侧前额叶背外侧皮质治疗的患者设为联合组(n=40),单独采用1Hz rTMS刺激双侧颞顶叶皮质治疗的患者设为rTMS组(n=40),仅进行了假刺激的患者设为对照组(n=40)。比较三组患者治疗前后的耳鸣残疾量表(THI)、疼痛视觉模拟量表(VAS)评分及不良反应。结果与治疗前比较,联合组和rTMS组治疗后的THI和VAS评分均明显降低(t分别=4.30、2.50;2.62、3.04,P均<0.05);对照组治疗前后THI和VAS评分比较,差异均无统计学意义(t分别=0.10、0.24,P均>0.05)。治疗后联合组的THI评分低于rTMS组及对照组(t分别=4.03、2.96,P均<0.05),rTMS组的VAS评分明显低于对照组(t=3.82,P<0.05);联合组治疗后VAS评分与rTMS组比较,差异无统计学意义(t=0.91,P>0.05)。三组患者治疗前后运动皮质阈值和言语频率纯音听阈检测结果比较,差异均无统计学意义(F分别=0.82、2.24;1.56、0.52,P均>0.05)。三组患者治疗后均并未出现耳鸣加重、癫痫发作、头痛头晕等不良反应。结论低频rTMS模式刺激双侧颞顶叶皮质联合cTBS模式刺激右侧前额叶背外侧皮质治疗主观性耳鸣具有明显的治疗效果,可以有效降低患者耳鸣的残疾程度,改善患者的主观感受。
Objective To investigate the clinical effect of continuous θ burst stimulation(cTBS)combined with low frequency repetitive transcranial magnetic stimulation(rTMS)in the treatment of subjective tinnitus.Methods Totally 120 patients with subjective tinnitus were retrospectively selected as the research subjects.According to the treatment methods,the patients who were treated with 1Hz rTMS stimulation of bilateral temporal parietal cortex combined with cTBS stimulation of right prefrontal dorsolateral cortex were selected as the combined group(n=40),and the patients treated with 1Hz rTMS stimulation of bilateral temporal pariet al cortex were selected as the rTMS group(n=40),and the patients treated with sham stimulation alone were enrolled as the control group(n=40).Tinnitus disability scale(THI),visual analogue scale(VAS)scores and adverse reactions among the three groups were compared before and after treatment.Results Compared with before treatment,the THI and VAS scores in the combined group and rTMS group were significantly lower after treatment(t=4.30,2.50,2.62,3.04,P<0.05).There was no significant difference in THI and VAS scores in the control group before and after treatment(t=0.10,0.24,P>0.05).After treatment,the THI score in the combined group was lower than that in the rTMS group and the control group(t=4.03,2.96,P<0.05).The VAS score in the rTMS group was significantly lower than that in the control group(t=3.82,P<0.05).There was no significant difference in the VAS score between the combined group and the rTMS group(t=0.91,P>0.05).There was no significant difference in the motor cortex threshold and the mean value of speech frequency pure tone threshold before and after treatment among the three groups(F=0.82,2.24,1.56,0.52,P>0.05).After treatment,no adverse reactions such as tinnitus aggravation,seizures,headache and dizziness occurred in the three groups.Conclusion The low frequency rTMS stimulation of bilateral temporo pariet al cortex combined with the cTBS stimulation of right prefrontal dorsolateral cortex has obvious therapeutic effect in the treatment of subjective tinnitus,which can effectively reduce the degree of tinnitus disability and improve the subjective feelings of patients.
作者
代丽丽
汤维
耿爽
吴宏林
陈朝辉
李圆
魏庆宇
周雪华
DAI Lili;TANG Wei;GENG Shuang(Department of Otolaryngology,Affiliated Hospital of Hangzhou Normal University,Hangzhou 310015,China)
出处
《全科医学临床与教育》
2021年第5期432-435,共4页
Clinical Education of General Practice
关键词
经颅磁刺激
连续性θ爆发刺激
重复经颅磁刺激
主观性耳鸣
transcranial magnetic stimulation
continuousθburst stimulation
repetitive transcranial magnetic stimulation
subjective tinnitus
