【摘要】 目的 探讨20 Hz重复经颅磁刺激(rTMS)联合奥氮平治疗精神分裂症患者精神症状、认知功能的疗效及安全性。方法 选取联勤保障部队第九八八医院精神科住院患者75例，按随机数字表分为研究组38例和对照组37例。研究组采用20 Hz rTMS刺激左侧前额叶背外侧皮质(DLPFC)，联合奥氮平治疗，对照组单独应用奥氮平治疗。于治疗前和治疗4周末采用阳性和阴性症状量表(PANSS)评估两组精神症状，应用探究性眼动(EEM)评估注意力、记忆力等认知功能，应用治疗中出现的副反应量表(TESS)评估安全性。结果 两组患者治疗4周后，PANSS量表总分、阳性症状分、阴性症状分及一般症状分均低于治疗前，差异有统计学意义(P＜0.05)。治疗4周末，研究组总分(47.68±4.17)分、阴性症状分(12.24±1.98)分及一般症状分(20.18±3.48)分均低于对照组(53.42±4.66)、(14.35±2.21)、(23.47±3.89)分，差异有统计学意义(P＜0.05)。两组治疗4周末，探究性眼动的NEF分升高、RSS分升高、D值下降，与治疗前比较，差异有统计学意义(P＜0.05)。研究组NEF分(31.82±4.42)分、RSS分(10.56±2.37)分高于对照组(28.42±3.98)、(8.25±2.19)分，D值(－0.89±1.56)低于对照组(1.08±1.28)，差异均有统计学意义(P＜0.05)。结论 20 Hz rTMS联合奥氮平4周，能有效地改善精神分裂症患者阴性症状及注意力、记忆力，优于单用奥氮平治疗，且安全性较好。
【Abstract】Objective: To investigate the efficacy and safety of 20 Hz repetitive transcranial magnetic stimulation (rTMS) combined with olanzapine in the treatment of schizophrenia's mental symptoms and cognitive function.Methods: 75 inpatients in the psychiatric department of our hospital were selected and divided into a study group (38 cases) and a control group (37 cases) according to the number table.The study group was treated with 20 Hz rTMS to stimulate the left dorsolateral prefrontal cortex (DLPFC), combined with olanzapine, and the control group was treated with olanzapine alone.Before treatment and at the end of the 4th week of treatment, the Positive and Negative Symptom Scale (PANSS) was used to assess the mental symptoms of the two groups, exploratory eye movement (EEM) was used to assess the cognitive functions such as attention and memory, Using the Treatment Emergent Side Effects Scale (TESS) to assess safety.Results: After 4 weeks of treatment in the two groups, the total score of PANSS, positive symptom score, negative symptom score and general symptom score were all lower than those before treatment, and the difference was statistically significant (P<0.05).After 4 weeks of treatment, the total score, negative symptom score and general symptom score of the study group were lower than those of the control group. The difference was statistically significant (P<0.05). There was no significant difference in the positive symptom score between the two groups (P>0.05). At the end of the 4th week of treatment, the NEF score, RSS score and D value of exploratory eye movements increased, compared with those before treatment, the difference was statistically significant (P<0.05). The NEF score and RSS score of the study group were higher than those of the control group, and the D value was lower than that of the control group. The differences were statistically significant (P<0.05).Conclusion: 20 Hz rTMS combined with olanzapine for 4 weeks can effectively improve the negative symptoms, attention and memory of patients with schizophrenia, which is better than olanzapine alone and has better safety.
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