睡眠脑中波调制重复经颅磁刺激与常规重复经颅磁刺激治疗原发性失眠的疗效对比

摘要

Objective To compare sleep electroencephalogram-modulated repetitive transcranial magnetic stimulation (SEM-rTMS) with routine repetitive transcranial magnetic stimulation (R-rTMS) in the treatment of primary insomnia. Methods One hundred and twenty six patients with insomnia were divided randomly into a SEM-rTMS group (44 cases) , a R-rTMS group (42 cases) and a sham rTMS group (40 cases). Each case was treated with rTMS for 30 min once a day for 10 d under double blinding of the patient and therapist. The clinical effect was observed along with Krakow sleep scores, electroencephalograms and blood pressure before and after a 10-day course of therapy and 30 days later. Results During rTMS treatment, some patients reported feeling sleepy, and this was confirmed by their EEGs at the time. After the entire course of therapy, 80% of the SEM-rTMS group and 45% of the R-rTMS group showed improvements, a significant difference. At the 30th day after therapy, the effect in the SEM-rTMS group was still significantly better than in the R-rTMS group. There were no obvious side effects in any group throughout the whole observation period. Conclusions SEM-rTMS is more effective and more reliable than R-rTMS. SEM-rTMS is safe to use with primary insomnia patients.%目的 对比研究睡眠脑中波调制重复经颅磁刺激(SEM-rTMS)与常规重复经颅磁刺激(常规rTMS)对原发性失眠的临床疗效和安全性.方法 选择126例原发性失眠患者,随机分为SEM-rTMS组44例、常规rTMS组42例和假rTMS组40例,在患者和治疗师双盲前提下,每次治疗30 min,每日1次,疗程为10 d,分别观察3组治疗前、治疗第10天(全程治疗结束时)和治疗结束后30 d的临床疗效、Krakow睡眠积分、脑电图和平均血压的变化.结果 磁疗中,部分患者有浅睡感.其脑电图同步出现睡眠脑中波,以SEM-rTMS组更明显.治疗结束时,SEM-rTMS组和常规rTMS组的有效率分别为79.55%和45.24%,前者显著高于后者(P<0.001).治疗结束后30 d,SEM-rTMS组的有效率仍显著高于常规rTMS组(P<0.05).3组在观察期间未发现明显副作用.结论 SEM-rTMS治疗原发性失眠的疗效显著、稳定、安全,显著优于常规rTMS.