目的：探讨重复经颅磁刺激(rTMS)对脑梗死患者轻度认知障碍的影响及安全性。方法45例脑梗死后具有认知功能损害但未达痴呆诊断标准的患者，随机分为对照组(n=22)和观察组(n=23)。两组均予常规药物治疗和认知训练，观察组加以rTMS治疗(刺激左侧前额叶背外侧皮质，5 Hz，80%运动阈值)，疗程4周。结果治疗后两组蒙特利尔认知评估量表(MoCA)评分、事件相关电位P300的潜伏期和波幅均较治疗前显著改善(P<0.001)，且观察组优于对照组(P<0.05)。观察组治疗后MoCA得分与P300潜伏期呈高度负相关(r=-0.851, P<0.05)。治疗过程中未见明显不良反应。结论 rTMS可能对脑梗死患者的轻度认知功能障碍有改善作用，且相对安全。%Objective To explore the effects of repetitive transcranial magnetic stimulation (rTMS) on cognitive ability of patients after ischemic stroke. Methods 45 patients with mild cognitive impairment (MCI) after ischemic stroke were randomly assigned into control group (n=22) and observation group (n=23). Both groups received routine drugs and cognitive training. The observation group received rT-MS over the left dorsolateral prefrontal cortex (DLPFC) (5 Hz, 80%motor threshold) in addition for 4 weeks. Results The score of Montre-al Cognitive Assessment (MoCA), P300 latencies and amplitudes improved after treatment in both groups (P<0.001), and were better in the observation group than in the control group (P<0.05). The MoCA score was negatively related with P300 latency (r=-0.851, P<0.05). There was no severe adverse effect during the treatment. Conclusion rTMS could improve the cognitive ability of patients with MCI after stroke, with little side effect.
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