脑电生物反馈联合盐酸哌甲酯治疗儿童注意缺陷多动障碍的疗效及对脑血流和血清皮质醇水平的影响

doi:10.11852/zgetbjzz2023-0599

摘要/Abstract

摘要： 目的探究脑电生物反馈(EF)联合盐酸哌甲酯治疗儿童注意缺陷多动障碍(ADHD)的疗效及对脑血流和血清皮质醇(COR)水平的影响。方法选取2020年1月—2022年12月南充市中心医院儿科收治的120例ADHD患儿为研究对象,按随机数字表法随机分为对照组和观察组,各60例。对照组予以盐酸哌甲酯片治疗,观察组予以EF联合盐酸哌甲酯片治疗。两组均连续治疗15周。比较两组临床疗效及治疗前后儿童注意缺陷多动障碍筛查量表(SNAP-Ⅳ)评分、儿童困难问卷(QCD)评分、脑血流速度[左侧中动脉(MCA-L)、左侧前动脉(ACA-L)、左侧后动脉(PCA-L)]及血清COR水平。结果观察组临床总有效率明显高于对照组(93.33% vs. 78.33%,χ²=5.551,P<0.05)。观察组治疗后SNAP-Ⅳ中注意缺陷[(1.13±0.25)分 vs. (1.28±0.22)分]、多动-冲动[(1.47±0.32)分 vs. (1.61±0.29)分]、对立违抗[(0.96±0.17)分 vs. (1.12±0.17)分]评分均明显低于对照组(t=3.489、2.511、5.155,P<0.05)。观察组治疗后QCD评分[(42.86±3.15)分 vs. (41.32±2.96)分]、脑血流速度[MCA-L:(58.63±3.11)cm/s vs. (57.04±4.78)cm/s; ACA-L:(49.57±3.97)cm/s vs. (48.24±3.21)cm/s; PCA-L:(39.74±3.82)cm/s vs. (38.05±4.0)cm/s]及血清COR水平[(317.84±29.76)nmol/L vs. (283.92±30.54)nmol/L]均明显高于对照组(t=2.760、2.160、2.018、2.354、6.162,P<0.05)。结论 EF联合盐酸哌甲酯治疗儿童ADHD的疗效显著,可明显改善患儿核心症状、社会功能,提高脑血流速度及血清COR水平可能是其疗效的作用机制。

关键词: 脑电生物反馈治疗, 注意缺陷多动障碍, 脑血流, 皮质醇, 儿童

Abstract: Objective To explore the efficacy of EEG biofeedback(EF)combined with methylphenidate hydrochloride in the treatment of children with attention deficit hyperactivity disorder (ADHD) and its effects on cerebral blood flow and serum cortisol (COR) levels. Methods A total of 120 children with ADHD admitted to Nanchong Central Hospital from January 2020 to December 2022 were enrolled in this study, and were randomly divided into control group (n=60) and observation group (n=60) according to the random number table method. The control group was treated with methylphenidate hydrochloride tablets, while the observation group was treated with EFadditionally. Both groups were treated for 15 consecutive weeks. The clinical efficacy, scores of Chinese version of Swanson Nolan and Pelham Version Ⅳ Scale (SNAP-Ⅳ) and Questionnaire-Children with Difficulties (QCD), cerebral blood flow velocity [left middle artery (MCA-L), left anterior artery (ACA-L), left posterior artery (PCA-L)] and serum COR level before and after treatment were compared between the two groups. Results The total effective rate of the observation group was significantly higher than that of the control group (93.33% vs. 78.33%, χ²=5.551,P<0.05). After treatment, the scores of attention deficit (1.13±0.25 vs. 1.28±0.22), hyperactivity-impulsion (1.47±0.32 vs. 1.61±0.29) and oppositional defiance (0.96±0.17 vs. 1.12±0.17) in SNAP-Ⅳ in the observation group were significantly lower than those in the control group (t=3.489, 2.511, 5.155, P<0.05). After treatment, the QCD score (42.86±3.15 vs. 41.32±2.96), cerebral blood flow velocity [MCA-L:(58.63±3.11)cm/s vs. (57.04±4.78)cm/s; ACA-L:(49.57±3.97)cm/s vs. (48.24±3.21)cm/s; PCA-L:(39.74±3.82)cm/s vs. (38.05±4.0)cm/s] and serum COR level [(317.84±29.76)nmol/L vs. (283.92±30.54)nmol/L] in the observation group were significantly higher than those in the control group (t=2.760, 2.160, 2.018, 2.354, 6.162,P<0.05). Conclusions EF combined with methylphenidate hydrochloride is effective in the treatment of ADHD in children. It can significantly improve the core symptoms and social function of ADHD children. Improving cerebral blood flow velocity and serum COR level may be the mechanism of its efficacy.

Key words: EEG biofeedback therapy, attention deficit hyperactivity disorder, cerebral blood flow, cortisol, children

中图分类号:

R749.94

张沥文, 秦星, 李娟, 宋紫霞, 吴玮玮. 脑电生物反馈联合盐酸哌甲酯治疗儿童注意缺陷多动障碍的疗效及对脑血流和血清皮质醇水平的影响[J]. 中国儿童保健杂志, 2024, 32(10): 1135-1139.

ZHANG Liwen, QIN Xing, LI Juan, SONG Zixia, WU Weiwei. Efficacy of EEG biofeedback combined with methylphenidate hydrochloride in the treatment of childhood attention deficit hyperactivity disorder and its effect on cerebral blood flow and serum cortisol level[J]. Chinese Journal of Child Health Care, 2024, 32(10): 1135-1139.

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