【摘要】 目的 观察重复经颅磁联合头皮针治疗小儿精神发育迟滞（MR）肝肾不足型的临床疗效。方法选取2023年4月至2024年4月湖南省儿童医院康复中心电子病例信息数据库中6～15岁的MR肝肾不足型患儿150例，根据治疗方法不同分为颅磁组39例，头皮针组42例，联合组69例，使用倾向得分匹配法（PSM）对3组的一般资料进行匹配，匹配成功20对，颅磁组和头皮针组各20例，联合组40例。头皮针组予头皮针治疗，颅磁组予重复经颅磁治疗，联合组给予头皮针及重复经颅磁联合治疗，3组均30 d为1个疗程，治疗3个疗程后统计疗效。结果 治疗前3组的发育商（DQ）评分比较，差异无统计学意义（P>0.05），具有可比性；治疗后3组的精细动作、大动作、语言、社交、适应性评分均显著升高，与同组治疗前比较，差异均有统计学意义（P<0.05），联合组显著高于颅磁组和头皮针组（P<0.05），颅磁组与头皮针组比较，差异无统计学意义（P>0.05）。治疗前3组的社会适应能力评分比较，差异无统计学意义（P>0.05），具有可比性；治疗后3组的独立生活、交往、自我管理、作业、运动评分均显著升高，与同组治疗前比较，差异均有统计学意义（P<0.05），联合组显著高于颅磁组和头皮针组（P<0.05），颅磁组与头皮针组比较，差异无统计学意义（P>0.05）。治疗前3组的血气指标水平比较，差异无统计学意义（P>0.05），具有可比性；治疗后3组的酸碱度（pH）值、二氧化碳分压（PCO₂）、剩余碱（BE）、碳酸氢根（HCO₃^-）水平均显著升高，与同组治疗前比较，差异均有统计学意义（P<0.05），联合组显著高于颅磁组和头皮针组（P<0.05），颅磁组与头皮针组比较，差异无统计学意义（P>0.05）。联合组的总有效率为95.00%（38/40），显著高于颅磁组的75.00%（15/20）和头皮针组的70.00%（14/20），差异均有统计学意义（P<0.05），颅磁组与头皮针组比较，差异无统计学意义（P>0.05）。结论 重复经颅磁联合头皮针治疗小儿MR肝肾不足型疗效显著，可显著促进患儿智力发育，改善神经功能，提高社会适应能力，值得临床推广应用。更多还原

【Abstract】 ObjectiveTo observe the clinical efficacy of repetitive transcranial magnetic stimulation(rTMS)combined with scalp acupuncture in treating children with mental retardation(MR)of liver-kidney deficiency type.MethodsA total of 150 children aged 6-15 years with MR of liver-kidney deficiency type were selected from the electronic medical record database of the Rehabilitation Center of Hunan Children’s Hospital from April 2023 to April 2024. According to treatment methods,they were divided into the rTMS group(39 cases),scalp acupuncture group(42 cases),and combination group(69 cases). Propensity score matching(PSM)was used to match general data among the three groups,resulting in 20 matched pairs:rTMS group(20 cases),scalp acupuncture group(20 cases),and combination group(40 cases). The scalp acupuncture group received scalp acupuncture treatment,the rTMS group received repetitive transcranial magnetic stimulation,and the combination group received both treatments. All groups were treated for 30 days as one course,and efficacy was evaluated after three courses.ResultsBefore treatment,there were no significant differences in developmental quotient(DQ)scores among the three groups(P>0.05). After treatment,fine motor,gross motor,language,social,and adaptive scores significantly increased in all three groups compared with before treatment within the same group(P<0.05). The combination group was significantly higher than the rTMS and scalp acupuncture groups(P<0.05),while there was no significant difference between the rTMS and scalp acupuncture groups(P>0.05). Before treatment,there were no significant differences in social adaptation ability scores among the three groups(P>0.05). After treatment, independent living, communication, selfmanagement,occupation,and motor scores significantly increased in all three groups compared with before treatment within the same group(P<0.05). The combination group was significantly higher than the rTMS and scalp acupuncture groups(P<0.05),while there was no significant difference between the rTMS and scalp acupuncture groups(P>0.05). Before treatment,there were no significant differences in blood gas indicators among the three groups(P>0.05). After treatment,pH,PCO2,BE,and HCO3-levels significantly increased in all three groups compared with before treatment within the same group(P<0.05). The combination group was significantly higher than the rTMS and scalp acupuncture groups(P<0.05),while there was no significant difference between the rTMS and scalp acupuncture groups(P>0.05). The total effective rate was 95.00%(38/40)in the combination group,significantly higher than 75.00%(15/20)in the rTMS group and 70.00%(14/20)in the scalp acupuncture group(P<0.05),with no significant difference between the rTMS and scalp acupuncture groups(P>0.05).ConclusionThe combination of repetitive transcranial magnetic stimulation and scalp acupuncture shows significant efficacy in treating children with MR of liver-kidney deficiency type,significantly promoting intellectual development,improving neurological function,and enhancing social adaptation ability,making it worthy of clinical promotion and application.更多还原