摘要： 目的 探讨虚拟现实技术结合小组模式训练对脑卒中后抑郁患者康复疗效的影响。方法 选择2017年6月至2019年9月在天津大学环湖医院住院治疗的61例脑卒中后抑郁患者，分为常规康复治疗组（对照组，21例）、小组模式训练组（小组模式组，20例）和虚拟现实技术结合小组模式训练组（联合治疗组，20例）；于康复治疗前和治疗6周后行主观［Zung氏抑郁自评量表（SDS）］和客观抑郁状态［汉密尔顿抑郁量表17项（HAMD-17）］，以及肢体运动功能［Fugl-Meyer评价量表（FMA）］、平衡功能［Berg平衡量表（BBS）］和日常生活活动能力［改良Barthel指数（mBI）］评价。结果 与康复治疗前相比，3组患者治疗6周后SDS评分（F=1456.816，P=0.000）、HAMD-17评分（F=1583.392，P=0.000）降低，FMA评分（F=866.536，P=0.000）、BBS评分（F=1553.585，P=0.000）、mBI评分（F=2687.549，P=0.000）增加。不同组别患者SDS评分（F=9.163，P=0.000）、HAMD-17评分（F=6.490，P=0.003）、BBS评分（F=3.163，P=0.050）和mBI评分（F=4.546，P=0.015）比较差异具有统计学意义，其中，联合治疗组SDS评分（t=-4.530，P=0.000；t=-6.211，P=0.000）、HAMD-17评分（t=-3.308，P=0.002；t=-4.950，P=0.000）低于小组模式组和对照组，BBS评分（t=3.009，P=0.005；t=2.917，P=0.006）、mBI评分（t=3.405，P=0.002；t=4.462，P=0.000）高于小组模式组和对照组。相关分析显示，抑郁状态评分改善指数与mBI改善指数呈正相关（r=0.592，P=0.000）。结论 虚拟现实技术结合小组模式训练的康复治疗方法在改善脑卒中后抑郁患者心理、平衡功能和日常生活活动能力方面优于传统“一对一”的康复模式和小组模式训练，康复疗效更佳。

关键词: 脑卒中, 抑郁, 虚拟现实（非eSH词）, 康复

Abstract: Objective To explore the rehabilitation effect of virtual reality (VR) technology combined with group mode training in post-stroke depression (PSD) patients.Methods A total of 61 PSD patients who were hospitalized in Tianjin Huanhu Hospital, Tianjin University from June 2017 to September 2019 were collected. Patients were divided into control group (n = 21), group mode training group (n = 20) and VR technology combination with group mode training (combination group, n = 20) based on the different rehabilitation treatment method. Zung's Self-Rating Depression Scale (SDS) and Hamilton Depression Rating Scale-17 (HAMD-17) were used to evaluate the objective and subjective psychology, Fugl-Meyer Assessment Scale (FMA) was used to evaluate movement function, Berg Balance Scale (BBS) was used to evaluate balance function, and Modified Barthel Index (mBI) was used to measure activities of daily living before and after 6 weeks of treatment.Results The SDS (F = 1456.816, P=0.000) and HAMD-17 (F = 1583.392, P=0.000) scores in 3 groups after 6 weeks of treatment were lower than those before treatment, while FMA (F = 866.536, P=0.000), BBS (F = 1553.585, P=0.000) and mBI (F = 2687.549, P=0.000) scores after 6 weeks of treatment were higher than those before treatment. The differences of SDS (F = 9.163, P=0.000), HAMD-17 (F = 6.490, P=0.003), BBS (F = 1553.585, P=0.000) and mBI (F = 3.163, P=0.050) scores among 3 groups had statistically significant. The SDS (t=-4.530, P=0.000; t=-6.211, P=0.000) and HAMD -17 (t=-3.308, P=0.002; t=-4.950, P=0.000) scores in combination treatment group were lower than those in group mode training group and control group, and the BBS (t=3.009, P=0.005; t=2.917, P=0.006) and mBI (t=3.405, P=0.002; t=4.462, P=0.000) scores in combination treatment group were higher than those in group mode training and control group. Correlation analysis showed the depression status score improvement index was positively correlated with the mBI score improvement index (r=0.592, P=0.000), but had no correlation with the FMA and BBS scores improvement index (P>0.05, for all).Conclusions The rehabilitation treatment method of VR technology combined with group mode training is better than the traditional "one-to-one" rehabilitation mode and group mode training in improving the psychology, balance ability and activities of daily living of patients with PSD, and the rehabilitation effect is much better.

Key words: Stroke, Depression, Virtual reality (not in MeSH), Rehabilitation