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目的:探讨重复经颅磁刺激（rTMS）联合健康教育用于难治性抑郁症的临床疗效及对患者认知功能和睡眠质量的影响。方法:选取杭州市第七人民医院2018年1月至2021年1月收治的难治性抑郁症患者90例，采用随机数字表法分为观察组45例、对照组45例。对照组患者采用rTMS治疗，观察组在rTMS基础上联合健康教育。两组干预疗程均为4周。比较两组临床疗效，干预前后临床总体印象量表（CGI）评分和汉密尔顿抑郁量表（HAMD）评分、认知功能、睡眠质量和生活质量变化。结果:观察组总有效率为91.11%（41/45），高于对照组的71.11%（32/45）（χn 2=5.87，n P < 0.05）。干预后，观察组CGI评分为（45.23±7.89）分，高于对照组的（27.64±4.53）分，HAMD评分为（16.32±2.76）分，低于对照组的（21.86±3.98）分（ n t=12.97、7.67，均n P < 0.05）。干预后，观察组患者的完成分类数［（3.83±0.61）个］、正确反应数［（85.45±7.87）个］高于对照组［（2.98±0.37）个、（73.25±6.12）个］，持续性错误数［（32.02±1.89）个］低于对照组［（35.12±2.09）个］（ n t=7.99、8.20、7.38，均n P < 0.05）。干预后，观察组匹兹堡睡眠质量指数（PSQI）评分［（9.84±1.56）分］低于对照组［（12.32±1.62）分］（ n t=7.39，n P < 0.05）。干预后，观察组患者社会功能［（59.98±5.31）分］、物质生活［（34.23±4.12）分］、躯体健康［（56.87±5.32）分］和心理健康［（47.28±5.65）分］均高于对照组［（45.23±6.57）分、（27.98±2.65）分、（43.24±4.53）分和（36.21±4.12）分］（ n t=11.71、8.55、13.08、10.62，均n P < 0.05）。n 结论:rTMS联合健康教育用于难治性抑郁症患者疗效良好，且可改善患者认知功能和睡眠质量，具有显著创新性和科学性。“,”Objective:To investigate the efficacy of repetitive transcranial magnetic stimulation (rTMS) combined with health education in the treatment of refractory depression and its effects on cognitive function and sleep quality.Methods:Ninety patients with refractory depression who received treatment in Hangzhou Seventh People\'s Hospital from January 2018 to January 2021 were included in this study. They were randomly assigned to receive either rTMS (control group, n n = 45) or rTMS combined with health education (observation group, n n = 45). All patients received 4 weeks of treatment. Clinical efficacy, the scores of the Clinical Global Impressions (CGI) Scale and the Hamilton Rating Scale for Depression (HAMD), cognitive function, sleep quality, and quality of life pre- and post-intervention were compared between the two groups.n Results:Total response rate was significantly higher in the observation group than in the control group [91.11% (41/45) n vs. 71.11% (32/45), n χ2 = 5.87, n P < 0.05]. CGI scores post-intervention were significantly higher in the observation group than in the control group [(45.23 ± 7.89) points n vs. (27.64 ± 4.53) points, n t = 12.97, n P < 0.05]. HAMD scores were significantly lower in the observation group than in the control group [(16.32 ± 2.76) points n vs. (21.86 ± 3.98) points, n t = 7.67, n P < 0.05]. The number of categories achieved and the number of correct responses post-intervention in the observation group were (3.83 ± 0.61) and (85.45 ± 7.87), respectively, which were significantly higher than those in the control group [(2.98 ± 0.37), (73.25 ± 6.12), n t = 7.99, 8.20, both n P < 0.05]. The number of perseverative errors post-intervention in the observation group was significantly lower than that in the control group [(32.02 ± 1.89) n vs. (35.12 ± 2.09), n t = 7.38, n P < 0.05]. The Pittsburgh Sleep Quality Index post-intervention was significantly lower in the observation group than in the control group [(9.84 ± 1.56) points n vs. (12.32 ± 1.62) points, n t = 7.39, n P < 0.05). The scores of social function, material well-being, physical function, and psychological function post-intervention in the observation group were (59.98 ± 5.31) points, (34.23 ± 4.12) points, (56.87 ± 5.32) points, and (47.28 ± 5.65) points, which were significantly higher than those in the control group [(45.23 ± 6.57) points, (27.98 ± 2.65) points, (43.24 ± 4.53) points, (36.21 ± 4.12) points, n t = 11.71, 8.55, 13.08, 10.62, all n P < 0.05].n Conclusion:rTMS combined with health education is highly effective on refractory depression. The combined therapy can improve cognitive function and sleep quality and is of great innovation and science.