重复经颅磁刺激对脑损伤后意识障碍患者脑血流速度及神经电生理的影响  

Effect on cerebral blood flow velocity and electroneurophysiology in unconscious patients with brain injury after repetitive transcranial magnetic stimulation

作　　者：谢瑛[1] 何院娟[2] 陈滟 蒋燕 胡玥 

机构地区：[1]首都医科大学教学医院北京电力医院康复医学科,北京100073 [2]首都医科大学教学医院北京电力医院高干病房,北京100073

出　　处：《中华临床医师杂志（电子版）》2011年第18期5375-5379,共5页Chinese Journal of Clinicians(Electronic Edition)

基　　金：2010年度丰台区科委科技发展基金(xm101223)

摘　　要：目的研究重复经颅磁刺激(rTMS)对脑损伤后意识障碍患者脑血流速度及神经电生理的影响,以探索其可能的促苏醒机制。方法 30例脑损伤后意识障碍患者随机分为治疗组(n=15)和对照组(n=15),两组均给予常规促醒治疗,治疗组在常规治疗的基础上加用rTMS治疗,两组治疗前后均行脑电图(EEG),脑干听觉诱发(BAEP)及上肢体感诱发电位(SSEP)检查,同时行经颅多普勒脑血管超声检测患者大脑中动脉(MCA)、大脑前动脉(ACA)、基底动脉(BA)平均血流速度。治疗后行Glasgow昏迷评分(GCS)及JFK昏迷恢复量表评分(CRS-R)进行疗效评定。结果治疗1个月后,治疗组GCS评分及CRS-R评分较对照组有改善(P<0.05)。治疗组脑电图慢波减少,出现α节律或α波波幅增高(P<0.05),上肢SSEP波间潜伏期缩短,出现N20波或波幅增高(P<0.05)。但治疗前后两组BAEP及各动脉平均血流速度均未显示有显著性改变(P>0.05)。结论 rTMS能改善脑电生理活动,对意识障碍患者有一定的促苏醒作用。Objective To investigate the therapeutic effect on cerebral blood flow velocity and electroneurophysiology in unconscious patients with brain injury after repetitive transcranial magnetic stimulation(rTMS),and to explore the possible mechanism of hastening awakening from coma.Methods 30 unconscious patients with brain injury were randomly assigned to the treated group (n=15)and the control group (n=15).The patients in the control group were treated routinely.Besides routine therapy the patients in the treated group were treated with rTMS.Electroencephalography(EEG),brain stem auditory evoked potential(BAEP)and somatosensory evoked potential(SSEP)were determinated before and after treatment,at the same time,mean flow rates of middle cerebral artery(MCA),anterior cerebral artery (ACA)and basilar artery(BA)were determinated with transcranial Doppler (TCD),Glasgow scale(GCS)and JFK coma recovery scale (CRS-R)were used to evaluate the curative effect after treatment.Results After one-month treatment,the GCS and CRS-R score in treated group was increased than control group(P<0.05).In the treated group,test results showed improvement both in EEG and in SSEP(P<0.05)but no significant differences in BAEP or in the mean flow rates of cerebral artery(P>0.05).Conclusions The therapy of rTMS can improve the electroencephalography in comatose patients with brain injury,and it can help those patients hastening awakening from coma.

关 键 词：经颅磁刺激 血流速度 电生理学 意识障碍 脑损伤 

分 类 号：R651.1[医药卫生—外科学]