持续右正中神经刺激促进重型颅脑损伤昏迷患者恢复的前瞻性非随机同期病例对照研究  

A prospective non-random homeochronous case-control study on sustained right median nerve electrical stimulation to promote recovery of coma patients with severe brain injury

作　　者：黄强[1] 戴伟民[1] 揭园庆[1] 余国峰[1] 范晓峰[1] 吴安[1] 吕尧[1] 李运平[1] 

机构地区：[1]衢州市人民医院神经外科,浙江衢州324000

出　　处：《中国中西医结合急救杂志》2011年第3期138-141,共4页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：浙江省医药卫生重点科研项目（2008A165）

摘　　要：目的观察持续右正中神经刺激疗法促进重型颅脑损伤昏迷患者复苏的疗效。方法选择2004年1月至2008年12月住院的28例采用持续右正中神经刺激疗法治疗的重型颅脑损伤患者为治疗组，以同期入院性别、年龄、格拉斯哥昏迷评分（GCS）、颅脑损伤类型、手术与否等方面基本相同的28例患者为对照组，组成1：1配对。对照组患者除不接受右正中神经刺激治疗外，其他控制颅内压、防止并发症及一般性康复治疗与治疗组相同。观察治疗4周后两组GCS、脑功能障碍评分（DRS）、脑电图（EEG）评分、听觉脑干诱发电位（ABR）评分等主、客观指标的变化。结果两组治疗后意识障碍恢复情况随治疗前GCS评分升高呈逐渐好转趋势，GCS5～6分者中治疗组治疗后DRS（分）明显低于对照组（5．22±4．31比8．25±3．37），EEG评分（分）和ABR评分（分）明显高于对照组（EEG评分：9．18±2．87比7．25±2．04，ABR评分：3．33±0．54比2．71±0．63，均P〈O．05）。与对照组比较，治疗组治疗2周后GCS（分）明显升高（2周：9．03±2．74比7．12±2．13，3周：10．43±3．01比8．22±2．67，4周：10．85±2．35比9．46±3．23，均P〈0．05），DRS（分）明显降低（2周：10．45±6．73比13．76±4．87，3周：6．77±4．32比11．57±4．85，4周：5．58±3．91比7．84±2．64，均P〈0．05），EEG评分（分）和ABR评分（分）明显升高（EEG评分2周：5．31±2．11比3．43±1．81，3周：8．51±2．39比5．67±1．93，4周：9．47±3．59比7．71±1．64；ABR评分2周：2．23±0．79比1．44±0．51，3周：3．11±0．62比2．34±0．79，4周：3．43±0．81比2．88土0．59，均P〈0．05）。结论持续右正中神经刺激疗法可明显改善重型颅脑损伤患者的意识状态，是一种操作简便、疗效可靠、无明显不良反应的促醒治疗方法。Objective To observe the therapeutic effect of continued right median nerve electrical stimulation on patients with severe brain injury. Methods Twenty-eight patients with severe brain injury enrolled from January 2004 to December 2008 were treated by continued right median nerve electrical stimulation as the treatment group, and another 28 patients whose period of hospitalization, sexuality, age, Glasgow coma scale （GCS）, type of brain injury and whether or not being operated on were basically the same as those patients in treatment group were assigned in the control group, composing an one-to-one match. The patients in control group were treated with the same methods of controlling intracranial pressure, preventing complications and general rehabilitating treatment as those for the patients in treatment group, except the continued right median nerve electrical stimulation. After 4 weeks of treatment, the variation of subjective and objective indicators of these two groups as GCS, disability rating scale （DRS）, electroencephalogram （EEG） rating scale, auditory brainstem response （ABR） rating scale were observed. Results After treatment, along with the elevation of GCS score before the treatment, the situation of conscious impairment gradually had a tendency of recovery or getting better in the two groups; the patients in the treatment group with GCS score 5- 6 had lower DRS （5.22±4.31 vs. 8.25± 3.37）, higher EGG and ABR rating scales than those in the control group （EGG： 9.18±2.87 vs. 7.25±2.04, ABR： 3.33±0.54 vs. 2.71±0.63, all P〈0.05）. Compared with the control group, after 2 weeks of treatment, the GCS in the treatment group was increased significantly （2 weeks： 9. 03±2.74 vs. 7.12±2.13, 3 weeks： 10.43±3.01 vs. 8. 22±2.67, 4 weeks： 10. 85±2.35 vs. 9. 46±3.23, all P〈0. 05）, DRS decreased obviously （2 weeks： 10.45-t-6.73 vs. 13. 765= 4.87, 3 weeks： 6. 77±4.32 vs. 11. 57±4.85, 4 weeks： 5. 58±3.91 vs. 7. 84±2.64, all P〈0.05）, EGG and ABR rating

关 键 词：神经电刺激 颅脑损伤 昏迷 促醒 

分 类 号：R651.1[医药卫生—外科学] R245.9[医药卫生—临床医学]