右正中神经电刺激对颅脑创伤昏迷患者脑血流灌注的影响：SPECT-CT显像观察  

Effect of right median nerve electrical stimulation on cerebral blood infusion in traumatic coma patients ： evaluation with SPECT - CT

作　　者：雷晋[1] 高国一[1] 宋绍莉 郑秀娟 梁玉敏[1] 潘耀华[1] 包映晖[1] 丁圣豪[1] 江基尧[1] 

机构地区：[1]上海交通大学医学院附属仁济医院神经外科、上海市颅脑创伤研究所,200127 [2]上海市核医学科研究所

出　　处：《中华神经外科杂志》2012年第2期112-115,共4页Chinese Journal of Neurosurgery

基　　金：国家卫生公益性行业专项（200802093）;国家自然科学基金面上项目（30872671）;上海浦江人才项目（2010）

摘　　要：目的利用SPECT-CT融合机脑血流灌注显像技术检测重型颅脑创伤昏迷患者行右正中神经电刺激前后脑血流灌注变化隋况。方法重型颅脑损伤患者32例，伤后2周仍昏迷，接受右正中神经电刺激治疗。治疗前及治疗第7天，行SPECT-CT评价脑血流灌注变化情况。利用MATLAB和SPM软件对检测结果进行分析处理，得到昏迷患者脑皮层丘脑血流与健康成人比较值，用区域分析法分析脑皮层、丘脑和脑干部位的血流灌注增加的特征改变，利用图像重建迭加技术获得脑表面（含颅底面）血流灌注增加值。结果颅脑创伤昏迷患者与健康成人相比较，其感觉运动皮层、双侧丘脑和脑干部位脑血流灌注出现明显下降，经电刺激治疗后，患者缺血部位脑血流明显改善，且额叶底面、海马回等区域也出现血流灌注增加表现。结论颅脑创伤昏迷状况下存在脑血流灌注低下区域，右正中神经电刺激术不仅可显著改善颅脑创伤昏迷患者皮层及丘脑和脑干血流灌注状况，而且可以增加额叶、颞叶底面皮质的血流灌注，提示右正中神经电刺激可能通过改善脑重要功能部位血流状况达到促醒作用。Objective To investigate the effect of right median nerve electrical stimulation on cerebral blood infusion of traumatic coma patients with SPECT - CT. Methods Thirty - two severely traumatic brain injured patients undergone operation and intensive management received right median nerve electrical stimulation after diagnosing low consciousness state （GCS ≤ 8 ） at two weeks after injury. The measurements of cerebral blood infusion with SPECT - CT were carried out 1 day before initiation of electric treatment and 7 days thereafter, The results were compared and analyzed using matlab and statistical parameter mapping analyzing software. Results The cerebral blood infusions were significantly decreased on frontal lobe, thalamus and brain stem in coma patients. Electrical treatment induced profound increment of blood infusion in motor - sensor cortex, straight gyrus and hippocampus gyrus. The blood infusion in upper brain stern also increased after one week electric treatment. Conclusion Right median nerve electrical stimulation may benefit the recovery of impacted consciousness of head trauma patients through the increment of brain blood infusion in specific consciousness related brain areas.

关 键 词：右正中神经电刺激 外伤性脑损伤 昏迷 单光子发射计算机断层扫描-计算机断层扫描 

分 类 号：R651.15[医药卫生—外科学]