右正中神经电刺激早期干预对颅脑损伤昏迷患者的临床疗效观察  

Clinical efficacy of early right median nerve electrical stimulation for coma patients following craniocerebral trauma

作　　者：高国一[1] 包映晖[1] 梁玉敏[1] 潘耀华[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

出　　处：《中华创伤杂志》2012年第3期200-204,共5页Chinese Journal of Trauma

基　　金：基金项目：国家卫生部公益型行业科研专项经费资助项目（200802093）;国家自然科学基金面上资助项目（30872671）;上海浦江人才资助项目（2010-2012）

摘　　要：目的观察右正中神经电刺激对颅脑损伤早期昏迷患者的临床疗效。方法对2005—2011年间颅脑损伤昏迷患者（昏迷时间〉2周）按照随机数字表法分为常规治疗组（对照组）和右正中神经电刺激＋常规治疗（治疗组），治疗时间〉2周。观察患者对右正中神经电刺激的治疗依从性以及伤后6个月意识恢复情况。结果共纳入465例患者，完成治疗疗程437例，其中治疗组221例，对照组216例，治疗期间无电刺激相关并发症出现。脑血流灌注及脑干诱发电位检测提示治疗组出现明显改善。386例患者获得伤后6个月随访，治疗组患者（204例）意识清醒122例，微意识状态46例，植物状态36例；对照组（182例）意识清醒84例，微意识状态40例，植物状态58例。与对照组比较，治疗组患者意识恢复清醒比例明显高于对照组，植物状态比例明显低于对照组，微意识状态比例与对照组比较差异无统计学意义。结论右正中神经电刺激是适宜在颅脑损伤早期昏迷阶段应用的昏迷促醒手段。Objective To evaluate the clinical benefits of early right median nerve electrical stimulation on coma patients following craniocerebral trauma. Methods Craniocerebral trauma pa- tients with up to two weeks of coma in the years 2005-2011 were involved in the study and were randomly divided into control group （received routine management） and treatment group （routine management plus right median nerve electrical stimulation）. The treatment lasted for a period of more than two weeks. The clinical efficacy of the right median nerve electric stimulation and the conscious status of the patients with- in six months after craniocerebral trauma were observed. Results A total of 456 patients were enrolled in the study, of whom 437 patients completed the treatment course, including 221 patients in the treat- ment group and 216 in the control group. There was no complication related to electric stimulation during the treatment. Cerebral blood flow （CBF） imaging and brain stem evoked potential （BEP） examination demonstrated significant improvement in the treatment group. A total of 386 patients were followed up for six months postoperatively, which showed that there were 122 patients with regained consciousness, 46 in minimally conscious state and 36 in vegetative state in the treatment group （204 patients） and there were 84 patients with regained consciousness, 40 in minimally conscious state and 58 in vegetative state in the control group （ 182 patients）. The patients in the treatment group showed a higher ratio of regained con- sciousness and a lower ratio of vegetative state compared with the control group, but the ratio of minimally conscious state showed no statistical difference between two groups. Conclusions Right median nerve electrical stimulation is a suitable coma awaking means at early stage after craniocerebral trauma.

关 键 词：颅脑损伤 昏迷 脑损伤后 右正中神经电刺激 

分 类 号：R651.15[医药卫生—外科学]