右正中神经电刺激对颅脑创伤昏迷患者脑电活动的影响  

Effect of right median nerve electric stimulation on brain electrical activity of traumatic coma patients

作　　者：游文栋 唐琪临 王磊[1] 雷晋[1] 冯军峰[1] 毛青[1] 高国一[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》2016年第2期120-123,共4页Chinese Journal of Trauma

基　　金：上海市教委高峰计划（20152212）

摘　　要：目的观察右正中神经电刺激治疗前后创伤性脑损伤（TBI）昏迷患者脑电活动的改变，探讨右正中神经电刺激促苏醒的机制。方法收集TBI后昏迷患者45例，其中男28例，女17例；年龄26～64岁[（41．6±5．5）岁]；伤后2周格拉斯哥昏迷评分（GCS）≤8分[（6．2±0．9）分]。分别采集患者治疗前、治疗后1，3，7，14d的脑电图，行快速傅里叶转换进行功率谱分析，功率谱按频率分为8（1．0～4．0Hz）、0（4．1—8．0Hz）、ol（8．1～13．0Hz）、B（13．1～35．0Hz）4个频带，分别计算每个频带的绝对功率值及相对功率谱，并对电刺激前后的变化进行比较。结果刺激前昏迷患者脑电图功率谱显示以弥漫性慢波为主，刺激后患者脑电图慢波减少，快波增加。其中左侧顶枕叶改变最为明显，其他脑区的脑电活动改变的总体趋势与左顶枕区一致，但改变的幅度和时序性各有不同。结论右侧正中神经电刺激可以促进脑外伤后昏迷患者脑电活动从慢波向快波转变，与意识水平改善过程中出现的脑电变化一致，在脑电活动层面为右正中神经电刺激促苏醒提供了证据。Objective To investigate the effect of right median nerve electric stimulation on brain electrical activity of traumatic coma patients, and the possible mechanism. Methods Forty-five coma patients （28 males and 17 females） after traumatic brain injury （TBI） were included in this study, with age ranging from 26 to 64 years [ （41.6±5.5 ）years]. Glasgow Coma Score （GCS） was ~〈8 points [ （6.2 ±0.9）points] 2 weeks after injury. Electroencephalogram was acquired pre-stimulation and 1 d, 3 d, 7 d and 14 d after right median nerve electric stimulation. Power spectrum was analyzed based on fast Fourier transformation. Frequency spectrum was divided in 8（ 1.0-4.0 Hz） ,0（4.1-8.0 Hz） ,ct（8.1- 13.0 Hz） and （13. 1-35.0 Hz） bands. Absolute and relative powers of each frequency band were calculated. Changes in spectral measures were compared before and after the electric stimulation. Results Electroencephalogram showed diffuse slow waves in traumatic coma patients before the electric stimulation. Patients demonstrated a notably decrease in slow-wave activity and increase in fast-wave activity after the electrical stimulation. Electrical activity in the left parietal-occipital lobes displayed the most significant changes. Overall trend of electric activity in other brain parts was in line with the left parietal-occipital region, but the change amplitude and time serial of brain electric activity was different. Conclusions Right median nerve electric stimulation results in brain electrical activity variation fromslow waves to fast waves. The change is consistent with the brain electric activity while consciousness improved, which provides evidence for coma awakening by right median nerve electric stimulation.

关 键 词：颅脑损伤 昏迷 脑电描记术 右正中神经电刺激 

分 类 号：R651.15[医药卫生—外科学]