高压氧联合经颅磁刺激治疗颅脑损伤致昏迷患者的疗效观察  

Effect of hyperbaric oxygen combined with repetitive transcranial magnetic stimulation in the treatment of coma following craniocerebral trauma

作　　者：沈泉[1] 方以群[1] 吴建国[3] 李娜[4] 攸璞[2] 刘平小[2] 包晓辰[2] 

机构地区：[1]第二军医大学,上海200433 [2]海军医学研究所 [3]解放军第四一三医院 [4]海军总医院

出　　处：《中华航海医学与高气压医学杂志》2016年第1期9-12,共4页Chinese Journal of Nautical Medicine and Hyperbaric Medicine

摘　　要：目的研究高压氧（hyperbaric oxygen，HBO）联合经颅磁刺激（repetitive transcranial magnetic stimulation，rTMS）对颅脑损伤致昏迷患者的临床疗效。方法回顾性选取120例颅脑损伤致昏迷患者，未接受HBO或rTMS治疗患者为对照组，其中格拉斯哥昏迷量表（Glasgow coma scale，GCS）评分6～8分为CA组，GCS评分3～5分为CB组；接受HBO治疗患者中，GCS评分6～8分者为HA组，GCS评分3～5分者为HB组；接受HBO联合rTMS治疗患者中，GCS评分6～8分者为rTA组，GCS评分3～5分者为rTB组。6组均给予神经营养、抗感染、维持电解质平衡等脑外伤常规治疗。HA组、HB组加用HBO治疗，汀A组、rTB组加用HBO、rTMS治疗。其中，HBO治疗压力为0．25MPa，1次／d，每个疗程10d，连续治疗3个疗程；rTMS方案设定刺激强度为0．72T，磁场频率0．5Hz，每个序列刺激30次，1个序列／d，每个疗程12d，连续治疗3个疗程。观察和统计分析治疗前后患者格拉斯哥昏迷量表GCS评分、治疗后格拉斯哥预后量表（Glasgow outcome scale，GOS）评分的改变。结果连续治疗3个疗程后，GCS评分6～8分的患者存常规治疗加用HBO联合rTMS后的GCS评分（11．15±4．17）高于仅加用HBO后的GCS评分（9．05±3．12），且均高于常规治疗方案（7．50±1．99），差异均有统计学意义（P〈0．05）；常规治疗加用HBO联合rTMS后的GOS评分（4．45±0．83）高于常规治疗（3．90±0．55），差异有统计学意义（P〈0．05）。结论GCS评分6～8分的颅脑损伤致昏迷患者接受HBO联合rTMS疗法后的临床疗效较好。Objective To study the therapeutic, effect of hyperbaric oxygen （HBO） combined with repetitive transcranial magnetic stimulation （rTMS） in the treatment of coma following craniocerebral trauma. Methods One hundred and twenty coma patients caused by craniocerebral trauma were randomly selected for the study. Those patients without treatment or without rTMS were assigned as the control groups, and the group with Glasgow coma scale （GCS） scores of 6 -8 was further assigned as the CA group, and the group with GCS scores of 3 -5 was assigned as the CB group. In those patients who received HBO therapy, the ones with GCS scores of 6 -8 were assigned as the HA group, and the ones with GCS scores of 3 -5 were assigned as the HB group （conventional therapy group B）. In those patients who received both HBO and rTMS therapy, the ones with GCS scores of 6 -8 were assigned as the rTA group, while the ones with GCS scores of 3 -5 were assigned as the rTB group. The patients of the 6 groups were given conventional therapy for the treatment of brain trauma, such as neural nutrition, anti - infection and maintenance of electrodes. The patients in the HA group and HB group were additionally treated with HBO, while the patients in the rTA and rTB groups were further treated with HBO and rTMS. The patients received HBO therapy at a pressure of 0.25 MPa, once a day, 10 days a treatment course, for a succession of 3 courses. The stimulation intensity of the rTMS treatment protocol was set at 0.72 T, with the frequency of the magnetic field being 0.5 HZ. The patients had 30 stimulations for every sequence, one sequence a day, 12 days a treatment course for a succession of 3 courses. Scores of Glasgow Coma Scale （GCS） and Glasgow Outcome Scale （GOS） before and after treatment were assessed and statistically analyzed. Results After 3 successive treatment courses, the patients with GCS scores of 6 - 8 were further treated with HBO combined with rTMS in addition to conventional therapy. The GCS scores of the HBO ＋

关 键 词：颅脑损伤 昏迷 高压氧 经颅磁刺激 

分 类 号：R651.15[医药卫生—外科学]