高频重复经颅磁刺激对重症颅脑损伤后意识障碍的促醒疗效  

The effect of high-frequency repetitive transcranial magnetic stimulation on consciousness recovery in traumatic brain injury patients with disorders of consciousness

作　　者：沈龙彬 欧阳辉[1] 杨承佑[3] 林珍萍 牟志伟[1] 王红[1] 陈卓铭[1,2] SHEN Longbin;OUYANG Hui;YANG Chengyou(Dept.of Rehabilitation Medicine,The First Affiliated Hospital of Jinan University,Guangzhou,510630;不详)

机构地区：[1]暨南大学附属第一医院康复医学科,广东省广州市510630 [2]广东省神经功能康复工程技术研究中心 [3]暨南大学附属第一医院神经外科

出　　处：《中国康复医学杂志》2019年第12期1411-1417,共7页Chinese Journal of Rehabilitation Medicine

基　　金：国家自然科学基金项目(81372113);广东省中医药局项目(20171073)

摘　　要：目的:探讨高频重复经颅磁刺激对重症颅脑损伤后意识障碍的促醒疗效。方法:2017年4月至2018年5月将我院康复科、神经外科56例重症颅脑损伤后持续植物状态(VS)/无反应觉醒综合征(UWS)意识障碍患者,根据随机数字表法分为对照组(n=28)和试验组(n=28)。试验组按频率3Hz的rTMS治疗及常规康复治疗,对照组给假r TMS治疗及常规康复治疗,每天1次,每周5天,rTMS时间20min,共治疗20次。治疗前后采用格拉斯哥昏迷量表(GCS)、改良昏迷恢复量表(CRS-R)量表评估,脑电图(EEG)、上肢体感诱发电位(SSEP)神经电生理检查,评估患者能否从VS/UWS进入微弱意识状态(MCS)。结果:共55例患者完成试验。①治疗组GCS的评分较对照组有改善(P<0.05);②治疗组CRS-R的评分较对照组有改善(P<0.05);③治疗组脑电图慢波减少,出现α节律或α波波幅增高(P<0.05);④上肢SSEP波间潜伏期缩短,出现N20波或波幅增高(P<0.05)。结论:高频重复经颅磁刺激能有效帮助重症颅脑损伤后意识障碍的患者从VS/UWS进入MCS,对重症颅脑损伤后意识障碍患者的促醒有效。Objective:To investigate the effect of high-frequency repetitive transcranial magnetic stimulation(r TMS)on consciousness recovery in traumatic brain injury(TBI)patients with disorders of consciousness(DOC).Method:From April 2017 to May 2018,56 TBI patients with vegetative state(VS)or unresponsive wakefulness syndrome(UWS)in the departments of rehabilitation medicine and neurosurgery of the Frist Affiliated Hospital of Jinan University were randomized to either the experimental group(n=28)or the control group(n=28).The subjects in the experimental group were treated with 3 Hz r TMS and routine rehabilitation treatment,while the subjects in control group were treated with pseudo r TMS and routine rehabilitation therapy.All subjects underwent r TMS or pseudo r TMS treatment for 20 minutes,once a day and 5 days per week.The duration is one month with 20 times of treatments.Before and after the treatments,the Glasgow coma scale(GCS),the coma recovery scale-revised(CRS-R),electroencephalograph(EEG)and somatosensory evoked potential(SSEP)were used to assess whether the TBI patients with DOC were progressed into a minimally con-scious state(MCS)from VS/UWS.Result:There were 55 patients were included totally.Comparing with the control group,(1)The experimental group showed significant improvements in the scores of GCS(P<0.05);(2)The experimental group showed significant increases in the scores of CRS-R(P<0.05);(3)In the experimental group,the slow wave of EEG decreased and the rhythm and amplitude ofαwave increased(P<0.05);(4)The interwave latency of N13-N20 shortened and the N20 wave appeared or the amplitude of N20 increased(P<0.05).Conclusion:High-frequency r TMS can effectively help patients with DOC after TBI recover from VS/UWS MCS.

关 键 词：重症颅脑损伤 意识障碍 高频重复经颅磁刺激 康复 促醒 

分 类 号：R651.1[医药卫生—外科学] R493[医药卫生—临床医学]