经颅直流电刺激对一氧化碳中毒迟发性脑病认知功能的影响  

Effects of transcranial direct current stimulation on cognitive function in delayed encephalopathy after carbon monoxide poisoning

作　　者：曹双清 高珣[1] 朱保月[1] 刘倩[1] 刘永建[1] 肖青勉[1] 王维展[1] 杜艳雪 Cao Shuangqing;Gao Xun;Zhu Baoyue;Liu Qian;Liu Yongjian;Xiao Qingmian;Wang Weizhan;Du Yanxue(Department of Emergency Medicine,Hudson International Peace Hospital,Hebei Medical University,Hengshui 053000,China)

机构地区：[1]河北医科大学哈励逊国际和平医院急救医学部,衡水053000

出　　处：《中华劳动卫生职业病杂志》2020年第9期696-700,共5页Chinese Journal of Industrial Hygiene and Occupational Diseases

摘　　要：目的探讨经颅直流电刺激(tDCS)对一氧化碳中毒迟发性脑病(DEACMP)患者认知功能的影响。方法连续纳入2018年1月至2020年1月于哈励逊国际和平医院急救医学部就诊的58例DEACMP患者,根据随机数字表将患者随机分为研究组和对照组各29例。两组患者均给予营养神经、改善微循环、肾上腺糖皮质激素等药物治疗,以及高压氧及康复训练,1次/d。研究组在常规治疗的基础上辅以tDCS治疗(放置电极片,给予电流刺激30 min/次),对照组在常规治疗的基础上辅以tDCS伪刺激(放置电极片,给予电流刺激10 s),1次/d,连续治疗30 d。分别在治疗前和治疗30 d后对患者行听觉事件相关电位P300(ERP-P300)检测,应用《简易智力状态检查量表》(MMSE量表)、Barthel指数(BI)及美国国立卫生院神经功能缺损评分(NIHSS)对患者进行测评与分析。结果治疗前两组患者各评分差异均无统计学意义(P>0.05)。治疗30 d后,研究组MMSE总分及定向力、记忆力、注意力和计算力、语言能力得分均高于对照组(P<0.05)。研究组治疗90 d后BI高于对照组,治疗30 d后NIHSS评分低于对照组(P<0.05)。研究组治疗30 d后ERP-P300潜伏期短于对照组,波幅高于对照组(P<0.05)。患者治疗前后ERP-P300潜伏期与MMSE总分均呈负相关(r=-0.837、-0.819,P<0.05),ERP-P300潜伏期与治疗前定向力、注意力和计算力、语言能力均呈负相关(r=-0.698、-0.675、-0.742,P<0.05)。结论tDCS治疗有助于改善DEACMP患者的认知功能,ERP-P300检测能够协助判断患者认知功能严重程度。Objective To investigate the effect of transcranial direct current stimulation(tDCS)on cognitive function of delayed encephalopathy after carbon monoxide poisoning(DEACMP).Methods A total of 58 patients with DEACMP admitted to the Emergency Medicine Department of Hudson International Peace Hospital from January 2018 to January 2020 were included.According to the random number table,the patients were randomly divided into study group and control group,with 29 patients in each group.Patients in both groups were given nutritional nerve therapy,improved microcirculation,adrenal cortical hormone and other drugs,as well as hyperbaric oxygen and rehabilitation training,once per day.The study group was treated with tDCS(electrode pads were placed and current stimulation was given 30 min/time)1/d on the basis of conventional treatment,while the control group was treated with tDCS pseudo stimulation(electrode pads were placed and current stimulation was given for 10 s)1/d for 30 days consecutively.The auditory event-related potential P300(ERP-P300)was tested before and 30 days after treatment,and the Mini-Mental State Examination(MMSE)scale,Barthel index(BI)and the National Institutes of Health Neurological Impairment score(NIHSS)were used to evaluate and analyze the patients.Results There was no significant difference in scores between the two groups before treatment(all P>0.05).After 30 days of treatment,the MMSE score,orientation,memory,attention and computing power,and language ability of the study group were all higher than those of the control group,and the differences were statistically significant(P<0.05).90 days after treatment,the BI of the study group was higher than that of the control group(P<0.05).After 30 days of treatment,the NIHSS score of the study group was significantly lower than that of the control group(P<0.05).The latency of ERP-P300 in the study group was shorter than that in the control group,and the amplitude was higher than that in the control group at 30 days after treatment,and the difference

关 键 词：一氧化碳中毒 电刺激 经颅直流电刺激 一氧化碳中毒迟发性脑病 认知功能 事件相关电位-P300 简易智力状态检查 BARTHEL指数 

分 类 号：R747.9[医药卫生—神经病学与精神病学] R595.1[医药卫生—临床医学]