非侵入性神经调控对脑损伤后意识障碍的疗效观察  

Effect of noninvasive neuromodulation on disturbance of consciousness after brain injury

作　　者：李姣 冯海霞[1] 李亚斌[1] 许东升 王红霞 杨佳丽 曹志刚 刘忠[1] LI Jiao;FENG Haixia;LI Yabin;XU Dongsheng;WANG Hongxia;YANG Jiali;CAO Zhigang;LIU Zhong(Rehabilitation Center Hospital of Gansu Province,Lanzhou 730000,China;Tongji University School of Medicine,Shanghai 200092,China)

机构地区：[1]甘肃省康复中心医院,甘肃兰州730000 [2]同济大学医学院,上海200092

出　　处：《中国实用神经疾病杂志》2021年第18期1583-1590,共8页Chinese Journal of Practical Nervous Diseases

基　　金：兰州市人才创新创业项目(编号:2019-RC-40)。

摘　　要：目的观察非侵入性神经调控技术经颅直流电刺激(tDCS)结合正中神经电刺激(MNES)对脑损伤后患者意识水平和体感诱发电位的影响。方法纳入脑损伤后存在意识障碍的患者102例,随机分为3组,每组34例,A组给予常规治疗及阳极经颅直流电刺激,B组常规治疗及正中神经电刺激,C组给予常规治疗、阳极经颅直流电刺激及正中神经电刺激,分别于治疗前、治疗后4周及治疗后8周进行体感诱发电位N20潜伏期及波幅测定,格拉斯哥昏迷量表(GCS)及昏迷恢复量表(CRS-R)测评。结果(1)体感诱发电位:3组经4周治疗后N20潜伏期均治疗前缩短、波幅均较治疗前提高(P<0.05);3组经8周治疗后,与治疗4周时相比,N20潜伏期均缩短、波幅均增高,且C组N20潜伏期[(19.06±2.01)ms]及波幅[(2.23±0.45)μV]变化显著高于A组[N20潜伏期(21.06±2.36)ms,波幅(1.99±0.36)μV]、B组[N20潜伏期(20.92±2.33)ms及波幅(2.04±0.27)μV](P<0.01)。(2)GCS、CRS-R测评:3组经4周治疗后,GCS、CRS-R量表测评分值均提高(P<0.05);治疗8周后,3组GCS、CRS-R测评得分较4周时均提高(P<0.05),A、B组提高情况接近,而C组GCS[(12.76±1.46)分]、CRS-R[(16.23±0.49)分]评分显著优于A组[GCS(11.06±1.35)分,CRS-R(13.99±0.56)分]、B组[GCS(11.52±1.82)分,CRS-R(14.04±0.33)分](P<0.05)。结论中枢结合外周的非侵入性神经调控技术对提高脑损伤后患者意识水平及体感诱发电位的改善具有显著作用。Objective To observe the clinical effects of non-invasive neuroregulation technique of transcranial direct current stimulation combined with median nerve electrical stimulation on consciousness level and somatosensory evoked potential in patients with brain injury.Methods According to the random number table method,102 patients with consciousness disturbance after brain injury were divided into three groups:group A(conventional treatment+anodic tDCS group),group B(conventional treatment+MNES group),and group C(conventional treatment+anodic tDCS+MNES group),34 patients in each group.Somatosensory evoked potential N20 latency and amplitude were measured before treatment,4 weeks after treatment and 8 weeks after treatment,and measured by Glasgow coma scale(GCS)and the coma recovery scale-revised(CRS-R).Results①Somatosensory evoked potentials:after 4 weeks of treatment,N20 latency was shortened and amplitude was increased in all three groups compared with before treatment(P<0.05).The incubation period of N20 was shortened and the amplitude of N20 was increased in the three groups after 8 weeks of treatment compared with 4 weeks of treatment.The changes of N20 latency(19.06±2.01)ms and amplitude(2.23±0.45)μV in group C were significantly higher than those in group A(N20 latency(21.06±2.36)ms and amplitude(1.99±0.36)μV)and group B(N20 latency(20.92±2.33)ms and amplitude(2.04±0.27)μV)(P<0.01).②GCS and CRS-R:After 4 weeks of treatment,the scores of GCS and CRS-R were increased(P<0.05).After 8 weeks,GCS and CRS-R scores of the three groups increased compared with those of 4 weeks(P<0.05),and the improvement of group A and B was similar.GCS(12.76±1.46)and CRS-R(16.23±0.49)in group C were significantly better than those in group A(GCS 11.06±1.35,CRS-R 13.99±0.56),group B(GCS 11.52±1.82 and CRS-R 14.04±0.33)(P<0.05).Conclusion The non-invasive neuroregulation technique of central and peripheral has a significant effect on improving the level of consciousness and somatosensory evoked potential of patients a

关 键 词：脑损伤 神经调控技术 意识水平 体感诱发电位 促醒 

分 类 号：R651.15[医药卫生—外科学]