常规治疗辅以长时程经颅直流电刺激对创伤性脑损伤后微意识状态患者意识恢复的作用  

Effect of conventional treatment plus long-term transcranial direct current stimulation on consciousness recovery of minimally conscious patients after traumatic brain injury

作　　者：余泽[1] 蒋秋霞[1] 董燕[1] 郑曼丽[1] 赖琛[1] 孙建伟[1] 杜宏艳[1] 丁宇超 胡晓华[1] Yu Ze;Jiang Qiuxia;Dong Yan;Zheng Manli;Lai Chen;Sun Jianwei;Du Hongyan;Ding Yuchao;Hu Xiaohua(Centre of Rehabilitation,Zhejiang Armed Police Corps Hospital,Hangzhou 310051,China)

机构地区：[1]武警浙江省总队医院康复科,杭州310051

出　　处：《中华创伤杂志》2022年第5期401-406,共6页Chinese Journal of Trauma

基　　金：杭州市卫生科技计划(2018B097)。

摘　　要：目的探讨常规治疗辅以长时程经颅直流电刺激(tDCS)对创伤性脑损伤(TBI)后微意识状态(MCS)患者意识恢复的作用。方法采用回顾性队列研究分析2019年1月至2020年12月武警浙江省总队医院收治的60例TBI后MCS患者临床资料,其中男38例,女22例;年龄19~60岁[(45.7±11.4)岁]。病程3~6个月[(4.6±0.9)个月]。30例接受包括内科、高压氧和康复等常规治疗(常规治疗组);30例在常规治疗基础之上,接受4个周期共计28 d的tDCS刺激,每个周期7 d,刺激5 d,休息2 d(tDCS治疗组)。比较两组治疗前、4个治疗周期内和治疗结束后6个月和12个月修订版昏迷恢复量表(CRS-R)评分总分及脑干听觉诱发电位(BAEP)评分及临床有效率(显著有效+有效)。观察tDCS治疗组并发症情况。结果治疗前两组CRS-R评分总分和BAEP评分差异无统计学意义(P均>0.05),治疗周期内和治疗结束后6个月及12个月tDCS治疗组CRS-R总分和BAEP评分显著高于常规治疗组(P均<0.05)。两组治疗周期内和治疗结束后6个月及12个月CRS-R评分总分和BAEP评分逐渐提高(P均<0.05)。tDCS治疗组临床有效率为73%(22/30),常规治疗组临床有效率为57%(17/30)(P<0.05)。tDCS治疗组10例患者阴极刺激部位局部可逆性轻微泛红,未见tDCS刺激引起的如局部灼伤、破溃、渗液及癫痫等严重不良反应。结论相较常规治疗,常规治疗辅以长时程tDCS能更有效改善TBI后MCS患者的意识状态,且无严重不良反应。Objective To investigate the effect of conventional treatment plus long-term transcranial direct current stimulation(tDCS)on consciousness recovery in patients with minimally conscious state(MCS)after traumatic brain injury(TBI).Methods A retrospective cohort study was conducted to analyze the clinical data of 60 patients with MCS after TBI admitted to Zhejiang Armed Police Corps Hospital from January 2019 to December 2020,including 38 males and 22 females,aged 19-60 years[(45.7±11.4)years].Course of disease was 3-6 months[(4.6±0.9)months].Of all,30 patients received internal medicine,hyperbaric oxygen,rehabilitation and other conventional treatment(conventional treatment group),and 30 patients received tDCS stimulation on the basis of conventional treatment(tDCS treatment group).The tDCS stimulation contained 4 cycles for 28 days with each cycle lasting for 7 days(stimulation for 5 days,rest for 2 days).Coma recovery scale-revised(CRS-R)total score,brainstem auditory evoked potential(BAEP)score and clinical effictive rate(significantly effective+effective)were compared between the two groups before treatment,during 4 cycles of treatment and at 6 months and 12 months after treatment.Complications induced by tDCS were also evaluated.Results There was no significant difference in CRS-R total score and BAEP score between the two groups before treatment(all P>0.05).CRS-R total score and BAEP score in tDCS treatment group were significantly higher than those in conventional treatment group during 4 cycles of treatment and at 6 months and 12 months after treatment(all P<0.05).CRS-R total score and BAEP score in both groups gradually increased during 4 cycles of treatment and at 6 months and 12 months after treatment(all P<0.05).The clinical effective rate in tDCS treatment group was 73%(22/30)when compared to 57%(17/30)in conventional treatment group(P<0.05).In tDCS treatment group,10 patients had local reversible slight redness at the cathodal position,while no other serious adverse effects,such as local burns,ulcer

关 键 词：脑损伤 意识障碍 经颅直流电刺激 

分 类 号：R651.15[医药卫生—外科学]