正中神经磁刺激联合常规促醒治疗干预慢性意识障碍的临床研究  

Clinical study of median nerve magnetic stimulation combined with conventional wake-up therapy in prolonged disorders of consciousness

作　　者：司马振奋[1] 陈争一[1] 龚剑秋[1] 张芳[1] 冯飞 SIMA Zhenfen;CHEN Zhengyi;GONG Jianqiu;ZHANG Fang;FENG Fei(Department of Rehabilitation,Shaoxing People's Hospital,Shaoxing 312000,China)

机构地区：[1]绍兴市人民医院康复医学科,浙江绍兴312000

出　　处：《中国现代医生》2022年第19期11-14,共4页China Modern Doctor

基　　金：浙江省医药卫生科技计划项目(创新人才支持项目)(2020RC129)。

摘　　要：目的观察正中神经磁刺激联合常规促醒治疗干预慢性意识障碍(prolonged disorders of consciousness,pDoC)的临床疗效。方法选取2019年1月~2021年2月于绍兴市人民医院采用正中神经磁刺激治疗的19例pDoC患者,经改良昏迷恢复量表(coma recovery scale-revision,CRS–R)评分判定,8例为植物状态(vegetative state,VS),11例为微意识状态(minimally conscious state,MCS)。分析比较治疗前后患者的CRS–R评分、脑电图(electroencephalogram,EEG)检测及整体疗效。结果治疗6周后,VS患者的CRS–R视功能、口运动/言语功能、觉醒评分及总分均显著高于治疗前(均P<0.05),MCS患者的CRS–R各维度评分及总分均高于治疗前(均P<0.05);仅2例患者EEG有改善;2例VS患者转为MCS–,1例VS患者转为MCS+;6例MCS–患者转为MCS+,2例MCS–患者和1例MCS+患者转为脱离MCS;病程3个月以内的6例患者的意识均有明显提高。结论采用正中神经磁刺激联合常规促醒治疗干预pDoC患者是有积极意义的,病程在3个月以内及MCS患者更易从中获益。Objective To observe the clinical effect of median nerve magnetic stimulation combined with conventional wake-up therapy on prolonged disorders of consciousness(pDoC).Methods Nineteen patients with pDoC who re-ceived median nerve magnetic stimulation in Shaoxing People's Hospital from January 2019 to February 2021 were selected.According to the coma recovery scale–revision(CRS–R)score,8 patients were vegetative state(VS)and 11 patients were minimally conscious state(MCS).The CRS–R score,electroencephalogram(EEG)and overall curative effect were analyzed and compared before and after treatment.Results After 6 weeks of treatment,visual function,oral motor/speech function,arousal score and total score of VS patients were significantly higher than those before treatment(all P<0.05),and scores of CRS–R dimensions and total score of MCS patients were significantly higher than those before treatment(all P<0.05).Two patients showed improvement in EEG.Two VS patients converted to MCS–and one VS patient converted to MCS+.There were 6 MCS–patients converted to MCS+,2 MCS–patients and 1 MCS+patient converted to MCS dissociation.The consciousness of all 6 patients with disease course less than 3 months was significantly improved.Conclusion Median nerve magnetic stimulation combined with conventional wake-up therapy is of positive significance in the intervention of pDoC patients,and patients with disease course less than 3 months and MCS patients are more likely to benefit from this treatment.

关 键 词：正中神经 功能磁刺激 慢性意识障碍 促醒 

分 类 号：R493[医药卫生—康复医学]