基于执行控制网络的多靶点tDCS对急性意识障碍患者的临床疗效观察  

Clinical Efficacy of Multi-Target tDCS Based on Executive Control Network for Patients with Acute Disorders of Consciousness.

作　　者：杨挺[1,2] 胡成功 赵科洪[2] 殷培艺 侯昱童 蒙利娇 贾程森 Yang Ting;Hu Chenggong;Zhao Kehong(Department of Rehabilitation Medicine,West China Tianfu Hospital of Sichuan University,Chengdu,Sichuan 610000;Department of Rehabilitation Medicine,Department of Critical Care Medicine,West China Hospital of Sichuan University,Chengdu,Sichuan 610000,China.)

机构地区：[1]四川大学华西天府医院康复医学科,四川成都610000 [2]四川大学华西医院康复医学科,重症医学科,四川成都610000

出　　处：《四川医学》2023年第8期789-793,共5页Sichuan Medical Journal

基　　金：国家重点研发计划项目(编号:2022YFC3602603);四川省科学技术厅重点研发项目(编号:2021YFS0069)。

摘　　要：目的探索基于执行控制网络(ECN)的多靶点经颅直流电刺激(tDCS)对急性意识障碍患者(aDOC)的临床疗效及安全性。方法纳入2022年3月至2022年10月我院ICU收治的26例aDOC患者,随机分为多靶点组(13例)和单靶点组(13例)。多靶点组行阳极左侧背外侧前额叶和左侧后顶叶、阴极右侧眶上区和右侧枕叶刺激,单靶点组行阳极左侧背外侧前额叶、阴极右侧眶上区刺激,刺激强度为2 mA,时间为20 min/次,1次/d,连续干预10 d。采用修订版昏迷恢复量表(CRS-R)、全面无反应性量表(FOUR)分别于干预前1 d内、干预5 d和干预10 d进行评估,干预后结束进行安全性评价。结果干预后多靶点组CRS-R评分改善优于单靶点组差异有统计学意义(P<0.05),干预后组内不同时间段改善差异有统计学意义(P<0.05),表现为干预10 d改善最好,干预5 d改善次之;两组在FOUR评分改善上差异无统计学意义(P>0.05),但干预后组内不同时间段改善差异有统计学意义(P<0.05),表现为干预10 d改善最好,干预5 d改善次之;干预后,本研究干预措施安全性评价为2级,比较安全。结论基于ECN的多靶点tDCS应用于aDOC患者,相较于常规tDCS治疗方案更能促进意识恢复,具有较高的安全性,值得在ICU推广应用。Objective To explore clinical efficacy and safety of multi-target transcranial direct current stimulation(tDCS)based on executive control network(ECN)in patients with acute disorders of consciousness(aDOC).Methods From March 2022 to October 2022,total 26 patients with aDOC admitted to surgical ICU of West China Hospital of Sichuan University and ICU of West China Tianfu Hospital of Sichuan University were randomly divided into multi-target group(n=13)and single-target group(n=13).The multi-target group was performed with anodes stimulation over left dorsolateral prefrontal and left posterior parietal lobe,and cathodes stimulation over right supraorbital region and right occipital lobe.The single-target group was performed with anodes stimulation over left dorsolateral prefrontal and cathodes stimulation over right supraorbital region.The tDCS were provided for both groups with a stimulation intensity of 2 mA for 20 mins/time,1 time/day,and continuous intervention for 10 days.The Coma recovery scale-revised(CRS-R)and full outline of un-responsiveness scale(FOUR)were assessed within 1 day before intervention,5 days and 10 days after intervention,respectively,and the safety evaluation of the study were completed after intervention.Results The improvement of CRS-R score in the multi-target group after the intervention was statistically significant(P<0.05)and difference in the improvement in different time periods after the intervention(P<0.05),which was manifested as the best improvement at 10 days of intervention and the second improvement at 5 days of intervention.There was no significant difference between two groups in improvement of FOUR score(P>0.05),but the improvement at different time periods in the group was also significant difference(P<0.05),which shown that improvement of 10-day intervention was the best,followed by 5-day intervention.After intervention,the safety evaluation of the study was Grade 2,which was relatively safe.Conclusion Compared with conventional tDCS treatment,multi-target tDCS based on

关 键 词：急性意识障碍 经颅直流电刺激 执行控制网络 多靶点 

分 类 号：R741.05[医药卫生—神经病学与精神病学]