丰富环境量化刺激与常规康复治疗对创伤性脑损伤后意识障碍患者的促醒效果比较  

Comparison of awakening effects of enriched environmental quantitative stimulation and conventional rehabilitation on patients with consciousness disorder after traumatic brain injury

作　　者：刘克洪[1] 董天华 韩春 周卫[1] 王晓阳 胡晓华[1] Liu Kehong;Dong Tianhua;Han Chun;Zhou Wei;Wang Xiaoyang;Hu Xiaohua(Department of Rehabilitation,Hospital of Zhejiang Provincial Armed Police Corps,Hangzhou 310051,China;Hangzhou Xinyue Intelligent Technology Co.,Ltd.,Hangzhou 311400,China)

机构地区：[1]武警浙江省总队医院康复医学科,杭州310051 [2]杭州欣月智能科技有限公司,杭州311400

出　　处：《中华创伤杂志》2024年第2期111-117,共7页Chinese Journal of Trauma

基　　金：浙江省卫生科技面上项目(2022511677)。

摘　　要：目的比较丰富环境量化刺激与常规康复治疗对创伤性脑损伤(TBI)后意识障碍患者的促醒效果。方法采用回顾性队列研究分析2021年10月至2022年10月武警浙江省总队医院收治的60例TBI后意识障碍患者的临床资料,其中男38例,女22例;年龄26~72岁[(41.6±13.2)岁]。损伤部位:额颞叶损伤37例,脑干损伤9例,丘脑损伤14例。损伤类型:脑挫裂伤36例,脑内血肿24例。入院时格拉斯哥昏迷评分(GCS):5~8分11例,9~12分34例,13~15分15例。病程(19.2±5.4)d。30例接受常规康复治疗(常规康复组);30例在常规康复治疗基础上,接受4个周期共计28 d的丰富环境量化刺激(量化刺激组)。比较两组治疗前、治疗第2个及第4个治疗周期的修订版昏迷恢复量表(CRS-R)评分、日常生活活动能力(ADL)评分、脑波α/δ比率(ADR)。比较第4个治疗周期结束时两组并发症发生率和末次随访时格拉斯哥预后评分(GOS)良好率。结果患者均获随访6~12个月[(8.3±2.5)个月]。两组治疗前CRS-R评分、ADL评分、脑波ADR差异均无统计学意义(P>0.05)。量化刺激组第2个治疗周期的CRS-R评分、ADL评分、脑波ADR分别为(13.03±0.73)分、(14.83±0.95)分、0.35±0.11,均高于常规康复组的(11.18±0.14)分、(8.74±0.43)分、0.29±0.09(P<0.05);量化刺激组第4个治疗周期的CRS-R评分、ADL评分、脑波ADR分别为(17.83±0.23)分、(52.93±10.75)分、0.44±0.11,均高于常规康复组的(13.67±0.35)分、(40.56±7.15)分、0.37±0.07(P<0.05)。两组内CRS-R评分、ADL评分、脑波ADR第2个治疗周期均较治疗前显著提高,第4个治疗周期较第2个治疗周期均进一步提高(P<0.05)。第4个治疗周期结束时量化刺激组并发症发生率为13.3%(4/30),低于常规康复组的36.7%(11/30)(P<0.05)。末次随访时量化刺激组GOS预后良好率为80.0%(24/30),优于常规康复组的66.7%(20/30)(P<0.05)。结论与常规康复治疗相比,丰富环境量化刺激治疗TBI后意识障碍患者,Objective To compare the awakening effects of enriched environmental quantitative stimulation and conventional rehabilitation on patients with consciousness disorder after traumatic brain injury(TBI).Methods A retrospective cohort study was conducted to analyze the clinical data of 60 patients with consciousness disorder after TBI admitted to Hospital of Zhejiang Provincial Armed Police Corps from October 2021 to October 2022,including 38 males and 22 females,aged 26-72 years[(41.6±13.2)years].The injury was located at the frontal and temporal lobe in 37 patients,at the brain stem in 9,and at the thalamus in 14.The types of injury included cerebral contusion and laceration in 36 patients and intracerebral hematomas in 24 patients.The Glasgow Coma Scale(GCS)score on admission was 5-8 points in 11 patients,9-12 in 34,and 13-15 in 15.Disease course was(19.2±5.4)days.A total of 30 patients received conventional rehabilitation treatment(conventional rehabilitation group)and 30 patients received enriched environmental quantitative stimulation on the basis of conventional rehabilitation treatment,which lasted 4 cycles in 28 days(quantitative stimulation group).The Coma Recovery Scale-Revised(CRS-R)score,Activities of Daily Living(ADL)score,and brainwaveα/δratio(ADR)before treatment and at the second and fourth treatment cycles were compared between the two groups.The incidence of complications at the end of the fourth treatment cycle and the rate of favorable outcome of Glasgow Outcome Scale(GOS)at the last follow-up were compared between the two groups.Results All the patients were followed up for 6-12 months[(8.3±2.5)months].There were no significant differences in CRS-R score,ADL score,or brainwave ADR between the two groups before treatment(P>0.05).At the second treatment cycle,they were(13.03±0.73)points,(14.83±0.95)points and 0.35±0.11 respectively in the quantitative stimulation group,which were all higher than those in the conventional rehabilitation group[(11.18±0.14)points,(8.74±0.43)points and 0.29�

关 键 词：脑损伤 意识障碍 刺激 

分 类 号：R651.15[医药卫生—外科学]