不同时机右侧正中神经电刺激联合综合康复对老年脑损伤所致意识障碍的应用价值  

Application value of RMNES combined with comprehensive rehabilitation for consciousness disorders caused by senile brain injury

作　　者：张茜 李璇 郑新瑞 王毓 Zhang Qian;Li Xuan;Zheng Xinrui;Wang Yu(Department of Neurosurgery,the First Affiliated Hospital of Air Force Medical University,Xi'an 710000,Shaanxi Province,China)

机构地区：[1]解放军空军军医大学第一附属医院神经外科,西安710000

出　　处：《中华老年心脑血管病杂志》2024年第7期784-788,共5页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

基　　金：陕西省自然科学基础研究计划项目(2022JM-437)。

摘　　要：目的 探索不同时机右侧正中神经电刺激(RMNES)联合综合康复对老年脑损伤所致意识障碍的应用价值。方法 回顾性分析2020年1月至2023年11月解放军空军军医大学第一附属医院收治的老年脑损伤所致意识障碍患者160例,根据治疗方法分为3组,Ⅰ组53例仅采用综合康复干预;Ⅱ组54例先接受综合康复后,再进行RMNES治疗;Ⅲ组53例在固定室内同时进行综合康复、RMNES治疗。治疗1周后比较3组脑电图(EEG)分级、脑干听诱发(BAEP)分级、脑血流动力学参数[局部脑血容量(rCBV)、局部脑血流量(rCBF)、平均血流速度(Vm)]、残疾程度(DRS)评分、格拉斯哥昏迷评分(GCS)。结果 3组治疗1周后EEG分级Ⅰ级、EEG分级Ⅱ级、BAEP分级Ⅰ级比例、rCBV、rCBF、Vm、GCS高于治疗前,EEG分级Ⅴ级、BAEP分级Ⅲ级比例、DRS评分低于治疗前(P<0.05)。3组治疗1周后EEG分级、BAEP分级比较,差异有统计学意义(P<0.01);Ⅲ组治疗后rCBV、rCBF、Vm、GCS高于Ⅰ组、Ⅱ组,DRS评分低于Ⅰ组、Ⅱ组(P<0.05)。Ⅰ组和Ⅱ组与Ⅲ组不良反应发生率比较,差异无统计学意义(3.77%vs 7.41%vs 7.55%,χ^(2)=0.830,P=0.660)。结论 在室内同时进行综合康复、RMNES治疗对于老年脑损伤所致意识障碍患者效果更显著,可改善脑神经电生理活动,提高脑血流动力学,促进意识恢复。Objective To explore the application value of RMNES combined with comprehensive rehabilitation for consciousness impairment caused by senile brain injury.Methods A retrospective analysis was conducted on 160elderly patients with consciousness disorders caused by brain injury admitted in our hospital between January 2020and November 2023.According to treatment regiments,they were divided into comprehensive rehabilitation group(GroupⅠ,53cases),comprehensive rehabilitation followed by RMNES group(GroupⅡ,54patients),and simultaneous indoor comprehensive rehabilitation and RMNES(GroupⅢ,53patients).At 1week after treatment,electroencephalogram(EEG)grade,brainstem auditory induction(BAEP)grade,cerebral hemodynamic parameters[including relative cerebral blood flow(rCBF),relative cerebral blood volume(rCBV),and mean blood flow velocity(Vm)],Disability Rating Scale(DRS)score,and Glasgow Coma Scale(GCS)score were compared among the three groups.Results After 1week of treatment,the ratios of EEG gradeⅠ,EEG gradeⅡand BAEP gradeⅠ,rCBV,rCBF and Vm values and GCS score were increased,while the ratios of EEG grade V and BAEP gradeⅢ,and DRS score were decreased when compared with the levels before treatment(P<0.05).Significant differences were observed in EEG grade and BAEP grade among the 3groups after 1week of treatment(P<0.01);GroupⅢhad obviously higher rCBV,rCBF,Vm and GCS score and lower DRS score than GroupsⅠandⅡ(P<0.05).There was no statistical difference in the incidence of adverse reactions in GroupsⅠ,ⅡandⅢ(3.77%vs 7.41%vs 7.55%,χ^(2)=0.830,P=0.660).Conclusion Simultaneous indoor comprehensive rehabilitation and RMNES treatment achieves more significant efficacy for elderly patients with brain injury-caused consciousness disorders,and it can improve electrophysiological activities of brain nerves,enhance cerebral hemodynamics,and promote the recovery of consciousness.

关 键 词：电刺激 正中神经 脑损伤 意识障碍 脑电描记术 回顾性研究 康复 

分 类 号：R651.15[医药卫生—外科学]