选择性音乐疗法联合重复经颅磁刺激对颅脑损伤后意识障碍患者的促醒疗效  

作　　者：洪梦琪 吕晓 李新科 

机构地区：[1]浙江省宁波市第九医院,315020

出　　处：《浙江临床医学》2024年第11期1655-1657,共3页Zhejiang Clinical Medical Journal

基　　金：浙江省医药卫生科技计划项目(2021KY333)。

摘　　要：目的探讨选择性音乐联合重复经颅磁刺激(rTMS)对颅脑损伤(TBI)后植物状态(VS)患者及微意识状态(MCS)患者的促醒疗效。方法选取69例TBI患者,其中VS患者36例,MCS患者33例。通过随机分配,将VS患者分为A1组、B1组、C1组,每组12例;MCS患者分为A2组、B2组、C2组,每组11例。研究设计了不同的治疗方案:A组接受常规康复治疗(A1组+A2组)、B组接受常规康复治疗+rTMS刺激(B1组+B2组)、C组接受常规康复治疗+rTMS刺激上+选择性音乐疗法(C1组+C2组),每组23例。比较治疗前后的格拉斯哥昏迷评分(GCS)和昏迷评分量表-修订版(CRS-R)评分来评估治疗效果。结果治疗4周后所有组别的GCS评分、CRS-R评分均有显著提升(P<0.01):B组和C组在GCS评分上的提升幅度显著高于A组(P<0.01),CRS-R评分的提升幅度也显著高于A组水平(P<0.05)。在VS患者中(A1组、B1组、C1组)和MCS患者(A2组、B2组、C2组)中,也观察到了类似的治疗效果,B1、B2组和C1、C2组在GCS评分和CRS-R评分上的提升幅度均显著高于相应的A1、A2组(P<0.05或P<0.01)。结论选择性音乐联合rTMS治疗对颅脑损伤后VS患者和MCS患者的促醒疗效显著,联合治疗方案不仅操作简单、安全,副作用小,值得在临床广泛应用,为TBI后VS患者及MCS患者带来新的治疗方法。Objective To explore the efficacy of selective music combined with repetitive transcranial magnetic stimulation(rTMS)in promoting the awakening of patients in a vegetative state(VS)and minimally conscious state(MCS)following traumatic brain injury(TBI).Methods A total of 69 TBI patients were selected,including 36 VS patients and 33 MCS patients.They were randomly assigned into three groups for VS patients(A1,B1,C1)and three groups for MCS patients(A2,B2,C2),with 12 and 11 patients in each group,respectively.Different treatment plans were designed:Group A(A1+A2)received conventional rehabilitation therapy,Group B(B1+B2)received conventional rehabilitation therapy plus rTMS stimulation,and Group C(C1+C2)received conventional rehabilitation therapy plus rTMS stimulation plus selective music therapy,with 23 cases in each group.The Glasgow Coma Scale(GCS)and Coma Recovery Scale-Revised(CRS-R)scores before and after treatment were compared to evaluate the therapeutic effect.Results After 4 weeks of treatment,there was a significant increase in GCS and CRS-R scores in all groups(P<0.01).The improvement in GCS scores in Groups B and C was significantly higher than that in Group A(P<0.01),and the improvement in CRS-R scores was also significantly higher than that in Group A(P<0.05).Similar therapeutic effects were observed in both VS patients(A1,B1,C1)and MCS patients(A2,B2,C2),with B1,B2,and C1,C2 groups showing significantly higher improvements in GCS and CRS-R scores than the corresponding A1,A2 groups(P<0.05 or P<0.01).Conclusion The combined treatment of selective music and rTMS is significantly effective in promoting the awakening of VS and MCS patients after TBI.This combined treatment plan is not only simple but also safe with minimal side effects,making it worthy of widespread application in clinical practice,offering new treatment options for VS and MCS patients after TBI.

关 键 词：颅脑损伤 意识障碍 植物状态 微意识状态 音乐疗法 重复经颅磁刺激 

分 类 号：R651.15[医药卫生—外科学]