脑电图在评估重复经颅磁刺激促醒重症脑损伤昏迷临床疗效中的应用  

The Use of EEG in Evaluating the Clinical Efficacy of Repetitive Transcranial Magnetic Stimulation in Coma Patients with Severe Brain Injury

作　　者：李维 LI Wei(Neurosurgery Intensive Care Unit of Jiujiang First People's Hospital,Jiujiang 332000,Jiangxi Province,China)

机构地区：[1]九江市第一人民医院神经外科重症监护室,江西九江332000

出　　处：《罕少疾病杂志》2025年第1期32-34,共3页Journal of Rare and Uncommon Diseases

摘　　要：目的 探讨脑电图在重复经颅磁刺激促醒重症脑损伤昏迷患者临床疗效中的评估作用。方法 选择九江市第一人民医院医院神经外科2021年1月至2023年1月接收的重症脑损伤昏迷患者24例,格拉斯哥昏迷评分法(GCS)<9分,入院均接受重复经颅磁刺激促醒治疗,观察治疗前后脑电图相关参数变化,对比不同通道上的平均功率、慢波比(DTR)指标水平,评价脑电图在评估疗效中的应用价值。结果 本组患者经rTMS治疗后83.33%的恢复至Ⅰ级、Ⅱ级,另有4例处于Ⅲ、Ⅳ级,但无Ⅴ级患者,大部分患者基本恢复良好。治疗前后脑电图反应性分级比较差异有意义(P<0.05);与治疗前相比,经rTMS治疗后患者F p1、F3、C3、F7和T3通道上的平均功率和DTR均呈下降趋势,差异有意义(P<0.05)。另外,纳入的24例重症脑损伤昏迷患者均存在程度不一的脑电图异常,图像主要表现为中高幅慢波和θ阵发型,分别占比25%(6/24)、41.67%(10/24),而经过rTMS治疗后上述异常均有明显减少,波形分化得到改善,结论脑电图在评估重复经颅磁刺激促醒重症脑损伤昏迷患者临床疗效中具有重要的应用价值,重复经颅磁刺激也值得作为症脑损伤昏迷患者促醒的一种可行方案。Objective To evaluate the clinical efficacy of EEG in patients with severe brain injury.Methods Select Jiujiang First People's hospital neurosurgery in January 2021 to January 2023 received severe brain injury coma patients 24 cases,Glasgow coma score(GCS)<9 points,admission to accept repeated transcranial magnetic stimulation awake treatment,observe the EEG related parameters before and after treatment,compared the average power and slow wave ratio(DTR)on different channels,evaluate the application value of EEG in evaluating curative effect.Results After rTMS treatment,83.33%of the patients recovered to grade I and gradeⅡ,and another 4 patients were in gradeⅢand gradeⅣ,but no grade V patients,most of the patients basically had a good recovery.Significant difference before and after treatment(P<0.05);decreasing mean power and DTR on Fp 1,F3,C3,F7 and T3 after rTMS compared with before treatment(P<0.05).In addition,of the 24 included severe brain injuries,comatose patients had EEG abnormalities of varying degrees,the images mainly show the medium and high amplitude slow wave andθarray hairstyle,25%(6/24)and 41.67%(10/24)respectively.However,all of the above abnormalities were significantly reduced after rTMS treatment,with an improved waveform differentiation.Conclusion EEG is useful in the evaluation of clinical outcome in coma patients with severe brain injury,Repeated rTMS is also worthwhile as a feasible option for getting awake in coma patients with severe brain injury.

关 键 词：脑电图 重复经颅磁刺激 促醒 重症脑损伤 昏迷 

分 类 号：R651.15[医药卫生—外科学]