经皮耳迷走神经电刺激联合多感官情景刺激对持续性植物状态患者的促醒效果研究  

Awakening effect of transcutaneous auricular vagus nervestimulation combined with multi-sensory environmentalstimulation in patients with persistent vegetative state

作　　者：张丽丽 王肃馨 王立峰 王辉 ZHANG Lili;WANG Suxin;WANG Lifeng;WANG Hui(Department of Neurological Rehabilitation,Shaanxi Rehabilitation Hospital,Xi′an,Shaanxi,710065)

机构地区：[1]陕西省康复医院神经康复科,陕西西安710065

出　　处：《实用临床医药杂志》2025年第1期23-27,共5页Journal of Clinical Medicine in Practice

基　　金：陕西省重点研发计划项目(2024SF-YBXM-686);陕西省临床重点专科建设资助项目[陕卫办医函(2022)185号]。

摘　　要：目的 分析经皮耳迷走神经电刺激(taVNS)联合多感官情景刺激对持续性植物状态(PVS)患者的促醒效果。方法 选取60例PVS患者为研究对象,并随机分为对照组(n=30)和观察组(n=30)。对照组脱落3例,最终纳入27例,观察组脱落2例,最终纳入28例。2组均给予基础治疗及常规康复训练。观察组采用多感官情景刺激联合taVNS治疗,对照组采用多感官情景刺激联合假刺激治疗。2组治疗频率均为1次/d, 5次/周,连续治疗8周。比较2组患者治疗前,治疗4、8周后,以及随访时(12周)的格拉斯哥昏迷量表(GCS)评分、改良国际昏迷恢复量表(CRS-R)评分。分析2组治疗前、治疗8周后的脑电图(EEG)分级情况。比较2组随访时的促醒效果。结果 治疗4、8周后以及随访时,2组患者的GCS、CRS-R评分高于治疗前,且观察组高于对照组,差异有统计学意义(P<0.05)。治疗8周后,2组患者EEG分级优于治疗前,且观察组优于对照组,差异有统计学意义(P<0.05)。随访时,观察组促醒率为46.43%,高于对照组的29.63%,差异有统计学意义(P<0.05)。结论 taVNS联合多感官情景刺激对PVS患者的促醒作用较好,可改善其意识障碍水平,且安全性较高。Objective To analyze the awakening effect of transcutaneous auricular vagus nerve stimulation(taVNS)combined with multi-sensory environmental stimulation in patients with persistent vegetative state(PVS).Methods Sixty PVS patients were selected as study subjects,and randomly divided into control group(n=30)and observation group(n=30).Three patients in the control group shed 3 cases and eventually included 27 cases,and the observation group shed 2 cases and eventually included 28 cases.Both groups received basic treatment and routine rehabilitation training.The observation group was treated with multi-sensory environmental stimulation combined with taVNS,while the control group received multi-sensory environmental stimulation combined with sham stimulation.Both groups were treated once per day,five times per week,for eight consecutive weeks.The Glasgow Coma Scale(GCS)and the Coma Recovery Scale-Revised(CRS-R)scores were compared between the two groups before treatment,after 4,8 weeks of treatment and during follow-up(12 weeks).The electroencephalogram(EEG)grading was analyzed before and after 8 weeks of treatment.The awakening effect during follow-up was compared between the two groups.Results After 4,8 weeks of treatment and during follow-up,the GCS and CRS-R scores of both groups were significantly higher than before treatment,and the observation group had significantly higher scores than the control group(P<0.05).After 8 weeks of treatment,the EEG grading of both groups was significantly better than before treatment,and the observation group was significantly better than the control group(P<0.05).During follow-up,the awakening rate in the observation group was 46.43%,which was significantly higher than 29.63% in the control group ( P <0.05). Conclusion The method oftaVNS combined with multi-sensory environmental stimulation has a good awakening effect in PVS patients, and can improve their level of consciousness disorder with high safety.

关 键 词：持续性植物状态 经皮耳迷走神经电刺激 多感官情景刺激 促醒 意识障碍 

分 类 号：R741[医药卫生—神经病学与精神病学] R454[医药卫生—临床医学] R319