耳迷走神经电刺激对慢性意识障碍促醒的效果  

Effect of transcutaneous auricular vagus nerve stimulation on patients with prolonged disorders of consciousness

作　　者：化龙昂 赖海芳 杨威 刘勇[2] 叶祥明[2] HUA Longang;LAI Haifang;YANG Wei;LIU Yong;YE Xiangming(Department of Rehabilitation Medicine,Ruijin Hospital,Shanghai Jiaotong University School of Medicine,Shanghai 200025,China;Department of Rehabilitation Medicine,Zhejiang Provincial People's Hospital(Affiliated People's Hospital of Hangzhou Medical College),Hangzhou,Zhejiang 310014,China)

机构地区：[1]上海交通大学医学院附属瑞金医院康复医学科,上海市200025 [2]浙江省人民医院(杭州医学院附属人民医院)康复医学科,浙江杭州市310014

出　　处：《中国康复理论与实践》2025年第3期339-347,共9页Chinese Journal of Rehabilitation Theory and Practice

基　　金：浙江省医药卫生科技项目(No.2023KY032;No.2024KY706);浙江省中医药科技计划项目(No.2023ZL238)。

摘　　要：目的探讨耳迷走神经电刺激(ta-VNS)对慢性意识障碍(p Do C)患者意识水平恢复的影响。方法2023年1月至2024年8月,浙江省人民医院p Do C患者50例,随机分为对照组(n=25)和观察组(n=25)。两组均接受常规促醒治疗和醒脑开窍针法治疗,观察组在此基础上增加ta-VNS治疗,共4周。每组根据入组时修订版昏迷恢复量表(CRS-R)评分分为无反应觉醒综合征/植物状态(UWS/VS)、微小意识状态(MCS)两种类型,分别在治疗前、治疗4周后进行格拉斯哥昏迷量表(GCS)、CRS-R、脑电图(EEG)分级和上肢体感诱发电位(SSEP)评估。结果观察组3例,对照组5例因转院未能完成试验。治疗前,两组UWS/VS、MCS类型患者各项评估指标均无显著性差异(P>0.05);治疗后,观察组UWS/VS、MCS类型患者GCS评分(|t|>16.000,P<0.001)、CRSR评分(|t|>14.318,P<0.001)、SSEP的N20振幅(|t|>5.247,P<0.05)均提高,EEG分级降低(Z>2.264,P<0.05),SSEP的N20潜伏期缩短(|t|>2.884,P<0.05),且均优于对照组同类型患者(|t|>1.883,|Z|>2.244,P<0.05)。结论ta-VNS可促进p Do C患者从UWS/VS和MCS状态中觉醒,提升脑电活动和感觉运动传导通路的功能状态。Objective To investigate the effect of transcutaneous auricular vagus nerve stimulation(ta-VNS)on the recovery of consciousness in patients with prolonged disorders of consciousness(p Do C).Methods From January,2023 to August,2024,50 patients with p Do C in Zhejiang Provincial People's Hospital were randomly divided into control group(n=25)and observation group(n=25).Both groups received conventional wakefulness-promoting treatment and Xingnao Kaiqiao acupuncture,and the observation group added ta-VNS treatment on the basis of the control group,for four weeks.Each group was further divided into unresponsive wakefulness syndrome/vegetative state(UWS/VS)and minimally consciousness state(MCS)types based on their initial the score of Coma Recovery Scale-Revised(CRS-R).They were assessed with Glasgow Coma Scale(GCS),CRS-R,EEG grading and upper limb somatosensory-evoked potentials(SSEP)before and four weeks after treatment.Results Three in the observation group and five in the control group dropped down for transferring to other hospitals.There was no significant difference in all the indexes between two groups before treatment(P>0.05).After treatment,the GCS score(|t|>16.000,P<0.001),CRS-R score(|t|>14.318,P<0.001)and N20 amplitude of SSEP(|t|>5.247,P<0.05)improved,the EEG grading was reduced(Z>2.264,P<0.05),and the N20 latency of SSEP was shortened(|t|>2.884,P<0.05)in both UWS/VS and MCS type patients in the observation group;and they were better in the observation group than in the control group for the same type(|t|>1.883,|Z|>2.244,P<0.05).Conclusion ta-VNS can significantly promote the awakening of patients with p Do C from UWS/VS and MCS,and improve the functional status of electroencephalogram activities and sensorimotor conduction pathways.

关 键 词：慢性意识障碍 耳迷走神经电刺激 针法 

分 类 号：R741.041[医药卫生—神经病学与精神病学]