神经反馈训练对缺血缺氧性脑病患者床旁连续脑电监测相对α变异评分与超声测定神经鞘直径的影响  

Effect of neurofeedback training on relativeαvariant score monitored by bedside continuous electroencephalography and optic nerve sheath diameter evaluated by ultrasound in patients with ischemic hypoxic encephalopathy

作　　者：孙杰[1] 万健[1] Sun Jie;Wan Jian(Department of Emergency and Critical Care Medicine,Shanghai Pudong New Area People's Hospital,Shanghai 201200,China)

机构地区：[1]上海市浦东新区人民医院急诊与重症医学科,上海201200

出　　处：《中华危重病急救医学》2025年第1期65-69,共5页Chinese Critical Care Medicine

基　　金：上海市浦东新区卫生计生科研项目(PW2021A-11)。

摘　　要：目的探讨床旁连续脑电监测相对α变异评分与超声测定视神经鞘直径(ONSD)变化对缺血缺氧性脑病患者脑功能的评价,并观察神经反馈训练对患者脑功能的影响。方法采用前瞻性观察性研究方法,选择2021年1月至2023年12月上海市浦东新区人民医院急诊与重症医学科收治的符合缺血缺氧性脑病诊断标准、入院时格拉斯哥昏迷评分(GCS)≤8分且接受神经反馈训练的患者作为研究对象(观察组),同时选择同期入院时GCS评分≤8分且未接受神经反馈训练的缺血缺氧性脑病患者作为对照(对照组)。给予两组患者静脉滴注神经节苷酸联合脑活素治疗,该治疗方式以连续用药10 d作为1个疗程;观察组患者在此基础上给予视觉反馈、听觉反馈、冥想放松等神经反馈训练,持续14 d。应用床旁连续脑电监测相对α变异评分,应用超声测定ONSD;分别于神经反馈训练前和训练14 d检测脑电图5个通道的平均功率和慢波功率〔以慢波比(DTR)表示〕;比较两组外周血中性粒细胞/淋巴细胞比值(NLR)、汉密尔顿抑郁量表(HAMD)评分、美国国立卫生研究院卒中量表(NIHSS)评分、血浆5-羟色胺(5-HT)及脑源性神经营养因子(BDNF)水平。结果最终观察组共纳入60例患者,对照组共纳入50例患者;两组患者性别、年龄、病程等一般资料差异均无统计学意义。观察组患者ONSD及相对α变异评分均显著高于对照组〔ONDS(mm):5.59±0.42比3.23±0.34,相对α变异评分(分):2.28±0.39比0.83±0.28,均P<0.01〕。经过14 d的神经反馈训练,观察组患者脑电图5个通道平均功率和DTR值均较治疗前显著降低〔平均功率(μV^(2)/Hz):左额区1(Fp1)为95.35±3.61比102.58±4.23,前额区3(F3)为38.56±4.73比46.13±2.36,中央区3(C3)为34.33±5.87比51.71±4.65,F7为58.37±4.45比62.95±3.22,颞区3(T3)为45.23±2.41比54.14±2.45;DTR(μV^(2)/Hz):接地电极(GND)为75.21±11.34比84.12±11.35,参考电极(REF)为72.31±21.67Objective To approach the evaluation of relativeαvariant score monitored by bedside continuous electroencephalography and optic nerve sheath diameter(ONSD)evaluated by ultrasound in patients with ischemic hypoxic encephalopathy,and to observe the effect of neurofeedback training on brain function.MethodsA prospective observational study was conducted.The patients admitted to the emergency and intensive care department of Shanghai Pudong New Area People's Hospital from January 2021 to December 2023,who meet the diagnostic criteria of ischemic hypoxic encephalopathy with the Glasgow coma score(GCS)≤8 at admission receiving neurofeedback training were enrolled as the study object(observation group),and the patients without neurofeedback training and GCS score≤8 at admission were enrolled as the controls(control group).Both groups received intravenous neurotrophic therapy combining ganglioside and cerebrolysin for 10 days as one course of treatment.On this basis,the observation group additionally received continuous neurofeedback training including visual feedback,auditory feedback,meditation and relaxation for 14 days.Bedside continuous electroencephalography was used for monitoring relativeαvariation score,and ultrasound was used to determine ONSD.The average power and slow wave power[expressed as delta-theta ratio(DTR)]of five channels in electroencephalography before and 14 days after neurofeedback training were examined.The differences in peripheral blood neutrophil/lymphocyte ratio(NLR),Hamilton depression scale(HAMD)score,National Institutes of Health stroke scale(NIHSS)score,plasma levels of 5-hydroxytryptamine(5-HT)and brain-derived neurotrophic factor(BDNF).ResultsA total of 60 patients were enrolled in the observation group and 50 patients in the control group finally.There was no significant difference in gender,age or course of disease between the two groups.The ONSD and relativeαvariant score in the observation group were significantly higher than those in the control group[ONDS(mm):5.59±0.42 vs

关 键 词：局部脑电图 视神经鞘直径 重复颅磁刺激 慢波功率 

分 类 号：R743[医药卫生—神经病学与精神病学]