短时程脊髓电刺激与长时程脊髓电刺激治疗慢性意识障碍的临床疗效比较  

A Comparative Study on the Clinical Effects of Short⁃term and Long⁃term Spinal Cord Stimulation in Patients with Prolonged Disorders of Consciousness

作　　者：孙凤侨 牛弘川 杨艺 何江弘 赵元立 SUN Fengqiao;NIU Hongchuan;YANG Yi;HE Jianghong;ZHAO Yuanli(Department of Neurosurgery,Peking University International Hospital,Beijing 102206,China;Department of Neurosurgery,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China;Department of Neurosurgery,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100730,China)

机构地区：[1]北京大学国际医院神经外科,北京102206 [2]首都医科大学附属北京天坛医院神经外科,北京100070 [3]中国医学科学院北京协和医院神经外科,北京100730

出　　处：《协和医学杂志》2025年第2期307-313,共7页Medical Journal of Peking Union Medical College Hospital

摘　　要：目的比较短时程脊髓电刺激(short-term spinal cord stimulation,stSCS)与长时程脊髓电刺激(long-term spinal cord stimulation,ltSCS)对慢性意识障碍患者的治疗效果。方法回顾性纳入2020年1月—2021年12月于北京大学国际医院神经外科接受脊髓电刺激手术的慢性意识障碍患者临床资料,根据手术方式将患者分为stSCS组和ltSCS组。采用改良昏迷恢复量表(Coma recovery scale-revised,CRS-R)评估患者治疗前及治疗后3个月的意识状态水平,根据CRS-R评分将患者的临床诊断分为植物状态、微小意识状态(minimally conscious state,MCS)-、MCS+和脱离微小意识状态4个等级。以意识状态临床诊断分级的提升作为治疗有效的标准,比较stSCS组和ltSCS组疗效差异。结果44.8%的慢性意识障碍患者通过脊髓电刺激治疗后意识状态临床诊断分级有所提升。与术前相比,术后3个月stSCS组和ltSCS组CRS-R评分均显著提高(P均<0.05),且ltSCS组和stSCS组临床疗效无显著差异(P=0.613)。结论stSCS和ltSCS均可显著提高慢性意识障碍患者的意识水平,且stSCS可能能够取得与ltSCS相当的短期治疗效果。Objective To compare the therapeutic effects of short⁃term spinal cord stimulation(stSCS)and long⁃term spinal cord stimulation(ltSCS)on patients with prolonged disorders of consciousness(pDoC).Methods Clinical data of patients with pDoC who underwent SCS surgery at Peking University International Hospital from January 2020 to December 2021 were retrospectively included.Patients were divided into the stSCS group and the ltSCS group based on the surgical approach.The Coma recovery scale⁃revised(CRS⁃R)was used to assess the level of consciousness before and 3 months after SCS treatment.Based on CRS⁃R scores,the clinical diagnosis of the patient's level of consciousenss was categorized into four levels:vegetative state,minimally conscious state minus(MCS⁃),MCS plus(MCS+),and emergence from the minimally conscious state(EMCS).Improvement in the clinical diagnostic level of consciousness was defined as effective treatment,and the therapeutic outcomes of the stSCS and ltSCS groups were compared.Results 44.8%of patients with pDoC showed improvement in their clinical diagnostic level of consciousness after SCS treatment.Compared to preoperative scores,the CRS⁃R scores at 3 months postoperatively were significantly increased in both the stSCS and ltSCS groups(both P<0.05).However,there was no significant difference in clinical efficacy between the ltSCS and stSCS groups(P=0.613).Conclusions Both stSCS and ltSCS can significantly improve the level of consciousness in patients with pDoC.Compared to ltSCS,stSCS may achieve comparable short⁃term therapeutic outcomes.

关 键 词：慢性意识障碍 微小意识状态 植物状态 短时程脊髓电刺激 长时程脊髓电刺激 改良昏迷恢复量表 

分 类 号：R651[医药卫生—外科学] R454.1[医药卫生—临床医学]