摘要
目的探讨脑深部电刺激（DBs）和脊髓电刺激（scs）,O经调控治疗对持续性植物状态患者的促醒作用。方法自2011年7月至2012年12月北京军区总医院共收治持续性植物状态患者53例，筛选后人组42例。其中男27例，女15例；平均（42．9~5．47）岁。按照患者病情及家属意愿将其分为对照组20例，手术组22例。其中手术组采用DBS治疗5例，SCS治疗17例；对照组接受手术外的常规康复治疗。采用改良的昏迷恢复量表（CRS—R1作为评估手段，部分患者接受功能磁共振（舢RI）做进一步评估。结果入组时2组患者性别、年龄、患病时间及意识评定差异无统计学意义（胗O．05）。获得随访37例（对照组17例，手术组20例），平均随访11．2月。手术组患者7例获得意识恢复，促醒率为35％；对照组1例患者获得意识恢复，促醒率为5．9％，差异有统计学意义（P〈0．05）。且手术组患者CRS—R量表评定结果明显优于对照组，差异有统计学意义（P〈0．05）；DBS与SCS治疗患者间CRS—R评分差异无统计学意义（p0．05）。fMRI结果提示，静息态默认网络中关键脑区激活及功能连接程度与临床评定具有较好的一致性。结论神经调控治疗能有效促进PVS患者的意识恢复，DBS与SCS之间未发现疗效差异。
Objective To investigate the effect of neruomodulation treatment, including deep brain stimulation （DBS） and spinal cord stimulation （SCS）, on patients under persistent vegetative state （PVS）. Methods Fifty-three patients diagnosed as having PVS, admitted to our hospital fi＇om July 2011 to December 2012, were chosen in our study; after selection, 42 patients were enrolled （27 males and 15 females, mean 42.9~5.47 years old） and prospectively divided into control group （n=20） and surgical group （n=22）. Patients fi＇om surgical group received DBS （n=5） and SCS （n=17） treatments, while patients from control group underwent routine rehabilitation activities. Behavioral assessments were repeatedly performed using Revised Coma-Recovery Scale （CRS-R）. Some patients underwent functional magnetic resonance imaging （fiVIRI） to further assess the outcomes. Clinical baseline values were collected and compared to follow-up data. Results No statistical significant differences of age, duration of coma and CRS-R scores were noted between the two groups before treatment. Thirty-seven patients （17 in control group and 20 in surgical group） got follow-up for 6-24 months （median 11.2 months）; seven patients in the surgical group emerged from PVS to achieve consistent discernible behavioral evidence of consciousness with a recovery rate of 35 % （7/20）, while only 1 from the control group with a recovery rate of 5.9%（1/17）; significant difference was noted between the two groups （P〈0.05）. Improvement in behavioral assessments （CRS-R scores） in the surgical group was significantly better than that in the control group （P〈0.05）; however, no significant difference of CRS-R scores was noted between patients received DBS and SCS treatment （P〉0.05）. The fMRI showed good consistency of activation of resting state default network key area and function connected degree with clinical assessment. Conclusion Neuromodulation therapy can effectively promote awareness of
出处
《中华神经医学杂志》
CAS
CSCD
北大核心
2013年第12期1197-1200,共4页
Chinese Journal of Neuromedicine
关键词
持续性植物状态
神经调控
脑深部电刺激
脊髓电刺激
Persistent vegetative state
Neuromodulation
Deep brain stimulation
Spinal cord stimulation
