摘要
目的:探讨右正中神经刺激对创伤性颅脑损伤所致意识障碍的临床疗效及对预后的影响。方法:将入选的92例患者按照随机数字表分为对照组和试验组,每组46例。对照组采用常规促醒疗法,试验组在对照组的基础上联合右正中神经刺激治疗。比较2组治疗前后神经递质水平、脑血流动力学、临床评分、不良反应和预后情况。结果:治疗前2组神经递质水平、脑血流动力学、临床评分比较差异无统计学意义(P>0.05);治疗后2组去甲肾上腺素(NE)、多巴胺(DA)、平均血流速度(VM)、血流流动速度(VS)、脑电图(EEG)评分、听觉脑干诱发电位(ABR)、格拉斯哥昏迷量表(GCS)均上升(P<0.05),试验组均高于对照组(P<0.05);2组β-内啡肽(β-EP)、搏动指数(PI)均下降(P<0.05),且试验组低于对照组,2组比较差异均有统计学意义(P<0.05)。2组不良反应发生率比较差异无统计学意义(P>0.05)。试验组预后情况优于对照组(P<0.05)。结论:右正中神经刺激对创伤性颅脑损伤所致意识障碍患者有积极的促醒作用,可调节神经递质释放,改善脑血流量和脑电活动,降低致残率。
Objective:To investigate the clinical effect of right median nerve stimulation on consciousness disorder caused by traumatic brain injury and its influence on prognosis.Methods:A total of 92 patients were divided into control group and experimental group according to random number table method,with 46 cases in each group.The control group was given conventional wake-up promotion therapy,while the experimental group was given right median nerve stimulation therapy on the basis of that in the control group.The levels of neurotransmitters,cerebral hemodynamics,clinical scores,adverse reactions and prognosis before and after treatment were compared between the two groups.Results:Before treatment,there was no significant difference in neurotransmitter level,cerebral hemodynamics and clinical score between the two groups(P>0.05).After treatment,norepinephrine(NE),dopamine(DA),mean blood flow velocity(VM),blood flow velocity(VS),electroencephalogram(EEG)score,auditory brainstem response(ABR),and Glasgow Coma Scale(GCS)increased in both groups(P<0.05),and the above indexes in the experimental group were higher than those in the control group(P<0.05).The β-endorphin(β-EP)and pulsatility index(PI)of the two groups decreased(P<0.05),while that of the experimental group was lower than that of the control group,with statistically significant difference(P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).The prognosis of the experimental group was better than that of the control group(P<0.05).Conclusion:Right median nerve stimulation has a positive wake-up promoting effect on patients with consciousness disorders caused by traumatic brain injury.It can regulate neurotransmitter release,improve cerebral blood flow and brain electrical activity,and reduce disability rate.
作者
赵坤
刘爱贤
ZHAO Kun;LIU Aixian(Beijing Rehabilitation Hospital,Capital Medical University,Beijing 100144,China)
出处
《康复学报》
CSCD
2020年第3期192-196,共5页
Rehabilitation Medicine
基金
中央级公益性科研院所基本科研业务费专项资金项目(2015CZ-4)
首都医科大学附属北京康复医院2019-2021年科技发展临床研究培育专项-青年项目类(2019-027)。
关键词
创伤性颅脑损伤
意识障碍
右正中神经刺激
预后
traumatic brain injury
awareness disorder
right median nerve stimulation
prognosis
