正中神经电刺激对脑外伤后昏迷患者促醒作用的临床及机制研究

关键词：脑外伤  正中神经电刺激  昏迷  促醒

Keywords:traumatic brain injury  median nerve electrical stimulation  coma  wake promoting

摘要：

      摘要 目的：探讨正中神经电刺激（median nerve electrical stimulation，MNS）对脑外伤（traumatic brain injury，TBI）后昏迷患者的促醒作用及可能机制。 方法：将60例脑损伤后昏迷患者随机分为试验组（n=30）和对照组（n=30），两组均给予常规促醒治疗，试验组在常规治疗的基础上加用MNS治疗。两组治疗前后均行格拉斯哥昏迷评分（Glasgow coma scale,GCS）和脑电图（electroencephalograph，EEG）及单光子发射计算机化断层显像（SPECT）检查。 结果：治疗4W后试验组平均GCS评分明显优于对照组，差异有显著性意义(P＜0.05)；试验组脑电图病灶侧δ/θ活动减少，α波波幅降低；SPECT视觉分析表明治疗后试验组病灶区脑血流量较治疗前明显增加，半定量分析显示病灶区（右ROI—左ROI）/右ROI%也较治疗前平均提高12.34%±0.36%，差异有显著性意义(P＜0.05)。 结论：MNS对TBI后昏迷患者具有促醒作用，其机制可能与病灶区脑血流灌注增加有关。

Abstract:

      Abstract Objective: To investigate the arousal effect of median nerve electrical stimulation(MNS) on traumatic brain injury(TBI) induced coma. Method: 60 patients with coma after TBI were randomly divided into two groups: the experimental group (n=30) and the control group (n=30). The two groups were given conventional awakening treatment, but the experimental group with extra MNS. Glasgow coma scale(GCS), electroencephalograph（EEG）and single photon emission computed tomography（SPECT）were taken on two groups, before and after treatment. Result: After 4 weeks treatment, average score of GCS in the experimental group is better than average score of the control group, the difference is statistically significant (P<0.05)。EEG shows that δ/θ wave and α wave amplitudes decrease in injured side of patients in the experimental group, SPECT visual analysis indicates that blood flow in ischemia area increases significantly than before treatment, semi-quantitative analysis displays that (right ROI－left ROI ) / right ROI increases by 12.34%±0.36% comparing with before treatment. The difference is statistically significant (P<0.05). Conclusion: MNS treatment plays predominant role in awakening in patients with TBI induced coma. Its mechanism may be related to increasing blood flow in ischemia area blood flow increased.