脑电仿生电刺激结合醒脑开窍针法对持续植物状态患者脑影像结构和血流量的影响

关键词：持续植物状态  脑电仿生电刺激  醒脑开窍针法  弥散张量成像  动脉质子自旋标记

Keywords:persistent vegetative state  electroencephalograph bionic electrical stimulation  Xingnao Kaiqiao acupuncture  diffusion tensor imaging  arterial proton labeling

摘要：

      摘要 目的：观察持续植物状态（PVS）患者采取脑电仿生电结合醒脑开窍针法刺激后弥散张量成像（DTI）、动脉质子自旋标记（ASL）变化，为临床治疗PVS提供可行性方案。 方法：按照随机数字表将90例PVS患者分为3组：脑仿生电刺激组（仿生电组）、醒脑开窍针法组（针刺组）和脑电仿生电刺激结合醒脑开窍针法组（联合组）3组，各30例。仿生电组在常规治疗的基础上，采用脑电仿生电刺激治疗，主电极置于天柱穴和完骨穴，每次治疗为连续刺激99min，间歇30min，再刺激99min，每日1次，连续治疗30d；针刺组在常规治疗的基础上，采用醒脑开窍针法治疗，每日1次，连续治疗30d；联合组在常规治疗的基础上，接受脑电仿生电刺激结合醒脑开窍针法治疗，连续治疗30d。选用昏迷恢复量表修订版（CRS-R）疗效评分量表记录评估开始治疗前1d及结束治疗后1d的意识障碍变化，并观察记录DTI额枕束各向异性分数（FA）和ASL丘脑、额叶感兴趣区脑血流（CBF）值。 结果：3组CRS-R量表评分、FA值、CBF值分比较，治疗前3组间差异无显著性意义（P>0.05）；3组治疗后较治疗前差异均有显著性意义（P<0.05），针刺组与仿生电组治疗后比较，差异无显著性意义（P>0.05）；针刺组、仿生电组与联合组治疗后比较，联合组较针刺组、仿生电组差异有显著性意义（P<0.05）。 结论：脑电仿生电刺激结合醒脑开窍针法可显著提高临床促醒疗效，在一定程度上可改善脑影像结构和血流量。

Abstract:

      Abstract Objective: To observe the changes of magnetic resonance spectroscopy 、diffusion tensor imaging and arterial proton spin labeling in patients with persistent vegetative state (PVS)， and to provide the feasible program for clinical treatment of persistent vegetative state. Method:Ninety patients of PVS were divided into 3 groups with 30 cases in each group，including electroencephalograph bionic electrical stimulation group (bionic electricity group)， Xingnao Kaiqiao acupuncture group (acupuncture group)， and electroencephalograph bionic electrical stimulation combined with Xingnao Kaiqiao acupuncture group (commbined group) according to the random number table. All groups were given routine treatment， including basic management， hyperbaric oxygen therapy， awakening drugs， sensory stimulation， etc. Bionic Electricity group， on the basis of conventional treatment， received electroencephalograph bionic electrical stimulation.The main electrodes were placed in GB12 and BL10.Each treatment lasted for a continuous 99 min followed by a rest of 30min and another 99min treatment，and 30d was a course of treatment. For acupuncture group，on the basis of conventional treatment，Xingnao Kaiqiao acupuncture method was used once a day with a 30d course of treatment. In combined group，on the basis of conventional treatment，the patients received electroencephalograph bionic electrical stimulation combined with Xingnao Kaiqiao acupuncture for a 1 month course of treatment. The CRS-R efficacy rating scale was used to evaluate the changes in consciousness disorder at the first day before treatment and the first day after treatment，and brain imaging indicators including DTI and ASL were observed and recorded . Result: The CRS-R scale scores of the combined group were significantly better than those of the acupuncture group and the biomimetic group (P<0.05). The combined group was significantly better than the acupuncture group and bionic electricity group in improving DTI and ASL (P<0.05). Conclusion: Electroencephalograph bionic electrical stimulation combined with Xingnao Kaiqiao acupuncture can significantly improve the clinical effect of awakening， and improve cerebral imaging structure and blood flow to some extent.