右正中神經電刺激對高血壓腦出血后昏迷患者早期促醒治療的研究

陳加富　陳新生

摘 要：目的 探討早期右正中神經電刺激對于高血壓腦出血后昏迷患者的促醒效果以及對其遠期康復的影響。方法 選擇2016年1月～2018年6月安徽醫科大學附屬安慶醫院收治的高血壓腦出血性昏迷患者41例，按照隨機數字表法分為對照組（n=20）和實驗組（n=21），對照組給予常規臨床治療，實驗組在此基礎上增加右正中神經電刺激治療。通過比較兩組患者治療前后的腦電圖（EEG）評分、格拉斯哥昏迷量表（GCS）、殘疾分級量表（DRS）評分、NICU住院日以及6個月時兩組患者的蘇醒率，了解早期右正中神經電刺激對于高血壓腦出血性昏迷患者的療效。結果 在接受不同治療措施后，實驗組NICU住院日低于對照組，6個月的蘇醒率高于對照組，兩組間差異有統計學意義（P<0.05）；在治療后的不同時間維度，實驗組的EEG評分，GCS評分，DRS評分均優于對照組，差異有統計學意義（P<0.05）。結論 右正中神經電刺激治療可提高HICH昏迷患者蘇醒率，減少NICU平均住院日，改善患者預后，提高生存質量。該方案經濟有效，操作簡便，作為一種早期臨床輔助促醒治療措施，值得臨床借鑒應用。

關鍵詞：右正中神經電刺激；高血壓腦出血；昏迷；促醒；腦電圖評分

中圖分類號：R651.1+2 文獻標識碼：A DOI：10.3969/j.issn.1006-1959.2018.22.023

文章編號：1006-1959（2018）22-0085-04

Study of the Clinical Effect of the Early Right Median Nerve Electrical Stimulation to Hypertensive Intracerebral Hemorrhage-induced Coma

CHEN Jia-fu，CHEN Xin-sheng

（Department of Neurosurgery，Anqing Hospital Affiliated to Anhui Medical University，Anqing 246003，Anhui，China）

Abstract：Objective To investigate the effect of early right median nerve stimulation on the recovery of coma patients after hypertensive intracerebral hemorrhage and the effect on its long-term rehabilitation.Methods From January 2016 to June 2018， 41 patients with hypertensive hemorrhagic coma were selected from Anqing Hospital affiliated to Anhui Medical University and were divided into two groups： control group（n=20） and experimental group（n=21） according to the method of random number table.The control group was treated with routine clinical therapy， and the experimental group was treated with right median nerve stimulation on this basis.By comparing the electroencephalogram （EEG） scores before and after treatment in the two groups， the Glasgow Coma Scale （GCS）， the Disability Rating Scale （DRS） score， the NICU hospitalization day， and the awake rate of the two groups of patients at 6 months， The effect of right median nerve stimulation on patients with hypertensive cerebral hemorrhagic coma.Results After receiving different treatment measures， NICU in the experimental group was lower than that in the control group， and the recovery rate in 6 months was higher than that in the control group，the difference between the two groups was statistically significant（P<0.05）.The scores of EEG， GCS and DRS in the experimental group were better than those in the control group in different time dimensions after treatment，the difference between the two groups was statistically significant（P<0.05）.Conclusion Right median nerve electrical stimulation can improve the recovery rate of HICH coma patients， reduce the average hospitalization days of NICU patients， improve the prognosis of patients and improve the quality of life.The measurement is economical， effective and easy to operate. As an early clinical assistant therapy， it is worthy of clinical reference.

Key words：Right median nerve stimulation；Hypertensive cerebral hemorrhage；Coma；Wakefulness； EEG score

高血壓性腦出血（hypertensive intracerebral hemorrhage，HICH）是我國第一大致死性疾病腦卒中的主要病因，其發病率在65～74歲人群中高達295/10萬[1]，且發病年齡呈年輕化趨勢，是神經外科急診中最常見的疾病之一。無論是內科保守治療，傳統的開顱手術，還是近些年流行的微創手術，多數患者在治療早期處于昏迷狀態，部分患者經治療后呈最小意識狀態（minimally conscious state，MCS）或長期植物生存狀態[2]。如何有效的使HICH昏迷患者早日清醒，仍是神經外科領域的研究方向之一。HICH患者昏迷狀態的治療早期在NICU，多接受心電監測，呼吸機以及藥物治療，患者不宜過多搬動，因此尋求適合于昏迷發生早期的促醒治理措施有極大的臨床意義。……