聯合電刺激對腦外傷后昏迷患者促醒的臨床療效觀察

陳琴 余晴 謝徐勇 程毛鋒 梅卉子 楊珊 余鴻斌

[摘要] 目的 探討正中神經電刺激（MNES）聯合經顱直流電刺激（tDCS）治療顱腦外傷（TBI）后昏迷患者的促醒療效。 方法 選取2017年6月至2019年6月九江市第一人民醫院康復醫學科和神經外科腦外傷后昏迷患者52例，按照隨機數字表法隨機分為聯合組和對照組，每組各26例。對照組患者接受常規康復治療方法，聯合組在對照組的基礎上給予MNES和tDCS，共治療4周。采用格拉斯哥昏迷量表（GCS）、格拉斯哥預后量表（GOS）、殘疾評定量表（DRS）、腦干聽覺誘發電位（BAEP）和上肢體感誘發電位（USEP）評估，并對兩組臨床療效進行分析比較。 結果 治療后，兩組患者GCS評分均高于治療前，差異有統計學意義（P<0.05）;且聯合組GCS評分高于對照組，差異有統計學意義（P<0.05）;治療后，聯合組GOS評分明顯高于對照組，差異均有統計學意義（P<0.05）;治療后，兩組患者DRS評分均較治療前降低，差異有統計學意義（P<0.05），且聯合組治療后DRS評分低于對照組，差異有統計學意義（P<0.05）;治療后，兩組患者BAEP、USEP評分均高于治療前，差異有統計學意義（P<0.05），且聯合組治療后BAEP、USEP評分高于對照組，差異有統計學意義（P<0.05）;治療后，聯合組總有效率為88.46%，顯著高于對照組的65.38%，差異有統計學意義（P<0.05）。 結論 常規康復治療能提高TBI后昏迷患者的意識水平，改善預后，在此基礎上，增加MNES聯合tDCS的干預方案治療效果更顯著，具有一定的臨床推廣價值。

[關鍵詞] 經顱直流電刺激;正中神經電刺激;顱腦外傷;昏迷;促醒

[中圖分類號] R742? ? ? ? ? [文獻標識碼] B? ? ? ? ? [文章編號] 1673-9701（2021）24-0117-05

Observation on the clinical efficacy of combined electrical stimulation on awakening promotion of coma patients after traumatic brain injury

CHEN Qin1? ?YU Qing1? ?XIE Xuyong1? ?CHENG Maofeng2? ?MEI Huizi1? ?YANG Shan1? ?YU Hongbin1

1.Department of Rehabilitation Medicine， Jiujiang No.1 People′s Hospital in Jiangxi Province， Jiujiang? ?332000， China; 2.Department of Neurosurgery，Jiujiang No.1 People′s Hospital in Jiangxi Province， Jiujiang? ?332000， China

[Abstract] Objective To investigate the therapeutic efficacy of median nerve electrical stimulation（MNES） combined with transcranial direct current stimulation（tDCS） on awakening promotion of coma patients after traumatic brain injury（TBI）. Methods A total of 52 coma patients after TBI admitted to the department of rehabilitation and neurosurgery， Jiujiang first people′s Hospital， from June 2017 to June 2019 were selected and divided into the combined group（n=26） and the control group（n=26） according to the random number table method. Patients in the control group were treated with conventional rehabilitation therapy， while those in the combined group were treated with MNES and tDCS on the basis of the control group for totally 4 weeks. Glasgow coma scale（GCS）， Glasgow outcome scale（GOS）， disability rating scale（DRS）， brainstem auditory evoked potential（BAEP） and upper limb somatosensory evoked potential（USEP） were adopted and evaluated， and the clinical efficacy of the two groups were analyzed and compared. Results After treatment， the GCS scores of patients in both groups were higher than before treatment， with statistically significant difference（P<0.05）. Meanwhile， the GCS score of the combined group was higher than that of the control group， with statistically significant difference（P<0.05）. After treatment， the GOS score of the combined group was significantly higher than that of the control group， with statistically significant difference（P<0.05）. After treatment， the DRS scores of patients in both groups were lower than those before treatment，with statistically significant difference（P<0.05）， and the DRS score of the combined group was lower than that of the control group，with statistically significant difference（P<0.05）. After treatment， BAEP and USEP scores of patients in the two groups were higher than before treatment， with statistically significant difference（P<0.05）， and BAEP and USEP scores of the combined group were higher than those of the control group，with statistically significant differences（P<0.05）. After treatment， the overall response rate of the combined group was 88.46%， which was significantly higher than that of 65.38% of the control group， with statistically significant difference（P<0.05）. Conclusion Conventional rehabilitation treatment can boost the consciousness level of coma patients after TBI and improve the prognosis. On this basis， the intervention scheme of MNES combined with tDCS has more significant therapeutic efficacy， which is worthy of clinical promotion to a certain extent.