摘要
背景脑干损伤是导致昏迷的重要原因,而昏迷促醒作为临床康复医学的重要课题备受关注。目前重复经颅磁刺激虽被证实对颅脑损伤后植物状态患者的促醒作用明显,但关于其用于脑干损伤致昏迷患者最合适频率的研究鲜有报道。目的探讨不同频率重复经颅磁刺激治疗脑干损伤致昏迷患者的促醒效果及安全性。方法选取2016年5月—2019年5月空军军医大学第一附属医院西京医院神经外科收治的脑干损伤致昏迷患者103例,根据不同频率重复经颅磁刺激分为低频率组49例和高频率组54例。两组患者入院后均行常规促醒治疗,低频率组患者采用10 Hz重复经颅磁刺激治疗,高频率组患者采用20 Hz重复经颅磁刺激治疗,两组患者均持续治疗10 d。比较两组患者治疗前后格拉斯哥昏迷量表(GCS)评分、脑干听觉诱发电位(BAEP)分级及脑电图(EEG)分级,并观察两组患者治疗期间不良反应发生情况。结果两组患者治疗前睁眼反应评分、运动反应评分、语言反应评分、GCS总分及治疗后睁眼反应评分比较,差异无统计学意义(P>0.05);高频率组患者治疗后运动反应评分、语言反应评分及GCS总分高于低频率组(P<0.05)。两组患者治疗前BAEP分级、EEG分级比较,差异无统计学意义(P>0.05);高频率组患者治疗后BAEP分级、EEG分级优于低频率组(P<0.05)。高频率组患者治疗期间不良反应发生率高于低频率组(P<0.05)。结论与10 Hz重复经颅磁刺激比较,20 Hz重复经颅磁刺激可更明显改善脑干损伤致昏迷患者的意识状态,提高促醒效果,但不良反应发生率较高,因此临床应结合患者的家族史、身体状况等因素合理选择治疗方案。
Background Brainstem injury is an important cause of coma.Wake-promoting in coma has been a wide concern as an important topic of clinical rehabilitation medicine.At present,repetitive transcranial magnetic stimulation(RTMS)has been proved to have a significant effect on arousing patients with vegetative state after brain injury,but there are few reports on the most appropriate frequency of its application in coma caused by brainstem injury.Objective To study the wakepromoting effect and safety of different frequencies of RTMS in patients with coma caused by brainstem injury.Methods One hundred and three cases of coma caused by brainstem injury from Department of Neurosurgery,Xijing Hospital,First Affiliated Hospital of Air Force Military Medical University from May 2016 to May 2019 were enrolled.All of them received a regular wakepromoting therapy plus a 10-day RTMS.According to the frequency of RTMS,they were divided into low-frequency(10 Hz)group(49 cases)and high-frequency(20 Hz)group(54 cases).The Glasgow Coma Scale(GCS)score,brainstem auditory evoked potential(BAEP)grade and EEG grade before and after treatment were compared between the two groups.The incidence of adverse reactions during treatment was observed.Results The average scale score of GCS and its subscale scores of eye opening,motor response,and verbal response showed no significant intergroup differences before treatment(P>0.05).After treatment,the average scale score of GCS and its subscale scores of motor response and verbal response increased more significantly in high-frequency group(P<0.05).But the average score of eye opening still showed no significant intergroup differences(P>0.05).No significant difference of BAEP or EEG grade distribution was found between the two groups before treatment(P>0.05).However,post-treatment BAEP grade and EEG abnormality grade distributions in high-frequency group were much better than those in low-frequency group(P<0.05).The incidence of adverse reactions in high-frequency group was higher than that in low-frequency group(P<0.05).Conclusion 20 Hz RTMS is superior to 10 Hz RTMS in terms of improving the state of consciousness and wake-promoting effect in patients with coma caused by brainstem injury,but with higher incidence of adverse reactions.Therefore,clinical treatment should be reasonably selected based on the family history,physical condition and other factors of the patient.
作者
魏莲
李妮
WEI Lian;LI Ni(Department of Neurosurgery,Xijing Hospital,First Affiliated Hospital of Air Force Military Medical University,Xi'an 710032,China)
出处
《实用心脑肺血管病杂志》
2020年第6期79-84,共6页
Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease
关键词
昏迷
脑损伤后
重复经颅磁刺激
昏迷促醒
安全性
Coma
post-head injury
Repeated transcranial magnetic stimulation
Coma-induced awakening
Safety
