《中国康复理论与实践》

《中国康复理论与实践》 ›› 2023, Vol. 29 ›› Issue (8): 940-947.doi: 10.3969/j.issn.1006-9771.2023.08.011

• 应用研究 • 上一篇    下一篇

经颅磁刺激联合正中神经电刺激干预不同年龄段慢性意识障碍的效果

蒙象强1, 熊琪1, 陈庚发2, 白洋1, 邹田子1, 冯珍1()   

  1. 1.南昌大学第一附属医院，江西南昌市 330006
    2.南昌大学，江西南昌市 330006
  • 收稿日期:2023-08-07 修回日期:2023-08-14 出版日期:2023-08-25 发布日期:2023-10-09
  • 通讯作者: 冯珍 E-mail:fengzhenly@sina.com
  • 作者简介:蒙象强(1998-)，男，汉族，江西赣州市人，硕士研究生，主要研究方向：神经重症康复。
  • 基金资助:
    国家自然科学基金项目(82160437);国家重点研发计划项目(2020YFC2002904);江西省卫生健康委员会科技计划项目(202130145);江西省重点研发计划项目(20202BBG72002)

Effect of repetitive transcranial magnetic stimulation combined with median nerve electrical stimulation on patients with prolonged disorders of consciousness in different age

MENG Xiangqiang1, XIONG Qi1, CHEN Gengfa2, BAI Yang1, ZOU Tianzi1, FENG Zhen1()   

  1. 1. The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, China
    2. Nanchang University, Nanchang, Jiangxi 330006, China
  • Received:2023-08-07 Revised:2023-08-14 Published:2023-08-25 Online:2023-10-09
  • Contact: FENG Zhen E-mail:fengzhenly@sina.com
  • Supported by:
    Natural Science Foundation of China(82160437);National Key Research and Development Program of China(2020YFC2002904);Science and Technology Planning Project of Jiangxi Provincial Health Commission(202130145);Key Research and Development Program of Jiangxi Province(20202BBG72002)

RichHTML

PDF (PC)

摘要：

目的 探讨经颅磁刺激(rTMS)联合正中神经电刺激(MNS)对不同年龄段慢性意识障碍(pDOC)患者的临床疗效。
方法 2021年1月至2023年5月，南昌大学第一附属医院康复医学科pDOC患者93例，根据年龄分为青年组(≤ 45岁)、中年组(46~60岁)和老年组(> 60岁)，同时给予rTMS和MNS，共4周。治疗前及每周治疗后，分别采用改良昏迷恢复量表(CRS-R)、格拉斯哥昏迷量表(GCS)、全面无反应性量表(FOUR)进行评定，并比较促醒有效率;治疗4周后，CT灌注成像测量局部脑血流量(CBF)。治疗结束后6个月，采用格拉斯哥结局扩展量表(GOS-E)进行评定。
结果 治疗3周后开始，各组CRS-R、GCS和FOUR评分均升高(P < 0.05)。每周治疗后，各组各种意识水平构成比、促醒有效率比较均无显著性差异(χ2 < 11.057, P > 0.05)。治疗4周后，各组双侧额叶、颞叶、枕叶、丘脑区等感兴趣区CBF均增加(|t| > 2.495, P < 0.05)，各组间比较均无显著性差异(F < 1.887, P > 0.05)。治疗结束后6个月，各组GOS-E评分比较无显著性差异(F = 3.083, P = 0.055)。
结论 rTMS联合MNS能够有效治疗不同年龄段的pDOC患者，老年人也能获得同样的疗效。

关键词: 慢性意识障碍, 重复经颅磁刺激, 正中神经电刺激

Abstract:

Objective To investigate the effect of combination with repetitive transcranial magnetic stimulation (rTMS) and median nerve electrical stimulation (MNS) on patients with prolonged disorders of consciousness (pDOC) in different age.
Methods From January, 2021 to May, 2023, 93 patients with pDOC in the First Affiliated Hospital of Nanchang University were divided into young group (≤ 45 years old), middle-aged group (46 to 60 years old) and elderly group (> 60 years old). All the groups were treated with rTMS and MNS for four weeks. The Coma Recovery Scale-Revised (CRS-R), Glasgow Coma Scale (GCS), and Full Outline of Unresponsiveness Scale (FOUR) were used to evaluate the efficiency of awakening after treatment and the awakening ratios were compared among three groups weekly. Four weeks after treatment, regional cerebral blood flow (rCBF) was measured with CT perfusion imaging. The score of Glasgow Outcome Scale Extended (GOS-E) was compared six months after treatment.
Results From three weeks after treatment, the scores of CRS-R, GCS and FOUR increased in all groups (P < 0.05). After weekly treatment, there was no significant difference in the composition ratio of consciousness level and the awakening ratio among three groups (χ2 < 11.057, P > 0.05). After four weeks of treatment, rCBF improved in three groups (|t| > 2.495, P < 0.05), however, there was no difference among three groups (F < 1.887, P > 0.05). There was no difference in the score of GOS-E at six months after treatment (F = 3.083, P = 0.055).
Conclusion rTMS combined with MNS is effective on pDOC patients in different ages, and elderly patients could also benefit from it.

Key words: prolonged disorder of consciousness, repetitive transcranial magnetic stimulation, median nerve electrical stimulation

中图分类号: