严重意识障碍患者对唤名和音乐刺激的脑电反应研究

EEG Response to Patient's Own Name and Music in Severe Disorders of Consciousness

唤名和音乐刺激是目前临床上严重意识障碍患者促醒的常用方法之一,研究唤名和音乐等不同声音刺激下的脑电响应机制,对临床上促醒治疗具有重要意义。采集严重意识障碍患者样本33例,分别采集患者在唤自名、唤他名和音乐刺激前后的脑电数据,利用小波变换的方法求取刺激后60 s和刺激前60 s安静状态下的小波能量值,统计分析3种声音刺激前后的脑电小波能量的比值差异性,以比较3种不同声音刺激下最小意识状态(MCS)和植物状态(VS)意识障碍患者的脑电响应。结果显示:MCS患者在唤自名刺激下,刺激前后脑电能量变化的平均值为3.839,高于唤他名刺激下的1.609(P<0.05 vs唤自名)和音乐刺激下的1.937(P<0.05 vs唤自名);VS患者在唤自名刺激下,刺激前后脑电能量变化的平均值2.873,高于唤他名刺激下的1.443(P<0.05 vs唤自名)和音乐刺激下的1.263(P<0.05 vs唤自名)。结论表明,严重意识障碍患者对唤自名刺激的脑电响应程度大于对音乐和唤他名刺激的脑电响应,MCS患者对声音刺激的反应整体要大于VS对刺激的反应,该研究为临床上对严重意识障碍患者实施唤自名刺激的合理性提供了理论依据。

Patient＇s own name and music stimulations are the most commonly used means in clinical awaking therapy for patients in vegetative state （VS） and minimally conscious state （MCS）. Therefore, to explore the mechanism of patient＇s brain EEG response to those different sound stimulations is of great value in clinical practice. In this paper, to compare the EEG responses to the different sound stimulations in the vegetative and minimally conscious states, 33 patients with severe consciousness disorder were selected in the study. Changes of EEG＇s wavelet energy value before and after the stimulations lasting 60 s were calculated and statistically analyzed using wavelet transform method under 3 different sounds stimulations. Results showed that for MCS state, EEG energy change under patient＇ s own name stimulation （ mean value was 3. 839） was greater than both other subject＇ s name stimulation （ mean value was 1. 609 with P 〈 0.05 vs patient＇ s own name ） and Chinese classical music stimulation （mean value was 1. 937 with P 〈 0. 05 vs patient＇ s own name） ; for VS state, it was also showed that EEG energy change under patients＇ s own name stimulation （mean values was 2. 873 ） was greater than other subject＇ s name stimulation（mean value was 1. 443 with P 〈0. 05 vs patient＇ s own name） and Chinese classical music stimulation （ mean value was 1. 263 with P 〈 0.05 vs patient＇ s own name）. In conclusion, patients in MCS state or VS state, EEG energy change under patient＇ s own name stimulation was greater than other subject＇ s name stimulation and Chinese classical music stimulation; Patients in MCS state produced a greater EEG response than those in VS state under the sound stimulations. This study provided a experimental foundation for the clinical awaking therapy by means of patient＇s own name and music stimulations for patients in the vegetative and minimally conscious states.