高颈段脊髓电刺激治疗重度意识障碍的疗效分析

Efficacy analysis of high cervical spinal cord stimulation for severe consciousness disturbance

目的探讨高颈段脊髓电刺激(spinal cord stimulation,SCS)对重度意识障碍病人的促醒疗效。方法回顾性分析22例重度意识障碍病人的临床资料,其中植物状态8例,最小意识状态14例。病人在原发病急性期后3个月接受电生理评估,15例病人在满足电生理评估标准后接受高颈段SCS治疗,余9例未接受治疗。结果所有病人随访9个月,接受SCS治疗的15例病人中清醒9例,GOS评分:轻度残疾2例,中度残疾2例,重度残疾5例;刺激后脑血流量较刺激前增加了36.6%(t=2.775,P<0.05)。未接受SCS治疗的病人均未清醒。结论高颈段SCS是治疗重度意识障碍病人较为适合的方法。

Objective To explore the awakening effects of high cervical spinal cord stimulation （SCS） on patients with severe consciousness disturbance （SCD）. Methods Clinical data of 22 SCD patients were analyzed retrospectively, including 8 patients in the vegetative state and 14 in the minimally conscious state. All the patients underwent electrophysiological evaluation 3 months after acute period of primary disease. Fifteen patients including 4 patients in the vegetative state and 11 in the minimally conscious state satisfied the criteria of electrophysiological evaluation and received high cervical SCS. The remaining 9 patients did not receive SCS. Results All the patients were followed-up for 9 months, 9 out of patients undergoing SCS waked up and the GOS results were mildly disabled in 2, moderately disabled in 2 and severely disabled in 5. Compared with cerebral blood flow before SCS, the cerebral blood flow of above 9 patients increased by 36.6% after SCS （t = 2.775, P 〈 0.05）. The patients who did not receive SCS remained in consciousness disturbance state. Conclusion High cervical SCS is a proper method for the treatment of SCD.