正中神经电刺激对脑外伤后昏迷促醒治疗的参数研究

Parameters of Median Nerve Electrical Stimulation for Coma after Traumatic Brain Injury

目的探讨正中神经电刺激促进脑外伤后昏迷患者觉醒的最佳治疗参数。方法 2013年至2015年,本院161例颅脑外伤患者随机分为对照组(n=40)、实验1组(n=41)、实验2组(n=39)和实验3组(n=41)。对照组使用常规促醒方法;实验组在此基础上加用正中神经电刺激治疗。参数设置:实验1组200μs,30 Hz;实验2组200μs,100 Hz,实验3组200μs,50 Hz。每次60min,每天2次,30 d为1个疗程,共治疗3个疗程。治疗前、治疗30 d和治疗结束后分别比较格拉斯哥昏迷量表(GCS)和改良国际昏迷恢复量表(CRS-R)得分。结果治疗30 d和治疗后,各组在GCS评分、CRS-R评分、治疗次数、清醒人数、昏迷时间有非常显著性差异(P<0.01);实验各组均优于对照组(P<0.05),实验1组与实验2组间无显著性差异(P>0.05),实验3组优于实验1组和实验2组(P<0.05)。结论正中神经电刺激治疗参数为波宽200μs、频率50 Hz时,能更好更早地促进患者的苏醒。

Objective To compare the effects of median nerve electrical stimulation on coma patients after traumatic brain injury with different settings. Methods From 2013 to 2015, 161 patients with traumatic brain injury were randomly divided into control group（n=40）,experimental group 1（n=41）, experimental group 2（n=39） and experimental group 3（n=41）. The control group received routine consciousness-promoted methods, and the experimental groups received median nerve electrical stimulation with 200 μs and 30 Hz, 100 Hz and 50 Hz in sequence, 60 minutes a day for 90 days. They were assessed with Glasgow Coma Scale（GCS） and Coma Recovery Scale- Revised（CRS-R） before, 30 days and 90 days after treatment. Results There was significant difference in the scores of CCS and CRS-R, times of treatment, number of sobered patients and coma time among groups（P〈0.01）, that the experimental groups were better than the control group（P〈0.05）, and no significant difference was found between the experimental groups 1 and 2（P〉0.05）. The experimental group 3 was better than the experimental groups 1 and 2（P〈0.05）. Conclusion Median nerve electrical stimulation with 200 μs, 50 Hz could promote coma patients to wake up optimally.