早期右正中神经刺激对颅脑外伤昏迷患者促醒作用的临床观察

Clinical observation of the short-term arousal effect of early right median nerve electrical stimulation on coma patients with traumatic brain injury

目的探讨早期右侧正中神经电刺激对颅脑外伤后昏迷患者的短期促醒作用以及长期临床疗效和价值。方法 126例颅脑外伤后昏迷患者随机分为治疗组(n=63)和对照组(n=63)。对照组按常规治疗;治疗组在常规治疗基础上加用右侧正中神经刺激治疗,每次治疗时间30分钟,每天3次,连续治疗4周。在4周治疗开始前及结束后分别对两组患者行GCS评分及脑电图检查。4周治疗结束后继续随访6个月,6个月后再次评估患者意识状态,并对意识恢复的患者进行FCA评估。结果经过4周右侧正中神经刺激治疗,治疗组患者GCS评分及EEG分级均较治疗前明显改善,具有显著的统计学差异(P<0.05),同时治疗后治疗组患者的GCS评分及EEG分级显著优于对照组(P<0.05)。随访6月后,对照组有更多患者恢复意识,与对照组具有显著统计学差异(68.42%vs 49.09%,P=0.038),同时恢复意识的患者中,治疗组患者的FCA评分明显高于对照组(P<0.01)。结论右正中神经刺激疗法应用于颅脑外伤后昏迷患者不仅能够在短期内达到促醒效果,且对于患者长期的预后以及生活质量的提高均具有显著疗效。

Objective To investigate the short-term arousal effect of early fight median nerve electrical stimulation on coma patients with traumatic brain injury and observe its long-term clinical efficacy and value. Methods 126 coma patients with traumatic brain injury were randomly divided into treatment group （n=63）and control group （n=63）. The control group received conventional treatment,and the treatment group received fight median nerve stimulation for 4 weeks. Glasgow Coma Score（GCS）and electroencephalogram（EEG）were taken on two groups,before and after treatment. After 6 months,for those patients who were conscious,the functional comprehensive assessment （FCA）instrument was used to assess the recovery of functional ability. Results After 4 weeks of treatment,the GCS and EEG grading of the treatment group were significantly improved （P〈0.05）, and were significantly better than those of the control group（P〈0.05 ）. After 6 months of follow-up ,more patients regained consciousness in the control group,with a statistically significant difference from the control group （68.42% vs 49.09% ,P=0.038）,and FCA scores were significantly higher in the treatment group（P〈0.01 ）. Conclusion For coma patients with traumatic brain injury ,fight median nerve stimulation therapy can not hasten the awakening of coma patients in a short time,but also ean significantly improve the quality of life and improve the prognosis of patients for a long time.