神经电生理在持续植物状态患者颈髓电刺激疗法中的应用

Application of neurophysiology in electrical cervical spinal cord stimulation for persistent vegetative state

目的 探讨非创伤性颅脑损伤后持续性植物状态（PVS）患者多模式神经电生理（EEG、BAEP、SEP）的总评分与颈髓电刺激（cSCS）促醒治疗疗效的相关性.方法 回顾性分析2010年1月至2017年2月大庆油田总医院神经外科收治的48例cSCS促醒治疗的PVS患者（研究组）的临床资料、神经电生理评分、治疗1年后的疗效,并与同期保守促醒治疗50例患者（对照组）的临床资料、疗效进行对比分析.研究组多模式神经电生理总评分与cSCS促醒疗效的等级进行Spearman秩相关分析,观察二者的相关性.结果 促醒治疗1年后,研究组48例患者中脱离PVS18例（37.5％）,显效11例（22.9％）,好转10例（20.8％）,无效9例（18.7％）;对照组50例患者中脱离PVS 3例（6.0％）,显效4例（8.0％）,好转30例（60.0％）,无效13例（26.0％）.研究组和对照组疗效的Ridit分析显示,研究组R值=0.6077,对照组R值=0.3966,差异有统计学意义（P＜0.05）,cSCS促醒治疗的疗效优于保守促醒治疗.cSCS促醒疗效与神经电生理总评分进行Spearman秩相关分析显示,神经电生理总评分与cSCS促醒疗效呈显著的正向相关关系（rs =0.854,P＜0.05）,即神经电生理总评分越高,cSCS促醒的疗效越好.结论 （1）cSCS促醒技术可以促进神经功能的康复,提高脱离PVS的比率,有利于患者早期促醒PVS.（2）多模式神经电生理总评分与cSCS促醒疗效存在正相相关性,对临床选择cSCS促醒技术具有指导作用.

 Objective To investigate the correlation between the overall scores of multimodal neurophysiological methods [electroencephalography （EEG）,brainstem auditory evoked potential （BAEP）,somatosensory evoked potential （SEP）] and therapeutic effect of cervical spinal cord stimulation （cSCS） in patients with persistent vegetative state （PVS） resulting from non-traumatic brain injury.Methods A retrospective analysis was conducted on the clinical data,neurophysiological scores and 1-year outcomes of 48 PVS patients who underwent treatment of cSCS （study group） at Department of Neurosurgery,Daqing Oilfield General Hospital from January 2010 to February 2017.The results were compared with the clinical data and outcomes of 50 patients undergoing conservative resuscitating treatment （control group） during the same period.We investigated the relationship between multimodal neurophysiological scores and therapeutic effect of cSCS treatment by Spearman rank correlation analysis in the study group.Results In the study group,18 cases （37.5%） were resuscitated from PVS,11 cases （22.9%） reported obvious therapeutic effect.In the control group,3 cases （6.0%） were resuscitated from PVS,4 cases （8.0%） had obvious therapetuic effect at 1 year post treatment.The treatment effect was significantly different between study group （（R-） =0.6077） and control group （（R-） =0.3966） by Ridit analysis （P 〈 0.05）.The cSCS treatment demonstrated better therapeutic effect than conservative resuscitating treatment.The Spearman rank correlation analysis showed that there was a positive correlation between the cSCS efficacy and neurophysiological scores （rs =0.854,P 〈 0.05）,i.e.,higher overall neurophysiological scores indicated better therapeutic effect of cSCS.Conclusions （1） The cSCS awakening technology could promote neurological rehabilitation,improve the awakening ratio in PVS patients and facilitate early wake-up of PVS patients.（2） There is a positive correlation between multimodal neurophysiological scores and therapeutic effect of cSCS treatment.Multimodal neurophysiological scores play an important role in helping doctor choose cSCS awakening technology in clinical practice.