经颅直流电刺激联合镜像神经元康复训练系统对重型颅脑损伤后意识障碍患者的疗效

Effect of transcranial direct current combined with mirror neuronal rehabilitation training system in post-traumatic unconscious patients with severe craniocerebral injury

目的观察经颅直流电刺激（tDCS）联合镜像神经元康复训练系统（MNST-V1.0）对重型颅脑损伤后意识障碍患者的疗效。方法采用前瞻性自身前后对照开放研究方法，选取2016年1月至2017年7月住院的重型颅脑损伤后意识障碍的患者36例，其中4例患者没有完成治疗，最后32例患者完成研究。患者均给予常规促醒治疗，并同时给予tDCS联合MNST-V1.0进行促醒治疗（20 min/次，1次/d，6次/周，共治疗8周）。在治疗前和治疗后2、4、8周采用格拉斯哥昏迷量表（GCS）、JFK昏迷恢复量表和Four昏迷评定量表进行测评。结果治疗后2、4和8周GCS评分的睁眼反应、语言反应和运动反应评分均较治疗前明显提高[（1.56 ± 0.82）、（2.06 ± 1.01）和（3.11 ± 1.45）分比（1.00 ± 0.45）分，（2.23 ± 1.06）、（2.56 ± 1.08）和（3.02 ± 1.04）分比（1.00 ± 0.61）分，（2.79 ± 1.12）、（3.22 ± 1.33）和（4.44 ± 1.07）分比（1.00 ± 0.54）分]，差异有统计学意义（P 〈 0.01或〈 0.05）。治疗后2、4和8周JFK昏迷恢复量表评分的听觉、视觉、运动、言语反应、交流和唤醒度评分均较治疗前明显提高，差异有统计学意义（P 〈 0.01）。治疗后2、4和8周Four昏迷评定量表评分的睁眼反应、运动反应和脑干反应评分均较治疗前明显提高，差异有统计学意义（P 〈 0.05）；治疗前后呼吸评分变化比较差异无统计学意义（P 〉 0.05）。结论tDCS联合MNST-V1.0可提高重型颅脑损伤后意识障碍患者的意识水平，具有促醒疗效。

ObjectiveTo observe the effect of transcranial direct current stimulation （tDCS） with mirror neuronal rehabilitation training system （MNST-V1.0） in post-traumatic unconscious patients after severe craniocerebral injury.MethodsA prospective, self controlled and open-label method was used. Thirty-six post-traumatic unconscious patients with severe craniocerebral injury from January 2016 to July 2017 were selected. Four cases of the patients did not complete the treatment and the last 32 cases completed the study. All patients were given routine wake-up therapy, and tDCS combined with MNST-V1.0 （20 min/time, 1 time/d, 6 times/week, a total of 8 weeks） was given at the same time. The Glasgow coma scale （GCS）, JFK coma recovery scale and Four coma rating scale before treatment and 2, 4, 8 weeks after treatment were recorded.ResultsThe scores of open reaction, language and motor response score of GCS 2, 4, 8 weeks after treatment were significantly higher than those before treatment： （1.56 ± 0.82）, （2.06 ± 1.01） and （3.11 ± 1.45） scores vs. （1.00 ± 0.45） scores, （2.23 ± 1.06）, （2.56 ± 1.08） and （3.02 ± 1.04） scores vs. （1.00 ± 0.61） scores, （2.79 ± 1.12）, （3.22 ± 1.33） and （4.44 ± 1.07） scores vs. （1.00 ± 0.54） scores, and there were statistical differences （P 〈 0.01 or〈0.05）. The scores of hearing, vision, movement, speech response, communication and arousal of JFK coma recovery scale 2, 4, 8 weeks after treatment were significantly higher than those before treatment, and there were statistical differences （P〈0.01）. The scores of open reaction, sport reaction, brainstem response of Four coma rating scale 2, 4, 8 weeks after treatment were significantly higher than those before treatment, and there were statistical differences （P〈0.05）; there was no statistical difference in respiratory score of Four coma rating scale before and after treatment （P〉0.05）.ConclusionsThe tDCS combined with MNST-V1.0 can improve the consciousness level in post-traumatic unconscious patients with severe craniocerebral injury, and have the effect of promoting awakening.