声刺激对昏迷患者苏醒影响的探讨

Effects of acoustic stimulation on the recovery of coma patients

目的:应用定量脑电图(quantitative electroencephalogram,QEEG)δ+θ/α+β相对功率值、格拉斯哥昏迷评分(Glasgow coma scale,GCS)作为评价指标,来观察声刺激对脑外伤昏迷患者的促醒作用。方法:选择符合入选标准的40例颅脑外伤后昏迷患者。20例为在康复科、神经外科病房内,家属能够积极配合,有长期固定护理人员,经过正规声刺激疗法治疗的脑外伤昏迷患者(声刺激组);20例为在重症监护室内、康复科及神经外科病房内,家属配合度一般,经常更换护理人员,未经过正规声刺激治疗的脑外伤昏迷患者(对照组)。入组后跟踪观察1个月,比较两组患者GCS评分、δ+θ/α+β值有无差异。两组间除有无正规声刺激治疗外,余治疗无明显区别,且两组间在年龄、性别、外伤类型及病程等相匹配。结果:40例颅脑外伤昏迷患者中,声刺激组与对照组治疗后比较,GCS评分明显增大,有统计学差异(P<0.05)。声刺激组与对照组治疗后比较,δ+θ/α+β值明显减小,有统计学差异(P<0.05)。治疗前40例患者GCS评分为3~8分与δ+θ/α+β值呈负相关(r=-0.482,P=0.002,n=40),治疗后31例患者GCS评分为9~15分与δ+θ/α+β值呈负相关(r=-0.493,P=0.005,n=31)。结论:通过对δ+θ/α+β值及GCS评分的观察,说明声刺激法对颅脑外伤昏迷患者有明显的促醒作用。定量脑电图(δ+θ/α+β值)作为一种客观、量化的脑功能检测手段,对昏迷患者大脑功能状态的评估有重要的价值。

Objective:Applying quantitative EEG(8+0/a+(3value)and GCS value to evaluate the role of Sensory Integration Training therapy for traumatic brain injury coma patients.Methods:40patients of traumatic brain injury coma meeting the inclusion crite-ria were chosen.20cases in rehabilitation and neurosurgery ward,whose families were actively cooperative,and who could receive a long-term fixed nursing staff and a formal Sensory Integration Training therapy was set as Sensory Integration Training group.20cases in the in-tensive care unit,the rehabilitation,and neurosurgery ward,whose family members were of the poor cooperation degree,changing nursing staff often,without a formal Sensory Integration Training therapy were set as control group.After one month following up,compared the GCS value and quantitative EEG(8+0/a+(3value).Two groups had no significant difference in age,gender,injury types and course age except having or having not the formal Sensory Integration Training therapy.Results:After treatment the GCS value of Sensory Integration Training group were increased,and the difference with control group was significant(P<0.05).The quantitative EEG value(8+0/a+(3value)of Sensory Integration Training group values were decreased after treatment,compared with the control group,the difference was statistically significant(P<0.05).Conclusion:The quantitative EEG(8+0/a+(3value)and GCS score showed that the Sensory Inte-gration Training therapy in patients with craniocerebral trauma coma has obvious effect on promoting to regain consciousness and the quan-titative EEG(8+0/a+(3value)can be used as an objective index to evaluate the brain function state.