不同频率重复经颅磁刺激对脑干损伤后昏迷促醒的对比研究

A comparative study of repetitive transcranial magnetic stimulation at different frequencies in arousal for coma patients after brain stem injury

目的比较不同频率重复经颅磁刺激(rTMS)作用于左前额叶背外侧皮层对脑干损伤后昏迷的促醒效果。方法选取南昌大学第一附属医院神经外科自2015年2月1日至2018年4月10日收治的脑干损伤致昏迷患者99例,其中未经rTMS治疗患者30例(对照组),经10 Hz rTMS治疗患者33例(10 Hz rTMS治疗组),经20 Hz rTMS治疗患者36例(20 Hz rTMS治疗组),治疗持续20 d。另外所有患者均接受常规的促苏醒治疗。比较3组患者治疗前后格拉斯哥昏迷量表(GCS)评分、脑电图(EEG)和脑干听觉诱发电位(BAEP)分级及治疗中不良反应的发生情况。结果治疗前3组患者GCS评分总分,语言反应、运动反应、睁眼反应评分,EEG和BAEP分级差异均无统计学意义(P>0.05);20 Hz rTMS治疗组与10 Hz rTMS治疗组患者治疗后GCS评分总分,语言反应、运动反应、睁眼反应评分的差值均高于对照组,且20 Hz rTMS治疗组患者GCS评分总分、运动反应评分的差值均高于10 Hz rTMS治疗组,差异均有统计学意义(P<0.05);治疗后对照组、10 Hz rTMS治疗组、20 Hz rTMS治疗组患者EEG分级、BAEP分级差异均有统计学意义(P< 0.05)。20 Hz rTMS治疗组患者不良反应发生率(19.4%)大于10 Hz rTMS治疗组(3.0%),差异有统计学意义(P<0.05)。结论高频rTMS对脑干损伤后昏迷患者具有促醒作用,且20 Hz rTMS对脑干损伤后昏迷的促醒效果优于10 Hz rTMS,但有增加癫痫、头皮烧伤等副反应的风险。

Objective To compare the effect of repeated transcranial magnetic stimulation (rTMS) at different frequencies acting on left dorsolateral prefrontal cortex (LPFC) on arousal for coma patients after brain stem injury.Methods Ninety-nine patients with coma resulted from brain stem injury,admitted to our hospital from February 1,2015 to April 10,2018,were chosen in our study.Among them,30 patients weren't treated with rTMS (control group),33 patients were treated with 10 Hz rTMS (10 Hz rTMS treatment group),and 36 patients were treated with 20 Hz rTMS (20 Hz rTMS treatment group);treatments lasted for 20 d.All patients received routine coma arousal treatment.Glasgow coma scale (GCS) scores,electroencephalogram (EEG) grading,brainstem auditory evoked potential (BAEP) grading and incidence of adverse reactions were compared among the three groups before and after treatment.Results Before treatment,there were no significant differences in GCS total scores,language response scores,motor response scores,eye opening reaction scores,EEG grading and BAEP grading among the three groups (P>0.05).The total GCS scores,and scores of language response,motor response and open eye response of patients in the 20 Hz rTMS treatment group and 10 Hz rTMS treatment group after treatment were significantly higher than those in the control group (P<0.05);the total GCS scores and motor response scores of patients in the 20 Hz rTMS treatment group were significantly higher than those in 10 Hz rTMS treatment group after treatment (P<0.05).After treatment,patients in the control group,10 Hz rTMS treatment group,and 20 Hz rTMS treatment group showed statistically significant differences in EEG grading and BAEP grading (P<0.05).The incidence of adverse reactions in the 20 Hz rTMS group (19.4%) was statistically higher than that in the 10 Hz rTMS group (3.0%,P<0.05).Conclusion High-frequency rTMS has an awakening effect on patients with coma resulted from brain stem injury,and the coma awakening effect of 20 Hz rTMS is partially better than that of 10 Hz rTMS,but it has the risk of increasing side effects such as epilepsy and scalp bum.