正中神经电刺激对NICU重型颅脑损伤昏迷促醒的临床研究

Clinical study of median nerve electrical stimulation on coma induced by severe traumatic brain injury in NICU

目的探讨正中神经电刺激对于神经外科重症监护病房(NICU)重型颅脑损伤(sTBI)患者昏迷促醒的临床疗效及促醒作用的可能机制。方法纳入解放军联勤保障部队第九〇〇医院神经外科自2019年6月至2020年7月收治的83例sTBI患者进行前瞻性研究,将患者随机分为试验组(42例)和对照组(41例)。对照组采用常规治疗,试验组在常规治疗基础上辅以正中神经电刺激(在NICU早期干预)。比较2组患者治疗前后GCS评分、血浆神经损伤指标[胶原纤维酸性蛋白(GFAP)、泛素羧基末端水解酶-L1(UCH-L1)]和神经营养指标[脑源性神经生长因子(BDNF)],评价其治疗效果。结果2组患者治疗后的GCS评分比较,差异有统计学意义(P<0.05),且试验组GCS评分高于对照组。2组患者治疗后的GFAP、UCH-L1及BDNF水平比较,差异均有统计学意义(P<0.05),且试验组GFAP、UCH-L1下降幅度高于对照组,BDNF升高幅度高于对照组。结论对于sTBI昏迷患者早期行正中神经电刺激,能明显改善患者预后,值得在NICU推广应用。

Objective To investigate the clinical effect of median nerve electrical stimulation on coma induced by severe traumatic brain injury(sTBI)in neurosurgical intensive care unit(NICU)and its possible mechanism.Methods A prospective study was conducted on 83 patients with sTBI admitted to Neurosurgery Department of 900th Hospital of the Joint Logistics Team from June 2019 to July 2020.They were randomly divided into experimental group(n=42)and control group(n=41).The control group was given conventional treatment,and the experimental group was supplemented with median nerve electrical stimulation(early intervention in NICU)on the basis of conventional treatment.GCS score,plasma nerve injury index[collagen fibrillary acidic protein(GFAP),ubiquitin carboxyl terminal hydrolase-L1(UCH-L1)]and neurotrophic index[plasma brain-derived nerve growth factor(BDNF)]were compared between the two groups before and after treatment to evaluate the therapeutic effect.Results There was significant difference in GCS score between the two groups after treatment(P<0.05),and the GCS score of the experimental group was higher than that of the control group.There were significant differences in the levels of GFAP,UCH-L1 and BDNF between the two groups after treatment(P<0.05),the decrease of GFAP and UCH-L1 in the experimental group was greater than that in the control group,and the increase of BDNF in the experimental group was greater than that in the control group.Conclusion For comatose patients with sTBI,early median nerve stimulation can significantly improve the prognosis of patients,which is worthy of promotion and application in NICU.