高频重复经颅磁刺激对重症颅脑损伤后意识障碍患者神经电生理及脑脊液兴奋性氨基酸水平的影响

Effect of high-frequency repetitive transcranial magnetic stimulation on neuroelectrophysiology and cerebrospinal fluid excitatory amino acid level in patients with disorders of consciousness after severe craniocerebral injury

目的探讨高频重复经颅磁刺激(rTMS)对重症颅脑损伤后意识障碍(DOC)患者神经电生理及脑脊液兴奋性氨基酸(EAA)水平的影响。方法选取2018年10月—2019年12月三河市燕郊人民医院收治的80例重症颅脑损伤后DOC患者,随机分为对照组和治疗组,每组40例。对照组采用rTMS假刺激4周,治疗组采用rTMS刺激4周。比较2组患者治疗前后格拉斯哥昏迷量表(GCS)评分、改良后昏迷恢复量表(CRS-R)评分、脑电图(EEG)分级、上肢体感诱发电位(SSEP)分级、谷氨酸(ASP)及门冬氨酸(GLU)水平。结果2组治疗后GCS、CRS-R评分均较治疗前升高,且治疗组治疗后GCS、CRS-R评分高于对照组,差异均有统计学意义(P<0.05)。治疗组治疗后EEG较治疗前改变,且治疗组治疗后EEG改变较对照组更明显,差异均有统计学意义(P<0.05)。2组治疗后SSEP均较治疗前改变,且治疗组治疗后SSEP改变较对照组更明显,差异均有统计学意义(P<0.05)。2组治疗后GLU、ASP均较治疗前降低,且治疗组治疗后GLU、ASP低于对照组,差异均有统计学意义(P<0.05)。结论高频rTMS应用于重症颅脑损伤后DOC患者可改善神经电生理活动和昏迷状态,降低脑脊液EAA水平。

Objective To investigate the effect of high-frequency repetitive transcranial magnetic stimulation(rTMS)on neuroelectrophysiology and cerebrospinal fluid excitatory amino acid(EAA)level in patients with disorders of consciousness(DOC)after severe craniocerebral injury.Methods Eighty patients with DOC after severe craniocerebral injury in Yanjiao People′s Hospital of Sanhe City from October 2018 to December 2019 were selected and randomly divided into control group and treatment group,with 40 cases in each group.The rTMS sham stimulation was performed 4 weeks in the control group,while rTMS stimulation was performed 4 weeks in the treatment group.The Glasgow Coma Scale(GCS)score,modified Coma Recovery Scale(CRS-R)score,electroencephalogram(EEG)grading,upper limb somatosensory evoked potential(SSEP)grading,glutamate(ASP)and glutamate(GLU)levels were compared between the two groups before and after treatment.Results The GCS and CRS-R scores in both groups after treatment were significantly higher than those before treatment,and the GCS and CRS-R scores in the treatment group after treatment were significantly higher than those in the control group(P<0.05).The change of EEG after treatment in the treatment group was more obvious than that before treatment and in the control group,and there were significant differences(P<0.05).After treatment,SSEP in both groups were changed,the change of SSEP in the treatment group was more obvious than that in the control group,and there was a significant difference(P<0.05).After treatment,GLU and ASP in both groups were significantly lower than those before treatment,and GLU and ASP after treatment in the treatment group were significantly lower than those in the control group(P<0.05).Conclusion Application of high-frequency rTMS in DOC patients after severe craniocerebral injury can improve neurophysiological activity and coma status,and reduce cerebrospinal fluid EAA level.