爆发式磁刺激联合多感官刺激对意识障碍患者的促醒作用

Effect of theta burst stimulation combined with multi-sensory stimulation on awakening in patients with disorder of consciousness

目的观察爆发式磁刺激(TBS)联合多感官刺激对CNS损伤致意识障碍患者促醒的临床疗效。方法回顾性分析2017年6月至2020年12月我院康复医学科收治的56例CNS损伤所致意识障碍患者的临床资料。接受TBS治疗的28例患者作为观察组,选择同期住院的性别、年龄、疾病、意识障碍程度相匹配的仅接受常规康复治疗的28例患者为对照组。观察治疗前后GCS、昏迷恢复量表(CRS-R)、Braden压疮评分、日常生活活动能力评定(ADL)、运动诱发电位潜伏期(MEPL)和静息运动阈值(RMT)的改变。结果对照组、观察组患者治疗前和治疗后GCS评分差异均有统计学意义(P=0.02,P=0.008)。与治疗前相比,对照组、观察组CRS-R评分均明显提高(P=0.03,P=0.007),治疗后观察组CRS-R评分较对照组明显提高(P=0.006)。与治疗前相比,治疗后观察组Braden评分明显增加(P=0.04)。治疗后两组患者RMT值均明显下降,差异均有统计学意义(P=0.03,P=0.00)。治疗后观察组RMT值较对照组明显降低(P=0.01)。与治疗前相比,治疗后两组潜伏期均明显缩短(P=0.02,P=0.01),治疗后观察组潜伏期较对照组明显缩短(P=0.02)。结论TBS疗法联合常规康复训练能提高促醒效果,有助于全面改善神经功能缺损症状,减轻并发症,提高自理能力。

Objective To observe the clinical effect of theta burst stimulation(TBS)combined with multi-sensory stimulation on awakening of patients with disorder of consciousness caused by central nervous system injury.Methods The data of 56 patients with disturbance of consciousness caused by CNS injury treated in Department of Rehabilitation of our Hospital from June 2017 to December 2020 were analyzed retrospectively.Twenty-eight patients who received TBS treatment were selected as the observation group,and 28 patients in the control group were selected from the inpatients in the same period,matched with sex,age,disease,and severity of consciousness disorder.The changes of GCS,coma recovery scale-revised(CRS-R),Braden pressure ulcer score,activity of daily living(ADL),motor evoked potential latency(MEPL)and resting motor threshold(RMT)were evaluated before and after treatment.Results The differences in GCS scores between the two groups before and after treatment were statistically significant(P=0.02,P=0.008).The CRS-R scores were significantly higher in two groups compared with those before treatment(P=0.03,P=0.007),and after treatment,the CRS-R scores in the observation group were significantly higher than in the control group(P=0.006).Braden score was significantly increased in the observation group after treatment(P=0.04).After treatment,the RMT values of the two groups were significantly decreased(P=0.03,P=0.001),and the RMT values in the observation group were significantly lower than those in the control group(P=0.01).Compared with that before treatment,the latency periods in two groups were significantly shorter after treatment(P=0.02,P=0.01),and the latency period was significantly shorter in the observation group than the observation group after treatment(P=0.02).Conclusion TBS combined with conventional rehabilitation training can enhance the awakening effect,it can help improve the overall symptoms of neurological deficits,reduce complications and improve self-care ability.