重复经颅直流电刺激联合康复治疗意识障碍研究

Clinical Study of Repetitive Transcranial Direct Current Stimulation Combined with Rehabilitation Therapy for Patients with Consciousness Disorder

目的:探讨重复经颅直流电刺激(tDCS)联合康复治疗对意识障碍患者促醒和改善痉挛的疗效。方法:回顾性分析2017年4月—2021年4月在兰州大学第二医院康复医学科入院的42例意识功能障碍患者,根据是否给予患者tDCS治疗分为观察组和对照组,每组21例。对照组给予常规康复治疗,观察组在常规康复治疗的基础上加用tDCS,阳极置于左侧初级运动皮质区(M1),阴极置于右肩部,刺激电流强度2 mA,20 min/次。2组均每日治疗1次,每周5 d,共治疗6周。2组治疗前后采用改良昏迷恢复量表(CRS-R)和格拉斯哥昏迷量表(GCS)评估患者的意识水平,应用改良Ashworth量表(MAS)评估患者右侧屈肘肌肌张力的改变。结果:治疗前2组CRS-R和GCS评分差异无统计学意义(P>0.05);治疗后2组评分均较治疗前改善,而且观察组CRS-R和GCS评分均优于对照组,差异具有统计学意义(P<0.05);在临床疗效方面,观察组反应者为13例(61.90%),无反应者为8例(38.10%);对照组反应者为2例(9.52%),无反应者为19例(90.48%),2组比较差异有统计学意义(P<0.05)。治疗前2组患者右侧屈肘肌MAS评分差异无统计学意义(P>0.05);对照组治疗前后屈肘肌的MAS评分差异无统计学意义(P>0.05),观察组治疗前后屈肘肌的MAS评分差异有统计学意义(P<0.05);组间比较,治疗后观察组屈肘肌MAS评分优于对照组,差异有统计学意义(P<0.05)。结论:重复经颅直流电刺激联合康复治疗能够有效改善意识障碍患者的意识水平和痉挛状态。

Objective:To explore the effect of repetitive transcranial direct current stimulation(tDCS)combined with rehabilitation therapy on promoting consciousness and improving spasticity in patients with consciousness disorder.Methods:A retrospective analysis was performed on 42 patients with disturbance of consciousness,whom hospitalized in Department of Rehabilitation Medicine in the Second Hospital of Lanzhou University from April 2017 to April 2021.Participants were divided into observation group and control group according to whether they received tDCS,with 21 cases in each group.The control group were treated with conventional rehabilitation therapy and the observation group were treated with conventional rehabilitation therapy and tDCS.The anode was placed in the left primary motor cortex(M1)and the cathode was placed in the right shoulder region,and the current was set to 2 mA,lasting for 20 min each time.Patients in both groups were treated once a day,5 days a week,for 6 weeks.Level of consciousness was assessed by Coma Recovery Scale-Revised(CRS-R)and Glasgow Coma Scale(GCS)pre and post the treatment sessions,while Modified Ashworth Scale(MAS)was used to assess changes muscle tone of the right flexor elbow muscle.Results:Before treatment,there were no significant difference in CRS-R and GCS scores between the two groups(P>0.05);after treatment,the CRS-R and GCS scores of the both groups improved,and statistically more improvement was seen in the observation group than those of the control group,and the differences were statistically significant(P<0.05).In terms of clinical efficacy,there were 13(61.90%)responders and 8(38.10%)non responders in the observation group.In the control group,there were 2(9.52%)responding patients and 19(90.48%)non responding patients,and the difference between the two groups was significant(P<0.05).There was no significant difference in MAS score of right flexor elbow muscle between the two groups before treatment(P>0.05);there was no significant difference in MAS score of bilateral flexor elbow muscle in the control group before and after treatment(P>0.05),but there was significant difference in the observation group before and after treatment(P<0.05).The comparison between groups showed that MAS score of flexor elbow muscle in the observation group was better than the control group,and the difference was statistically significant(P<0.05).Conclusion:Repetitive transcranial direct current stimulation combined with rehabilitation therapy can effectively improve the level of consciousness and spasticity of patients with consciousness disorder.