正中神经电刺激对儿童重型颅脑损伤昏迷的促醒作用及其机制研究

The effect of median nerve electrical stimulation on awakening comatose children with severe traumatic brain injury and its mechanism

目的探讨正中神经电刺激(MNES)对儿童重型颅脑损伤昏迷的促醒作用及其机制。方法2019年1月至2021年6月西南医科大学附属医院神经外科收治重型颅脑损伤后昏迷患儿67例,所有患儿均接受常规方法治疗,其中25例于常规治疗后2周接受MNES(8 h/d,共2周)。经1∶1倾向性评分匹配后,共纳入40例患儿进行回顾性研究,MNES组和非MNES组各20例。比较常规治疗后2、4周两组的格拉斯哥昏迷评分(GCS)、脑功能障碍评分(DRS)的差异。所有患儿常规治疗后2、4周行头颅CT灌注成像(CTP)和头颅磁共振波谱(MRS)检查,比较两组感兴趣区(丘脑)CTP的相关参数,以及MRS检测的N-乙酰天冬氨酸(NAA)/肌酸(Cr)值和胆碱复合物(Cho)/Cr值的改变情况。结果常规治疗后2、4周,MNES组的GCS分别为(6.0±1.2)、(10.3±1.7)分,DRS分别为(18.1±2.9)、(6.6±1.8)分;非MNES组的GCS分别为(6.1±1.3)、(9.2±1.6)分,DRS分别为(17.6±2.5)、(8.5±2.2)分。两组的GCS、DRS均改善,MNES组的改善程度优于非MNES组,差异均有统计学意义(均P<0.05)。CTP结果显示,常规治疗后4周两组感兴趣区的脑血流量、脑血容量均较常规治疗后2周升高,对比剂平均通过时间、达峰时间均降低,且MNES组的改善程度大于非MNES组,差异均有统计学意义(均P<0.05)。MRS结果显示,常规治疗后4周,两组感兴趣区的NAA/Cr值均较常规治疗后2周升高、Cho/Cr值均降低,且MNES组的改善程度大于非MNES组,差异均有统计学意义(均P<0.05)。结论MNES有助于重型颅脑创伤昏迷患儿的促醒和脑功能改善。其机制可能与改善脑组织血流灌注和代谢有关。

Objective To investigate the effects of median nerve electrical stimulation(MNES)on awakening comatose children with severe traumatic brain injury and its mechanism.Methods From January 2019 to June 2021,67 children with coma after severe craniocerebral injury were treated in the Department of Neurosurgery,the Affiliated Hospital of Southwest Medical University.All children received conventional treatment,and 25 of them received MNES treatment(8 h/d,a total of 2 weeks).After 1∶1 propensity score matching,a total of 40 cases were included for retrospective study,including 20 cases in the MNES group and 20 cases in the non-MNES group.There were no significant differences in age,gender,cause of injury,type of injury,Glasgow Coma Scale(GCS),or proportion of surgical treatment between the two groups(all P>0.05).The differences in GCS and disability rating scale(DRS)of the two groups between pre-treatment and 2 weeks post treatment were compared.All children underwent head CT cerebral perfusion imaging(CTP)and magnetic resonance spectroscopy(MRS)before and after treatment to analyze the relevant parameters of CTP in the region of interest,and to detect the changes of N-acetylaspartate(NAA)/creatine(Cr)value and choline complex(Cho)/Cr value in the thalamus using MRS.Results Before and after treatment,the GCS of the MNES group was 6.0±1.2 points and 10.3±1.7 points respectively,the DRS was 18.1±2.9 points and 6.6±1.8 points respectively;the GCS of the non-MNES group was 6.1±1.3 points and 9.2±1.6 points respectively,and DRS were 17.6±2.5 points and 8.5±2.2 points respectively.The GCS and DRS in both groups were improved after treatment,and the improvement degree of the MNES group was greater than that of the non-MNES group,and the differences were statistically significant(all P<0.05).The CTP results showed that after treatment,the cerebral blood flow and cerebral blood volume in the region of interest of the brain were increased in both groups compared with those before treatment,and the average transit time and peak time of the contrast agent were decreased,the improvement degree of the MNES group was greater than that of the non-MNES group,and the differences were statistically significant(all P<0.05).The MRS results showed that,compared with before treatment,the NAA/Cr values of the thalamus in both groups increased and the Cho/Cr values decreased after treatment,the improvement in the MNES group was greater than that in the non-MNES group,and the differences were statistically significant(all P<0.05).Conclusions MNES contributes to the recovery and improvement of brain function in comatose children with severe traumatic brain injury.The mechanism may be related to the improvement of cerebral tissue blood perfusion and metabolism.