低频重复经颅磁刺激治疗颅脑损伤后阵发性交感神经亢进27例疗效观察

Clinical effects of low-frequency repetitive transcranial magnetic stimulation on post-operational paroxysmal sympathetic hyperactivity in patients with brain injury

目的:探讨低频重复经颅磁刺激(rTMS)对颅脑损伤术后阵发性交感神经亢进的应用价值。方法:选取2020年6月至2021年6月在解放军总医院第六医学中心高压氧科暨康复医学科二病区住院收治的颅脑损伤术后患者54例,按照随机数字表法分为对照组(n=27)和rTMS组(n=27)。2组均给予常规药物治疗,rTMS组在患侧初级运动皮质区域再予以1 Hz rTMS治疗,对照组在同一区域予以相同参数的假刺激治疗。治疗后评价阵发性高血压缓解时间、阵发性肌强直缓解时间、24 h内阵发性肌强直缓解率、阵发性肌强直持续天数、体温降至正常时间、心率恢复正常时间、平均呼吸频率恢复到25次/min以下的时间及损伤后随访6个月格拉斯哥预后量表(GOS)的分级评分情况。结果:与对照组治疗后比较,rTMS组患者阵发性高血压缓解时间、阵发性肌强直缓解时间、阵发性肌强直持续天数、体温下降到正常时间、心率恢复正常时间和呼吸频率恢复到25次/min以下时间均明显短于对照组(P<0.01);而阵发性肌强直缓解率明显高于对照组(P<0.01)。术后6个月随访,rTMS组患者GOS分级评分优于对照组(P<0.05)。结论:rTMS治疗可明显改善颅脑损伤术后阵发性交感神经的亢进症状,且远期预后良好。

Objective To explore the application value of low-frequency repetitive transcranial magnetic stimulation(rTMS)on paroxysmal sympathetic hyperactivity(PSH)of patients after receiving surgeries on brain injury.Methods From June,2020 to June,2021,54 patients with PSH who were hospitalized in the Department of Hyperbaric Oxygen,also known as the Second Ward of the Rehabilitation Medicine Department,of the Sixth Medical Center of PLA General Hospital,were randomly divided into control group(n=27)and rTMS group(n=27).Both groups were given conventional drug treatment.The rTMS group was treated with 1 Hz rTMS on the affected primary motor cortex,and the control group was treated with sham stimulation of the same parameters at the same site.After treatment,the following indicators were evaluated:the time for paroxysmal hypertension alleviation,the mean time of paroxysmal myotonia alleviation,the rate of paroxysmal myotonia alleviation within 24 hours,the duration of paroxysmal myotonia,the average time for body temperature returning to normal,the time for heart rate returning to normal,the mean time for respiratory rate to back to below 25 times/min,and the Glasgow Outcome Scale(GOS)grading of six-month follow-up after surgery.Results After treatment,the mean time for paroxysmal hypertension alleviation,the mean time for paroxysmal myotonia alleviation,the duration of paroxysmal myotonia,the mean time for body temperature returning to normal,the mean time for heart rate returning to normal,the mean time for respiratory rate back to below 25 times/min in the rTMS group were all significantly shorter than those of the control group(P<0.01);and the rate of paroxysmal myotonia alleviation was significantly higher than that of the control group(P<0.01).After six months of follow-up,the GOS grading of the rTMS group was better than that of the control group(P<0.05).Conclusion The treatment of rTMS can significantly improve the postoperative PSH of in patients with brain injury,and the long-term prognosis is good.