生物波早期综合康复治疗对重型颅脑损伤昏迷患者神经功能因子及脑电图指标的影响

Effect of early comprehensive rehabilitation therapy on neurological factors and EEG indicators in coma patients with severe craniocerebral injury.

目的探究重型颅脑损伤昏迷患者采取生物波早期综合康复治疗对患者的神经功能因子及脑电图指标的影响。方法前瞻性选取2021年1月至2022年1月沧州市人民医院收治的88例重型颅脑损伤昏迷患者,按照随机数字表法分为对照组及观察组,各44例。对照组患者进行常规治疗,观察组患者在常规治疗的基础上联合生物波早期综合康复治疗。比较两组患者的神经功能因子[神经元特异性烯醇化酶(NSE)、S100-β、重组人泛素羧基末端水解酶L1(UCH-L1)、神经胶质纤维酸性蛋白(GFAP)、脑源性神经营养因子(BDNF)及神经生长因子(NGF)]水平变化;采用多普勒超声对患者的左、右侧椎动脉及基底动脉的血管收缩峰流速(Vs)及平均血流速度(Vm)进行检测并比较;比较两组患者治疗前后脑电波分级改变情况,比较两组患者治疗前后格拉斯哥昏迷评分(GCS)及1个月内苏醒率。结果治疗后,两组NSE、S100β、UCH-L1、GFAP水平均较治疗前下降,BDNF、NGF水平均较治疗前升高,且观察组患者的NSE、S100β、UCH-L1、GFAP水平分别为(20.79±2.43)ng/mL、(0.21±0.02)ng/mL、(0.99±0.01)ng/mL、(2.65±0.21)pg/mL,均低于对照组[(28.46±2.12)ng/mL、(0.36±0.03)ng/mL、(1.23±0.05)ng/mL、(3.53±0.35)pg/mL],BDNF、NGF水平分别为(11.77±1.51)pg/mL、(13.78±1.63)pg/mL,均高于对照组[(9.74±1.23)pg/mL、(8.23±1.23)pg/mL],差异均有统计学意义(P<0.05)。治疗后,两组左、右侧椎动脉及基底动脉Vs及Vm均较治疗前升高,观察组Vs分别为(57.61±6.47)、(64.75±5.41)、(58.71±7.44)cm/s,均高于对照组[(52.57±5.58)、(59.75±4.77)、(54.72±6.51)cm/s],Vm分别为(47.17±4.11)、(41.85±4.12)、(46.55±4.27)cm/s,均高于对照组[(41.45±3.78)、(37.68±3.41)、(41.59±3.65)cm/s],差异均有统计学意义(P<0.05)。治疗后,两组脑电波分级情况均有所改善,Ⅰ级、Ⅱ级占比增加,Ⅲ级、Ⅳ级占比减少,观察组分级变动幅度大于对照组,差异有统计学意义(P<0.05)。治疗后,两组GCS评分均较治疗前升高,且观察组GCS评分为(7.65±1.21)分,高于对照组[(6.53±1.35)分],差异均有统计学意义(P<0.05)。观察组1月内苏醒率为6.82%,高于对照组(2.27%),但差异无统计学意义(P>0.05)。结论采用生物波早期综合康复治疗重症颅脑损伤昏迷患者可改善其神经功能,降低患者脑电图分级,具有较高临床应用价值。

Objective To explore the effect of early comprehensive biological wave rehabilitation on neurological factors and electroencephalography indicators in coma patients with severe head injury.Methods A total of 88 coma patients with severe craniocerebral injury admitted to Cangzhou People's Hospital from January 2021 to January 2022 were prospectively selected,and divided into control group and observation group according to the random number table,with 44 cases in each group.Patients in the control group received conventional treatment,and patients in the observation group were treated on the basis of conventional therapy.The levels of Neurofunctional factors[neuron specific enolase(NSE),S-100β,recombinant human ubiquitin carboxyl terminal hydrolase L1(UCH-L1),glial fibrillary acidic protein(GFAP),brain derived neurotrophin(BDNF)and nerve growth factor(NGF)]were compared in two groups of patients.The left and right vertebral artery and basilar artery vasoconstriction and peak flow rate(Vs)and mean flow velocity(Vm),and the EEG grade changes were compared.Glasgow Coma cale(GCS)scores and awakening rate within one month were compared between the two groups.Results After treatment,the levels of NSE,S100β,UCH-L1,and GFAP in both groups decreased compared to those before treatment,while the levels of BDNF and NGF increased compared to those before treatment.The levels of NSE,S-100β,UCH-L1,and GFAP in the observation group were(20.79±2.43)ng/mL,(0.21±0.02)ng/mL,(0.99±0.01)ng/mL,and(2.65±0.21)pg/mL,respectively,which were lower than those in the control group[(28.46±2.12)ng/mL,(0.36±0.03)ng/mL,(1.23±0.05)ng/mL,and(3.53±0.35)pg/mL],the levels of BDNF and NGF were(11.77±1.51)pg/mL and(13.78±1.63)pg/mL,respectively,which were higher than those in the control group[(9.74±1.23)pg/mL and(8.23±1.23)pg/mL],the differences were statistically significant(P<0.05).After treatment,the Vs and Vm of left and right vertebral artery and basilar artery in the two groups were higher than those before treatment,the Vs in the observation group were(57.61±6.47),(64.75±5.41),(58.71±7.44)cm/s,respectively,which were higher than those in the control group[(52.57±5.58),(59.75±4.77),(54.72±6.51)cm/s],and the Vm were(47.17±4.11),(41.85±4.12),(46.55±4.27)cm/s,respectively,which were higher than those in the control group[(41.45±3.78),(37.68±3.41),and(41.59±3.65)cm/s],and the differences were statistically significant(P<0.05).After treatment,the EEG grade of both groups improved,the proportion of grade I and grade increased,the proportion of grade I and grade decreased,and the variation of the observation group was greater than that of the control group,and the difference was statistically significant(P<0.05).After treatment,the GCS scores of both groups increased compared to those before treatment,and the GCS score of the observation group was(7.65±1.21)points,which was higher than that of the control group[(6.53±1.35)points],and the difference was statistically significant(P<0.05).The recovery rate of the observation group in the treatment was 6.82%within 1 month,which was higher than that of the control group(2.27%),but the difference was not statistically significant(P>0.05).Conclusion Early biological wave comprehensive rehabilitation treatment in severe craniocerebral injury coma patients can improve their neurological function and reduce the EGG grade,which has high clinical application value.