高压氧联合高频rTMS对重型颅脑损伤后意识障碍患者促醒作用、神经电生理和脑损伤标志物的影响

Effects of Hyperbaric Oxygen Combined with High-Frequency rTMS on Wake-Promoting Effect,Neuroelectrophysiology and Brain Injury Markers in Patients with Disturbance of Consciousness after Severe Craniocerebral Injury

目的:探讨高压氧联合高频重复经颅磁刺激(rTMS)对重型颅脑损伤后意识障碍(DOC)患者促醒作用、神经电生理和脑损伤标志物的影响。方法:选取2021年6月~2023年6月期间安徽中医药大学附属六安医院收治的的80例重型颅脑损伤后DOC患者。根据随机数字表法分为对照组(n=40,高压氧治疗)和观察组(n=40,高压氧联合高频rTMS治疗)。对比两组疗效、促醒作用、神经电生理和脑损伤标志物水平变化情况。结果:观察组的临床总有效率高于对照组(P<0.05)。两组治疗4周后修订的昏迷恢复量表(CRS-R)、格拉斯哥昏迷量表(GCS)评分升高,观察组高于对照组(P<0.05)。两组治疗4周后脑干听觉诱发电位(BAFP)、四肢体感诱发电位(SEP)、脑电图(EEG)分级有所改善,观察组改善效果优于对照组(P<0.05)。两组治疗4周后髓鞘碱蛋白(MBP)神经元特异性烯醇化酶(NSE)、S100β蛋白下降,观察组低于对照组(P<0.05)。结论:高压氧联合高频rTMS治疗可有效促醒重型颅脑损伤后DOC患者,还可改善神经电生理活动,减轻脑损伤程度。

Objective:To investigate the effects of hyperbaric oxygen combined with high-frequency repetitive transcranial magnetic stimulation(rTMS)on wake-promoting effect,neuroelectrophysiology and brain injury markers in patients with disturbance of consciousness(DOC)after severe craniocerebral injury.Methods:80 patients with DOC after severe craniocerebral injury who were admitted to Lu'an Hospital Affiliated to Anhui University of Traditional Chinese Medicine from June 2021 to June 2023 were selected.Patients were divided into control group(n=40,hyperbaric oxygen therapy)and observation group(n=40,hyperbaric oxygen combine with high-frequency rTMS therapy)according to the random number table method.Control group received hyperbaric oxygen therapy,and observation group received hyperbaric oxygen combine with high-frequency rTMS therapy.The efficacy,wake-promoting effect,neuroelectrophysiology and brain injury markers were compared between two groups.Results:The total clinical effective rate in observation group was higher than that in control group(P<0.05).The scores of revised coma recovery scale(CRS-R)and Glasgow coma scale(GCS)in two groups increased 4 weeks after treatment,and observation group was higher than that of control group(P<0.05).The brainstem auditory evoked potential(BAFP),four limb sensory evoked potential(SEP)and electroencephalogram(EEG)grading were improved in two groups 4 weeks after treatment,and the improvement effect in observation group was better than that in control group(P<0.05).Myelin basic protein(MBP),neuron-specific enolase(NSE)and S10oβprotein decreased in two groups 4 weeks after treatment,and observation group was lower than that of control group(P<0.05).Conclusion:Hyperbaric oxygen combined with high-frequency rTMS therapy can effectively wake up patients with DOC after severe craniocerebral injury,improve neuroelectrophysiological activities,and reduce the degree of brain injury.