标题：正中神经电刺激配合rTMS对颅脑损伤患者的促醒作用研究

      作者：李元朋 1，魏欢 2    宝鸡市人民医院神经外科 1、神感染科 2，陕西 宝鸡 721000

      卷次： 2022年33卷16期

      【摘要】 目的 探讨正中神经电刺激配合重复经颅磁刺激(rTMS)对颅脑损伤患者的促醒作用。方法 回顾性分析2018年7月至2020年7月宝鸡市人民医院收治的60例颅脑损伤患者的临床资料，根据治疗方式的不同将患者分为观察组和对照组各30例。对照组患者给予常规治疗，观察组患者在对照组基础上联合正中神经电刺激配合rTMS治疗，均连续治疗4周。比较两组患者治疗4周后的临床疗效以及治疗前后的格拉斯哥昏迷评分(GCS)、残疾评定量表(DRS)、蒙特利尔认知评估量表(MoCA)、大脑中动脉平均血流速度(Vm)、局部脑血流量(rCBF)、局部脑血容量(rCBV)的变化及并发症发生情况。结果 治疗后，观察组患者的临床疗效总有效率为93.33%，明显高于对照组的73.33%，差异有统计学意义(P<0.05)；治疗前，两组患者的GCS评分、MoCA评分、DRS评分比较差异均无统计学意义(P>0.05)；治疗后，观察组患者的GCS评分、MoCA评分分别为(11.21±1.63)分、(27.93±2.01)分，明显高于对照组的(9.32±1.50)分、(26.58±1.39)分，DRS评分为(6.34±1.27)分，明显低于对照组的(8.36±1.55)分，差异均有统计学意义(P<0.05)；治疗前，两组患者的Vm、rCBF、rCBV比较差异均无统计学意义(P>0.05)；治疗后，观察组患者的Vm、rCBF、rCBV分别为(57.94±5.36) cm/s、(48.64±3.53) mg/100 g、(3.24±0.37) mg/100 g，明显高于对照组的(53.37±4.05) cm/s、(42.02±3.81) mg/100 g、(2.83±0.33) mg/100 g，差异均有统计学意义(P><0.05)；观察组和对照组患者的并发症总发生率分别为10.00%和6.67%，差异无统计学意义(P>0.05)。结论 正中神经电刺激配合 rTMS对颅脑损伤患者的促醒效果明显，值得临床推广应用。
      【关键词】 颅脑损伤；昏迷；重复经颅磁刺激；正中神经；血流动力学；并发症
      【中图分类号】 R651.1+5 【文献标识码】 A 【文章编号】 1003—6350（2022）16—2060—04

Effect of median nerve electrical stimulation combined with rTMS on arousal in patients with craniocerebralinjury.
LI Yuan-peng 1, WEI Huan 2. Department of Neurosurgery 1, Department of Neuroinfection 2, Baoji People's Hospital,Baoji 721000, Shaanxi, CHINA
【Abstract】 Objective To study the effect of median nerve electrical stimulation combined with repetitive tran-scranial magnetic stimulation (rTMS) on arousal in patients with craniocerebral injury. Methods The clinical data of60 patients with craniocerebral injury in Baoji People's Hospital from July 2018 to July 2020 were retrospectively ana-lyzed. According to different treatment methods, the patients were divided into an observation group and a control groupby different treatment methods, with 30 patients in each group. The patients in the control group were treated with con-ventional treatment, while the patients in the observation group were treated with median nerve electrical stimulationcombined with rTMS on the basis of the control group, for 4 weeks. The clinical efficacy at 4 weeks after treatment, thechanges of Glasgow Coma Scale (GCS), Disability Rating Scale (DRS), Montreal Cognitive Assessment Scale (MoCA),mean velocity of middle cerebral artery (Vm), regional cerebral blood flow (rCBF), regional cerebral blood volume(rCBV) before treatment and after treatment, and the incidence of complications were compared between the two groups.Results After treatment, the total effective rate in the observation group was 93.33%, which was significantly higherthan 73.33% of the control group (P<0.05). Before treatment, there was no significant difference in GCS score, MoCAscore, and DRS score between the two groups (P>0.05); after treatment, the GCS score and MoCA score in the observa-tion group were (11.21±1.63) points and (27.93±2.01) points, which were significantly higher than (9.32±1.50) pointsand (26.58±1.39) points of the control group, and the DRS score was (6.34±1.27) points, which was significantly higherthan (8.36±1.55) points of the control group; the differences were statistically significant (P<0.05). Before treatment,there was no significant difference in VM, rCBF, and rCBV between the two groups (P>0.05); after treatment, the Vm,rCBF, and rCBV in the observation group were (57.94±5.36) cm/s, (48.64±3.53) mg/100 g, (3.24±0.37) mg/100 g,which were significantly higher than (53.37±4.05) cm/s, (42.02±3.81) mg/100 g, (2.83±0.33) mg/100 g of the controlgroup; the differences were statistically significant (P<0.05). The total incidence of complications in the observationgroup and the control group patients was 10.00% and 6.67% , and the difference was not statistically significant (P>0.05). Conclusion Median nerve electrical stimulation combined with rTMS have significant effect on promoting con-sciousness in patients with craniocerebral injury, which is worthy of clinical application.
      【Key words】 Craniocerebral injury; Coma; Repetitive transcranial magnetic stimulation; Median nerve; Hemody-namics; Complicat