赵国顺,韩诗雨,孙勃,等.重复经颅磁刺激与正中神经电刺激在脑出血后慢性意识障碍患者促醒中的疗效对比[J].中华物理医学与康复杂志,2026,48(3):225-231
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| 重复经颅磁刺激与正中神经电刺激在脑出血后慢性意识障碍患者促醒中的疗效对比 |
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| DOI：10.3760/cma.j.cn421666-20250725-00626 |
| 中文关键词: 慢性意识障碍 脑出血 重复经颅磁刺激 正中神经电刺激 |
| 英文关键词: Consciousness Cerebral hemorrhage Transcranial magnetic stimulation Median nerve electrical stimulation |
| 基金项目:河南省医学科技攻关计划省部共建重点项目 (SBGJ202402072)；河南省卫生健康中青年学科带头人 [豫卫人 (2025) 4 号]；国家重点研发计划项目 (2022YFC3601700) |
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| 中文摘要: |
| 目的 比较重复经颅磁刺激 (rTMS) 与正中神经电刺激 (MNS) 在脑出血后慢性意识障碍 (pDoC) 患者中的促醒疗效差异。方法 采用随机数字表法将 51 例脑出血后 pDoC 患者分为对照组、MNS 组、rTMS 组，每组 17 例。研究过程中，3 组患者均有脱落，最终对照组、MNS 组、rTMS 组分别纳入 16 例、16 例、15 例。3 组患者均接受常规促醒治疗，在此基础上，MNS 组增加 MNS 干预（每日 1 次、每周 6d、共 4 周），rTMS 组增加 10Hz rTMS 干预（每日 1 次、每周 6d、共 4 周），对照组接受假 rTMS 与假 MNS 干预。治疗前及治疗 4 周后（治疗后），采用昏迷恢复量表修订版 (CRS-R)、脑电 Synek 分级、失匹配负波 (MMN) 和功能性近红外光谱技术 (fNIRS) 评估 3 组患者的促醒疗效，并记录不良事件。结果 治疗后，3 组患者的 CRS-R 评分、脑电 Synek 分级均有所改善（P<0.05），左侧前额叶背外侧区 (L-DLPFC)、右侧前额叶背外侧区 (R-DLPFC)、左侧前额叶皮质 (L-PFC)、右侧前额叶皮质 (R-PFC) 的氧合血红蛋白 (HbO) 浓度亦有所改善（P<0.05）。MNS 组治疗后左侧前运动皮质 (L-PMC) 的 HbO 浓度 [(0.0075±0.0211) mmol/L・mm]，rTMS 组治疗后 L-PMC 的 HbO 浓度 [(0.0081±0.0223) mmol/L・mm] 和右侧初级运动皮质 (R-M1) 的 HbO 浓度 [(0.0110±0.0311) mmol/L・mm]，较组内治疗前有所改善（P<0.05）。与对照组比较，MNS 组和 rTMS 组治疗后的 CRS-R 评分较高，MMN 波幅增大（P<0.05），但 MNS 组和 rTMS 组治疗后 CRS-R 评分、MMN 波幅比较差异无统计学意义（P>0.05）。3 组患者治疗后的脑电 Synek 分级、各感兴趣区域的 HbO 浓度比较差异均无统计学意义（P>0.05）。结论 rTMS 与 MNS 对脑出血后 pDoC 患者均具有促醒作用，且两者疗效无显著差异，提示 MNS 或可作为 rTMS 的替代疗法。 |
| 英文摘要: |
| Objective To compare the effectiveness of transcranial magnetic stimulation (rTMS) with that of median nerve stimulation (MNS) in promoting the awakening of patients with persistent decreased consciousness (pDoC) following a cerebral hemorrhage. Methods Using a random number table, 51 patients with post-hemorrhagic pDoC were divided into a control group of 16, an MNS group of 16, and an rTMS group of 15. All three groups received standard arousal measures, but the MNS and rTMS groups underwent MNS or 10Hz rTMS every day, 6 days per week for 4 weeks. The control group received sham rTMS or MNS. Arousal was assessed before and after the experiment using the revised Coma Recovery Scale (CRS-R), EEG Synek grading, mismatch negativity (MMN), and functional near-infrared spectroscopy (fNIRS). Any adverse events were recorded. Results All 3 groups improved their average CRS-R scores, EEG Synek grading, and MMN significantly. Oxygenated hemoglobin (HbO) concentrations in the left dorsolateral prefrontal cortex, the right dorsolateral prefrontal cortex, left prefrontal cortex, and the right prefrontal cortex also improved significantly, on average. In the MNS group, there was a significant improvement in the HbO concentration of the left premotor cortex [(0.0075±0.0211)mmol/L·mm], and the right primary motor cortex [(0.0110±0.0311)mmol/L·mm]. Compared with the control group, both the MNS and rTMS groups exhibited significantly better average CRS-R scores and increased MMN amplitudes after the treatment. There was, however, no significant difference between the MNS and rTMS groups' average CRS-R scores or MMN amplitudes after the interventions. And there were no significant differences among the three groups in their post-treatment EEG Synek grades or HbO concentrations in regions of interest. Conclusions Both rTMS and MNS can promote awakening from a persistent or deep coma following a cerebral hemorrhage. There is no significant difference in their effectiveness. This suggests that MNS may serve as an alternative treatment to rTMS. |
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