脑电仿生电刺激对持续植物状态患者脑血流速度和脑代谢的影响

摘要

Objective To study the effect of electroencephalograph (EEG) bionic electrical stimulation at Wangu (GB12), Tianzhu (BL10), Neiguan (PC6) on cerebral blood flow and metabolism in patients with persistent vegetative state (PVS). Methods 60 patients with PVS were divided into observation group (n=30) and control group (n=30) according to the random number table. The control group re-ceived routine treatment, including basic management, hyperbaric oxygen therapy, awaking medicine, sensory stimulation, and so on;while the observation group received EEG bionic electrical stimulation at bilateral Tianzhu, Wangu (cheif electrodes) and Neiguan (auxiliary elec-trodes) in addition. They were treated for 30 days. They were assessed with the PVS score, and observed with transcranial Doppler ultra-sound (TCD) and magnetic resonance spectroscopy (MRS) one day before and one day after treatment. Results The incidence of improve-ment was 86.67%in the observation group, more than 60.00%in the control group (P<0.05). The difference of blood flow velocity before and after treatment (ΔVm) of anterior-middle cerebral artery was more in the observation group than in the control group respectively (P<0.001), as well as those of posterior cerebral-vertebral-basilar artery (P<0.01). The N-acetyl aspartic acid/creatine (NAA/Cr) increased more in the observation group than in the control group respectively (P<0.01), and the choline/creatine (Cho/Cr) decreased more (P<0.01), after treatment. Conclusion EEG bionic electrical stimulation can improve the cerebral circulation and metabolism in patients with PVS, which may associate with the wake promoting.%目的：研究脑电仿生电刺激完骨、天柱、内关对持续植物状态(PVS)患者脑血流速度及脑代谢的影响。方法60例PVS患者按照随机数字表法分为观察组和对照组各30例，对照组接受基础管理、高压氧、促醒药物、感觉刺激等常规治疗；观察组在常规治疗基础上接受脑电仿生电刺激双侧天柱、完骨(主电极)、内关穴(辅助电极)治疗，连续治疗30 d。分别于治疗开始前1 d及治疗结束后1 d采用PVS疗效评分量表进行评估，经颅彩色多普勒超声(TCD)、磁共振波普(MRS)检查观察脑血流速度及脑代谢变化。结果观察组总有效率为86.67%，优于对照组的60.00%(P<0.05)。观察组大脑前动脉-大脑中动脉、大脑后动脉-椎动脉-基底动脉治疗前后平均流速改变(ΔVm)均明显高于对照组(P<0.01)。治疗后观察组N-乙酰天门冬氨酸/肌酸明显高于对照组(P<0.01)，胆碱复合物/肌酸明显低于对照组(P<0.01)。结论脑电仿生电刺激完骨、天柱、内关可明显改善PVS患者脑循环及脑代谢，有可能提高临床促醒疗效。