正中神经电刺激对颅脑损伤后植物状态患者的促醒作用

目的：研究正中神经电刺激治疗创伤性持续植物状态的疗效与机制，同时探索创伤性持续植物状态的有效治疗方法。方法：66例创伤性持续植物状态患者随机分为3组，即正中神经电刺激组，高压氧组，正中神经电刺激+高压氧组。在药物治疗的基础上分别进行正中神经电刺激，高压氧和联合应用正中神经电刺激及高压氧治疗，治疗前后分别检测脑电图，体感诱发电位，脑干听觉诱发电位，同时行经颅多普勒检查患者大脑中动脉，基底动脉的平均血流速度，治疗后6个月时应用格拉斯哥(GOS)结果评分进行疗效评定。结果：治疗后6个月时GOS评定结果：正中神经电刺激组：恢复良好1例，中残7例，重残2例，植物状态11例，死亡1例。高压氧组：恢复良好1例。中残5例，重残3例，植物状态11例，死亡2例。正中神经电刺激+高压氧组：恢复良好3例，中残6例，重残4例，植物状态8例，死亡1例。3组比较差异无显著性意义(P&;gt;0．05)。正中神经电刺激组及正中神经电刺激+高压氧组大脑中动脉平均血流速度分别为(56．7&;#177;13．1)cm／s和(58．2&;#177;13．8)cm／s，较高压氧组的(48．6&;#177;12．2)cm／s明显加快(P&;lt;0．05)。正中神经电刺激+高压氧组基底动脉平均血流速度为(28．4&;#177;5．3)cm／s，较高压氧组的(25．1&;#177;4．9)cm／s明显加快(P&;lt;0．05)。结论：正中神经电刺激治疗创伤性持续植物状态的机制主要是加快脑血流速度。正中神经电刺激，高压氧对持续性植物状态(persistent vegetative state，PVS)有较好的促醒作用，联合应用效果更好。在无高压氧治疗条件的医院正中神经电刺激可以替代高压氧治疗PVS，而更利于PVS的康复治疗。     

高压氧联合正中神经电刺激对植物状态患者的促醒疗效观察

目的：探索高压氧联合正中神经电刺激对植物状态患者的促醒疗效。方法：共纳入60例植物状态患者,随机分为对照组和观察组各30例。2组患者均接受正中神经电刺激,观察组加用高压氧治疗,对照组给与常规氧疗。治疗前后,分别记录2组患者的苏醒率,评估2组患者修订昏迷恢复量表（CRS-R）、全面无反应评分量表（FOUR）、脑电图（EEG）及扩展格拉斯哥结局量表（GOS-E）。结果：治疗4周后,对照组有8例（26.7%）患者CRS-R达到最小意识状态,观察组患者有13例（43.3%）患者CRS-R达到最小意识状态。2组苏醒率比较差异无统计学意义（χ2=1.832,P=0.176）。治疗后,2组患者CRS-R评分、FOUR评分EEG分级均较治疗前明显升高（P＜0.01）,且观察组均高于对照组（P＜0.01）。治疗后,2组患者GOS-E评分均较治疗前明显升高（P＜0.01）,但2组间比较差异无统计学意义。结论：高压氧联合正中神经电刺激可以改善植物状态患者的意识水平及预后。     

正中神经刺激治疗颅脑损伤后持续性植物状态7例报告

目的　对于持续性植物状态（ＰＶＳ） 的治疗,目前尚无满意的方法,我们应用正中神经刺激（ＭＮＳ）对７ 例颅脑损伤后ＰＶＳ促醒治疗,旨在探索其应用价值。方法　对７ 例ＰＶＳ患者应用国产低频诊疗仪行低频脉冲电刺激,刺激电极置于双侧腕关节掌面正中神经点,刺激前后检测脑电图（ＥＥＧ）、脑干诱发电位（ＢＡＥＰ） 。结果　３ 例意识恢复,４ 例无变化,患者ＥＥＧ、ＢＡＥＰ 均缺乏特异性,但ＢＡＥＰ的改善与临床的好转是一致的。结论　本组病例尚少,但可看出ＭＮＳ对ＰＶＳ的促醒具有一定的作用,值得进一步研究。     

高压氧综合治疗对持续性植物状态的促醒作用评价

目的探讨高压氧综合药物、物理治疗等对持续性植物状态(persistentvegetativestate,PVS)的促醒作用。方法沪州医学院附属医院2002-07/2004-07住院的50例PVS患者,随机分为高压氧综合治疗组(高压氧组)和单纯常规治疗组(常规组),前者接受高压氧结合常规治疗,后者仅接受常规治疗,对两组患者在治疗3个月后进行PVS评分,并进行比较。结果高压氧组治疗后有效率达81%(21/26),明显优于常规组(P<0.05)。结论高压氧综合治疗对PVS有明显的促醒作用。     

昏迷刺激疗法在持续植物状态促醒治疗中的应用

昏迷刺激疗法(comas timulation programs，CSP)对脑损伤形成的持续植物状态患者是一项非常重要的康复内容。昏迷刺激疗法的基本原理、治疗原则、刺激技术和现代临床研究进展，提示了该疗法的方便，及有效性。特别在当前医学对持续植物状态(persistent vegetative state，PVS)还没有找到有效的治疗方法的情况下，CSP应该被重视。     

颅脑损伤后持续植物状态52例的促醒护理

颅脑损伤后持续植物状态的促醒护理,目前国内外尚无成熟方案,国内报道护理自缢、药物中毒及外伤后持续植物状态,1个月~1 a促醒率约为35%[1];国外报道脑外伤后持续植物状态6个月~1 a,意识恢复的概率约1.6%[2],疗效均不满意。我科自2007-01-2010-12共收治颅脑损伤后持续植物状态患     

昏迷刺激疗法在持续植物状态促醒治疗中的应用

昏迷刺激疗法(comastimulationprograms,CSP)对脑损伤形成的持续植物状态患者是一项非常重要的康复内容。昏迷刺激疗法的基本原理、治疗原则、刺激技术和现代临床研究进展,提示了该疗法的方便,及有效性。特别在当前医学对持续植物状态(persistentvegetativestate,PVS)还没有找到有效的治疗方法的情况下,CSP应该被重视。     

不同参数的正中神经电刺激对意识障碍患者促醒的影响

目的:研究不同参数的正中神经电刺激(MNES)对意识障碍患者促醒的影响.方法:选取160例格拉斯哥昏迷量表(GCS)≤8分的意识障碍患者,随机分为对照组(n=40)、试验1组(n=40)、试验2组(n=40)和试验3组(n=40).对照组使用常规促醒方案治疗;试验组在此基础上联合MNES.试验1组电刺激脉宽参数为50μ...     

持续植物状态的中枢刺激促醒疗法

随着诊疗方法、微创外科技术、重症监护及社会紧急救护系统的发展 ,降低了一些危重疾病的死亡率。但是 ,随着死亡率的降低 ,也产生了新的社会及医学问题———持续植物状态 (ｐｅｒｓｉｓ ｔｅｎｔｖｅｇｅｔａｔｉｖｅｓｔａｔｅ ,ＰＶＳ)患者明显增多。ＰＶＳ是因大脑半球严重损伤 ,皮层功能丧失而脑干相对完好 ,处于皮层下生存的一种临床综合征。ＰＶＳ康复治疗过程中 ,促醒、认知功能的改善是主要的康复目标之一。其治疗手段主要包括维持营养、防止并发症及各种促醒技术的运用。本文就ＰＶＳ的各种刺激促醒疗法综述如下。一、刺激疗法的…     

高压氧配合康复治疗促进持续性植物状态患者的意识恢复

56例持续性植物状态患者综合治疗的同时采用高压氧和康复治疗,对照组26例只予一般综合治疗。结果高压氧和康复治疗组的疗效明显优于对照组。提示高压氧和康复治疗对持续性植物状态有较好的促醒作用。     

正中神经电刺激对脑外伤后昏迷患者促醒作用的临床及机制研究

目的:探讨正中神经电刺激(median nerve electrical stimulation,MNS)对脑外伤(traumatic brain injury,TBI)后昏迷患者的促醒作用及可能机制。方法:将60例脑损伤后昏迷患者随机分为试验组(n=30)和对照组(n=30),两组均给予常规促醒治疗,试验组在常规治疗的基础上加用MNS治疗。两组治疗前后均行格拉斯哥昏迷评分(Glasgow coma scale,GCS)和脑电图(electroencephalograph,EEG)及单光子发射计算机化断层显像(SPECT)检查。结果:治疗4W后试验组平均GCS评分明显优于对照组,差异有显著性意义(P0.05);试验组脑电图病灶侧δ/θ活动减少,α波波幅降低;SPECT视觉分析表明治疗后试验组病灶区脑血流量较治疗前明显增加,半定量分析显示病灶区(右ROI—左ROI)/右ROI%也较治疗前平均提高12.34%±0.36%,差异有显著性意义(P0.05)。结论:MNS对TBI后昏迷患者具有促醒作用,其机制可能与病灶区脑血流灌注增加有关。     

Left-hemisphere-dominant SII activation after bilateral median nerve stimulation

We used bilateral median nerve stimuli to find out possible hemispheric dominance in the activation of the second somatosensory cortex, SII. Somatosensory evoked fields (SEFs) were recorded from 14 healthy adults (7 right-handed, 7 left-handed) with a 306-channel neuromagnetometer. Electrical stimuli were applied once every 3 s simultaneously either to the left and right median nerves at the wrists or to the palmar skin of both thumbs. Sources of SEFs were modeled with four current dipoles, located in the SI and SII cortices of both hemispheres. The SI activation strengths did not differ between the hemispheres, whereas the SII responses were significantly stronger in the left than in the right hemisphere. In right-handers, the left/right SII ratios were 1.9 and 1.8 for wrist and thumb stimuli, respectively. The corresponding values were 1.5 and 1.7 in left-handers. The results indicate handedness-independent functional specialization of the human SII cortices.     

正中神经电刺激治疗意识障碍患者有效性的Meta分析

目的:系统评价经正中神经电刺激(Median nerve electrical stimulation,MNES)治疗意识障碍患者的有效性。方法:计算机检索Te Cochrane Library、PubMed、EMbase、CNKI、CBM、VIP和WanFang Data数据库,收集有关正中神经电刺激治疗意识障碍患者的随机对照试验(RCT),检索时限均为建库至2015年5月。由2位研究者独立进行文献筛选、资料提取和评价纳入研究的方法学质量后,采用RevMan 5.3软件进行Meta分析。结果:共纳入9个研究768例患者,其中观察组383例,对照组380例。Meta分析结果显示,观察组在治疗后格拉斯评分(glasgow coma scale,GCS)提高,治疗后1周[MD=2.24,95%CI(1.47,3.01),P0.01]、2周[MD=1.40,95%CI(0.64,2.16),P0.01]和4周[MD=2.17,95%CI(1.56,2.78),P0.01]的GCS评分提高水平均优于对照组,有统计学意义;2组在刺激后苏醒率比较,观察组优于对照组[RR=1.43,95%CI(1.20,1.72),P0.01],有统计学意义。结论:现有证据表明,经正中神经电刺激治疗意识障碍患者的有效性高于对照组,但是受纳入研究的质量和数量限制,上述结论尚需今后开展更多高质量、大样本、设计严格的RCT进行验证。     

The event-related optical signal to electrical stimulation of the median nerve

The event-related optical signal (EROS) uses near-infrared light to study changes in neuronal optical properties in response to stimuli and endogenous events. EROS responses to electrical stimulation of the median nerve at 1, 5, and 8 Hz were collected from 80 channels in 7 subjects. Optical recording channels were spatially aligned by co-registering the digitized fiber locations with structural magnetic resonance images (MRI) for each subject separately. The co-registered data sets were then transformed into Talairach space to permit alignment across subjects. After alignment, data from channels underlying pixels of a surface projection were combined to produce maps of Z statistics. Waveforms associated with voxels within an a priori region of interest (ROI) over the hand area of primary somatosensory (SI) cortex were compared across the three stimulus frequencies. Reliable early increases in light propagation time (i.e., increased phase delay) were found in SI as early as 16-32 ms of poststimulus for all three frequency conditions, and both an increase in phase delay and a decrease in signal intensity were observed over SI at longer latencies. A split-half analysis of the 8 Hz condition demonstrated the replicability of the response. This represents the first direct comparison of intensity and delay measures of these components of the somatosensory response; further, it shows that these early cortical components are replicable across subjects and correspond well to individual subjects' anatomical landmarks for SI.     

Transcutaneous electrical nerve stimulation after cesarean birth

The purpose of this study was to determine if women who had Cesarean birth experiences and used transcutaneous electrical nerve stimulation as a means of pain control requested less pain medication and had shorter hospital stays than those who did not use TENS. I reviewed the medical charts of 72 women (46 using TENS, 26 not using TENS) retrospectively. Significantly less (F = 5.77; df = 1,65; p less than .02) meperidine hydrochloride was administered to the women who used TENS. The length of hospital stay of women using TENS was not significantly different than those who did not use TENS. My findings suggest that the use of TENS after Cesarean birth may result in decreased usage of medication and, therefore, a reduction of the side effects of the medication both to the mother and the infant.     

Telethermographic findings after transcutaneous electrical nerve stimulation

The purpose of this study was to determine whether some types of transcutaneous electrical nerve stimulation cause local vasodilation. The amount of vascular perfusion was monitored using telethermography to gauge the skin temperature of the area to which TENS was applied. We studied the effects of four different modalities of TENS (intensities of 1.5 and 3 times the sensory threshold and frequencies of 3 pulses per second [pps] and 100 pps), delivered through small and large electrodes (1.5 cm and 4 cm in diameter), on 10 healthy subjects. Stimulation at 3 times the sensory threshold produced local hyperthermia, which was maximal when a current of 100 pps was delivered through small electrodes. Because any physical or chemical effects of the current could be eliminated as causes of hyperthermia, the rise in skin temperature was considered to be a result of increased vascular perfusion. The results of the study demonstrate that some types of TENS cause local vasodilation. This effect may represent another mechanism by which such techniques provide pain relief, particularly in the treatment of myofascial syndromes.     

脑外伤后持续性植物状态的动物模型(英文)

目的制作一种新的猫脑损伤后持续性植物状态模型,观察其临床特征。方法将40只猫行硬膜外水囊置放术,然后向水囊内注入无菌水直到昏迷,并对动物模型进行评估。结果手术1个月后,有12只猫处于植物状态,动物模型的临床表现、体征等与持续性植物状态患者相近。结论本实验制作的持续性植物状态动物模型与临床患者相似,是一种比较理想的持续性植物状态动物模型。