摘要
目的 探究高频重复经颅磁刺激联合高压氧对颅脑损伤后昏迷患者预后、意识障碍程度及血清水通道蛋白1(AQP-1)水平的影响.方法 前瞻性将2021年3月至2023年5月在沧州市人民医院就诊的88例颅脑损伤后昏迷患者纳入研究.按照随机数字表法将其分为对照组(n=44)和研究组(n=44).对照组采用高压氧治疗,研究组在对照组的基础上联合高频重复经颅磁刺激治疗.检测并比较两组患者治疗前、治疗4周后血清AQP-1、超氧化物歧化酶(SOD)、乳酸脱氢酶(LDH)、C反应蛋白(CRP)、胶质纤维酸性蛋白(GFAP)、脑源性神经营养因子(BDNF)、神经元特异性烯醇化酶(NSE)水平;用格拉斯哥昏迷评分量表(GCS)、昏迷恢复修订量表(CRS-R)评估患者治疗前后的意识状态,并统计两组患者清醒率及清醒时间、昏迷期间并发症情况以及不良反应.结果 研究组治疗4周后血清AQP-1、LDH、CRP 水平分别为(21.24±6.61)μg/L、(246.61±32.88)U/L、(24.70±4.37)mg/L,均显著低于对照组[(26.33±7.86)μg/L、(295.73±50.09)U/L、(30.88±5.92)mg/L],SOD 水平为(27.56±7.62)U/mL,显著高于对照组[(20.19±4.68)U/mL],差异均有统计学意义(P＜0.05).研究组患者治疗4周后GFAP、NSE水平分别为(2.07±0.68)、(3.81±1.16)ng/mL,均显著低于对照组[(4.49±1.13)、(7.20±1.44)ng/mL],BDNF 水平为(2.64±0.89)ng/mL,高于对照组[(1.87±0.51)ng/mL],差异均有统计学意义(P＜0.05).研究组患者治疗4周后GCS评分与CRS-R评分分别为(12.39±3.05)、(19.66±4.89)分,均显著高于对照组[(9.17±2.46)、(14.94±3.55)分],差异均有统计学意义(P＜0.05).研究组意识清醒时间为(22.36±5.74)d,显著短于对照组[(28.18±8.25)d,清醒率为93.18％,显著高于对照组(77.27％),并发症发生率为13.64％,显著少于对照组(38.63％),差异均有统计学意义(P＜0.05).两组不良反应发生率比较,差异无统计学意义(P＞0.05).结论 联合高频重复经颅磁刺激与高压氧治疗可以有效改善颅脑损伤后昏迷患者意识状态,降低血清AQP-1水平,缩短患者意识清醒时间.
Abstract
Objective To investigate the impacts of high-frequency repetitive transcranial magnetic stimulation combined with hyperbar-ic oxygenation on the prognosis,degree of consciousness disorders,and serum aquaporin-1(AQP-1)level in comatose patients with craniocere-bral trauma.Methods A prospective study was conducted on 88 comatose patients with craniocerebral trauma who visited Cangzhou People's Hos-pital from March 2021 to May 2023.According to the random number table method,they were divided into the control group(n=44)and the study group(n=44).The control group received hyperbaric oxygenation therapy,while the study group received high-frequency repetitive tran-scranial magnetic stimulation on the basis of the control group.The levels of serum AQP-1,superoxide dismutase(SOD),lactate dehydrogenase(LDH),C-reactive protein(CRP),glial fibrillary acidic protein(GFAP),brain-derived neurotrophic factor(BDNF),and neuron specific enolase(NSE)were detected and compared between two groups of patients before treatment and after 4 weeks of treatment.The Glasgow Coma Scale(GCS)and Revised-Coma Recovery Scale(CRS-R)were applied to evaluate the patient's state of consciousness before and after 4 weeks of treatment,the wakefulness rate,wakefulness time,complications during coma,and adverse reactions of the two groups were statistically analyzed.Results After 4 weeks of treatment,the serum levels of AQP-1,LDH,and CRP in the study group were(21.24±6.61)pg/L,(246.61±32.88)U/L,and(24.70±4.37)mg/L,respectively,which were significantly lower than those in the control group[(26.33±7.86)]μg/L,(295.73±50.09)U/L,(30.88±5.92)mg/L],the level of SOD was(27.56±7.62)U/mL,which was significantly higher than that in the control group[(20.19±4.68)U/mL],and the differences were statistically significant(P＜0.05).After 4 weeks of treatment,the levels of GFAP and NSE in the study group were(2.07±0.68)and(3.81±1.16)ng/mL,respectively,which were significantly lower than those in the control group[(4.49±1.13)and(7.20±1.44)ng/mL],the level of BDNF was(2.64±0.89)ng/mL,which was higher than that in the control group[1.87±0.51)ng/mL],and the differences were statistically significant(P＜0.05).After 4 weeks of treatment,the GCS score and CRS-R score of the study group patients were(12.39±3.05)and(19.66±4.89)points,respectively,which were significantly higher than those of the control group[(9.17±2.46)and(14.94±3.55)points],and the differences were statistically significant(P＜0.05).The wakefulness time of the study group was(22.36±5.74)d,which was obviously shorter than that of the control group[(28.18±8.25)d],and the wakefulness rate of the study group was 93.18％,which was obviously higher than that of the control group(93.18％),but the incidence of complications of the study group was 13.64％,which was obviously lower than that of the control group(38.63％),and the differences were sta-tistically significant(P＜0.05).There was no statistically significant difference in adverse reactions between the two groups(P＞0.05).Conclusion The combination of high-frequency repetitive transcranial magnetic stimulation and hyperbaric oxygenation therapy can effectively improve the consciousness state of comatose patients with craniocerebral trauma,reduce serum AQP-1 level,and shorten the time for patients to wake up.
基金项目
河北省卫生健康委重点研发指导项目(20200281)
维普
万方数据