Berezina I Yu, Badalyan A V, Sumsky L I, Gol'dfarb Yu S
Sklifosovsky Research Institute for Emergency Medicine, Public Healthcare Institution of Moscow Healthcare Department, Moscow, Russia.
Sklifosovsky Research Institute for Emergency Medicine, Public Healthcare Institution of Moscow Healthcare Department, Moscow, Russia; Russian Medical Academy of Postgraduate Education, Federal Public Educational Institution of Additional Professional Postgraduate Education of Russian Federation Healthcare Ministry, Moscow, Russia.
Zh Nevrol Psikhiatr Im S S Korsakova. 2017;117(2):53-63. doi: 10.17116/jnevro20171172153-63.
To evaluate the dynamics of functional activity of brain structures underlying cognitive functions in patients with encephalopathy due to poisoning with neurotoxicants on the stage of rehabilitation.
Fifty-six patients were examined. The main group consisted of 40 patients treated with intravenous injections with mexidol (n=10), combination of mexidol with non-pharmacological methods - mesodiencephalic modulation (MDM) (n=10), hyperbaric oxygenation (HBO) (n=10) and the combination of MDM and HBO (n=10). The comparison group included 16 people. All patients underwent neurophysiological (EEG, auditory event-related potentials) and neuropsychological examinations.
Marked EEG changes were noted in all patients. The domination of disturbances of functional activity on the diencephalic or mesodiencephalic levels was observed. After treatment, positive changes were found in 60% of patients. The positive dynamics was observed in 80% patients when the combination of mexidol, MDM and HBO was used. The negative dynamics was noted in 5 (12,5%) of patients of the main group, in particular when mexidol only was used. The results of the primary neuropsychological study revealed that cognitive impairment of different severity was found in 97,5% of patients of the main group and 100% of patients of the comparison group. After treatment, performance on neuropsychological tests improved by 62,5%, N200 and P300 latencies reduced, while the amplitudes increased, in the patients of the main group.
The use of mexidol, MDM and HBO in the treatment of patients with encephalopathy due to poisoning with neurotoxicants on the stage of rehabilitation improved the indicators of functional brain activity and cognitive functions.
评估神经毒物中毒所致脑病康复期患者认知功能相关脑结构功能活动的动态变化。
对56例患者进行了检查。主要组包括40例患者,分别接受静脉注射美西律(n = 10)、美西律与非药物方法(中脑间脑调制,MDM)联合治疗(n = 10)、高压氧治疗(HBO)(n = 10)以及MDM与HBO联合治疗(n = 10)。对照组包括16人。所有患者均接受了神经生理学(脑电图、听觉事件相关电位)和神经心理学检查。
所有患者脑电图均有明显变化。观察到间脑或中脑间脑水平功能活动障碍占主导。治疗后,60%的患者有积极变化。当使用美西律、MDM和HBO联合治疗时,80%的患者有积极动态变化。主要组5例(12.5%)患者出现消极动态变化,尤其是仅使用美西律时。初步神经心理学研究结果显示,主要组97.5%的患者和对照组100%的患者存在不同严重程度的认知障碍。治疗后,主要组患者神经心理学测试成绩提高了62.5%,N200和P300潜伏期缩短,波幅增加。
在神经毒物中毒所致脑病康复期患者的治疗中,使用美西律、MDM和HBO可改善脑功能活动指标和认知功能。