Department of Rehabilitation Medicine, Lanzhou University Second Hospital, Lanzhou 730000, China.
J Healthc Eng. 2022 Apr 12;2022:6133626. doi: 10.1155/2022/6133626. eCollection 2022.
Coma caused by craniocerebral injury is a common condition of neurosurgical acute injury. There is no specific method to promote awakening in a clinic. Early comprehensive treatment may be helpful to patients. The common methods are hyperbaric oxygen (HBO) and low-frequency repetitive transcranial magnetic stimulation (rTMS). However, the application effect and mechanism of rTMS combined with HBO on coma patients with traumatic brain injury need to be further studied. The brain stem auditory evoked potential (BAEP) is examined by the Kennedy coma recovery scale (CRS-R), the recovery of brain function and the state of consciousness are evaluated, and the therapeutic effect is evaluated by the Glasgow Coma Scale (GCS). Cerebrospinal fluid NE level, MCA blood flow velocity, and left brainstem and right brainstem auditory evoked potential are used to evaluate brain rehabilitation. RTMS combined with HBO could shorten the wake-up time, improve the wake-up rate, improve the GCS score and CRS-R score, shorten the brain wave latency time of the left and right brainstem, increase the NE level of cerebrospinal fluid, and decrease the blood flow velocity of MCA. RTMS combines with HBO can improve the nerve excitability of brain cells, reduce the disturbance of consciousness, promote the functional recovery of brain injury, and has a certain role in promoting the awakening of patients with traumatic brain injury coma.
颅脑损伤导致的昏迷是神经外科急性损伤的常见情况。目前临床上尚无促进意识恢复的特效方法,早期综合治疗可能对患者有益,常见方法有高压氧(HBO)和低频重复经颅磁刺激(rTMS)等,但 rTMS 联合 HBO 对颅脑损伤昏迷患者的应用效果及机制仍需进一步研究。采用 Kennedy 昏迷恢复量表(CRS-R)检查脑干听觉诱发电位(BAEP),评估脑功能恢复及意识状态,以格拉斯哥昏迷量表(GCS)评估治疗效果。通过检测脑脊液去甲肾上腺素(NE)水平、大脑中动脉(MCA)血流速度及左、右脑干听觉诱发电位,评估脑康复情况。rTMS 联合 HBO 可缩短患者觉醒时间,提高觉醒率,改善 GCS 评分及 CRS-R 评分,缩短左、右脑干脑电波潜伏期,增加脑脊液 NE 水平,降低 MCA 血流速度。rTMS 联合 HBO 可提高脑细胞神经兴奋性,减轻意识障碍,促进脑损伤功能恢复,对促进颅脑损伤昏迷患者的觉醒有一定作用。