Yang Jinkun, Li Xijuan, Yang Xueping, Zhu Tao, Ou Shan
Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
Department of Anesthesiology, Chengdu First People's Hospital, Chengdu, Sichuan, China.
Neurocrit Care. 2024 Oct 24. doi: 10.1007/s12028-024-02141-9.
Traumatic brain injury (TBI) is widely recognized as a major cause of death and disability. Optimizing recovery from coma is a priority for improving patient prognosis. Recently, an increasing number of studies have demonstrated that median nerve electrical stimulation (MNES) may be a potential approach for comatose patients awakening with TBI, although the results of these studies are not consistent. The aim of this study was to evaluate the effects of the MNES on recovery from coma in patients with TBI based on data from randomized controlled trials. The PubMed, Embase, Ovid MEDLINE, Cochrane Library, and China National Knowledge Infrastructure electronic databases were systematically searched from their inception to July 2023 using specific keywords. The χ test and I test were used to evaluate the heterogeneity across these studies. The mean differences with 95% confidence intervals (CIs) and relative risk (RR) with 95% CIs were adopted to analyze the continuous outcomes and binary outcomes, respectively. A total of 1831 patients from 18 studies were included in this meta-analysis. There were significant differences in the proportions of patients who regained consciousness between the MNES group and the control group after treatment (RR 1.36, 95% CI 1.18-1.56; P < 0.001) and at 6 months after injury (RR 1.31, 95% CI 1.16-1.47; P < 0.001). MNES significantly improved the Glasgow Coma Scale score (mean difference 2.38, 95% CI 1.78-2.98; P < 0.001). Furthermore, no significant differences in complications between the two groups of patients were observed, including pneumonitis (RR 0.86, 95% CI 0.72-1.03; P = 0.107), seizures (RR 1.24, 95% CI 0.49-3.10; P = 0.651), or gastric hemorrhage (RR 1.08, 95% CI 0.60-1.93; P = 0.795).The results of the present study indicate that patients with TBI in the MNES group recovered from coma more rapidly after treatment and at 6 months after injury. These results suggest that MNES is an effective approach for coma awakening after TBI.
创伤性脑损伤（TBI）被广泛认为是死亡和残疾的主要原因。优化昏迷后的恢复是改善患者预后的首要任务。最近，越来越多的研究表明，正中神经电刺激（MNES）可能是促进TBI昏迷患者苏醒的一种潜在方法，尽管这些研究结果并不一致。本研究的目的是基于随机对照试验的数据，评估MNES对TBI患者昏迷恢复的影响。使用特定关键词，对PubMed、Embase、Ovid MEDLINE、Cochrane图书馆和中国知网电子数据库从创建至2023年7月进行了系统检索。采用χ检验和I检验评估这些研究之间的异质性。分别采用95%置信区间（CI）的平均差和95%CI的相对风险（RR）分析连续结局和二分结局。本荟萃分析共纳入了来自18项研究的1831例患者。治疗后，MNES组和对照组之间意识恢复患者的比例存在显著差异（RR 1.36，95%CI 1.18-1.56；P < 0.001），在受伤后6个月时也存在显著差异（RR 1.31，95%CI 1.16-1.47；P < 0.001）。MNES显著提高了格拉斯哥昏迷量表评分（平均差2.38，95%CI 1.78-2.98；P < 0.001）。此外，两组患者在并发症方面未观察到显著差异，包括肺炎（RR 0.86，95%CI 0.72-1.03；P = 0.107）、癫痫发作（RR 1.24，95%CI 0.49-3.10；P = 0.651）或胃出血（RR 1.08，95%CI 0.60-1.93；P = 0.795）。本研究结果表明，MNES组的TBI患者在治疗后和受伤后6个月从昏迷中恢复得更快。这些结果表明，MNES是TBI后昏迷苏醒的一种有效方法。
