右正中神经电刺激联合高压氧对术后重型颅脑外伤患者的疗效及生存质量和运动能力的影响

罗灼明 孟兵 方志伟

【摘要】 目的：研究右正中神经电刺激联合高压氧对术后重型颅脑外伤患者的疗效及生存质量和运动能力的影响。方法：选取2016年9月-2018年9月于本院进行治疗重型颅脑外伤的60例患者，按非随机同期病例对照的原则分为试验组和对照组，每组30例。对照组给予高压氧等常规治疗，试验组在对照组治疗的基础上给予右正中神经电刺激治疗。对比两组治疗后3个月的清醒率、生存质量、格拉斯哥昏迷评分量表（GCS）、格拉斯哥预后量表（GOS）、功能障碍评分（DRS）及不良反应。结果：试验组清醒率高于对照组（P<0.05）;两组治疗后生存质量、GCS、GOS评分均高于治疗前，且试验组均高于对照组（P<0.05）;两组治疗后DRS评分低于治疗前，且试验组DRS评分低于对照组（P<0.05）;试验组不良反应发生率低于对照组（P<0.05）。结论：右正中神经电刺激联合高压氧治疗术后重型颅脑外伤患者能有效改善患者症状，提高生活质量，改善功能，促进患者苏醒。

【关键词】 右正中神经电刺激; 高压氧; 重型颅脑外伤; 生存质量

【Abstract】 Objective：To study the effect of right median nerve stimulation combined with hyperbaric oxygen on the efficacy，quality of life and exercise capacity of patients with postoperative severe craniocerebral trauma.Method：60 patients with severe craniocerebral trauma treated in our hospital from September 2016 to September 2018 were selected.They were divided into experimental group and control group according to the principle of non-randomized case-control，30 cases in each group.The control group was given routine treatment，and the experimental group was given the right median nerve stimulation treatment on the basis of the control group.The awake rate，quality of life，Glasgow coma scale（GCS），Glasgow outcome scale（GOS），dysfunction score（DRS）and adverse events were compared between the two groups at 3 months after treatment.Result：The awake rate of the experimental group was higher than that of the control group（P<0.05）.The quality of life，GCS and GOS scores of the two groups after treatment were higher than those before treatment，the experimental group of those were higher than those of the control group（P<0.05）.The DRS scores of the two groups after treatment were lower than those before treatment，the DRS scores of the experimental group was lower than that of the control group （P<0.05）.The incidence of adverse reactions in the the experimental group was lower than that in the control group（P<0.05）.Conclusion：Right median nerve electrical stimulation combined with hyperbaric oxygen therapy for patients with postoperativesevere craniocerebral trauma can effectively improve the patients symptoms，the quality of life，the function，and promote the patients recovery.

【Key words】 Right median nerve stimulation; Hyperbaric oxygen; Severe craniocerebral trauma; Quality of life

First-authors address：Dongguan Peoples Hospital，Dongguan 523000，China

doi：10.3969/j.issn.1674-4985.2019.16.002

重癥颅脑损伤是神经外科常见危急重症，包括重型颅脑创伤、重症脑血管病、缺血缺氧性脑病等，其可导致大脑结构损伤，肢体功能障碍，甚至出现昏迷、植物生存状态，进而增加病死率，给家庭和社会带来了沉重的负担[1]。临床中手术是治疗本病的最有效方法，但术后易出现昏迷症状，由于其机制尚未明确，临床中缺乏针对性救治措施，进而影响患者的生存质量[2-3]。近年来，右正中神经电刺激治疗颅脑损伤凸显出其优势[4]。本院采用右正中神经电刺激联合高压氧治疗术后重型颅脑外伤患者取得了较好的效果，现报道如下。

1 资料与方法

1.1 一般资料 选取2016年9月-2018年9月于本院进行治疗重型颅脑外伤的60例患者作为研究对象。纳入标准：（1）入组前1～2周因闭合性颅脑创伤住院的昏迷患者;（2）格拉斯哥昏迷评分量表（GCS）：4～8分;（3）年龄18～65周岁。……