Effects of rTMS Combined with Hyperbaric Oxygen on Inflammatory Factors, Cognitive Function and Cerebral Blood Flow in Comatose Patients with Severe Craniocerebral Injury
ZHAO Dong-sheng, XU Feng, BIE Xiao-hua,et al
Department of Functional Neurosurgery,Xi'an Honghui hospital,Xi'an 710000,Shaanxi
摘要【目的】探讨重复经颅磁刺激技术(repeated transcranial magnetic stimulation,rTMS)联合高压氧治疗对重型颅脑损伤昏迷患者炎症因子、认知功能及脑血流的影响。【方法】选择2017年10月至2020年2月本院收治的120例重型颅脑损伤昏迷患者,根据随机数表法分为观察组和对照组,各60例。分别采用rTMS治疗和rTMS联合高压氧治疗,并对比两组患者脑电图(EEG)以及治疗后各时间段的炎症因子、脑血流动力学、格拉斯哥昏迷量表评分(GCS)、修订版昏迷恢复量表评分(CRS-R)、简易智力状态检查量表评分(MMSE)的变化情况。【结果】治疗后2周和4周,观察组患者GCS评分分别为(10.49±3.26)分和(13.87±1.41)分;CRS-R评分分别为(16.49±3.62)分和(21.32±1.39)分,两组间比较差异具有统计学意义(P<0.05)。观察组患者治疗后4周的MMSE总分为(27.46±2.46)分,高于对照组的(23.39±2.33)分,其差异具有统计学意义(P<0.05)。治疗后2周和4周患者脑血管平均血流速度(Vm)、舒张期末血流速度(Vd)、大脑中动脉收缩期峰流速(Vs)、搏动指数(PI)、白介素-6(IL-6)、肿瘤坏死因子(TNF-α)、C反应蛋白(CRP)改变情况均优于对照组(P<0.05)。【结论】rTMS联合高压氧治疗重型颅脑损伤昏迷患者临床疗效显著,可下调患者炎症因子水平,改善脑血流,促使其认知功能恢复。
Abstract：【Objective】To explore the effect of repeated transcranial magnetic stimulation(rTMS) combined with hyperbaric oxygen treatment on inflammatory factors, cognitive function and cerebral blood flow in patients with severe head injury caused by coma. 【Methods】 A total of 120 comatose patients with severe craniocerebral injury treated in our hospital from October 2017 to February 2020 were randomly divided into observation group and control group, with 60 cases in each group. RTMS and rTMS combined with hyperbaric oxygen were used respectively. The changes of electroencephalogram(EEG), inflammatory factors, cerebral hemodynamics, Glasgow Coma Scale score(GCS), revised coma recovery scale score(CRS-R) and mini mental state examination scale score(MMSE) were compared between the two groups. 【Results】At 2 and 4 weeks after treatment, the GCS scores of the observation group were(10.49±3.26) and(13.87±1.41) respectively; The crs-r scores were(16.49±3.62) and(21.32±1.39) respectively. There was significant difference between the two groups(P<0.05). The total MMSE score of the observation group 4 weeks after treatment was(27.46±2.46), which was significantly higher than that of the control group(23.39±2.33)(P<0.05). At 2 and 4 weeks after treatment, the mean cerebral blood flow velocity(Vm), end diastolic blood flow velocity(Vd), middle cerebral artery peak systolic velocity(Vs), pulsatility index(PI), interleukin-6(IL-6) and tumor necrosis factor(TNF-α) and C-reactive protein(CRP) were better than those in the control group(P<0.05).【Conclusion】rTMS combined with hyperbaric oxygen is effective in the treatment of comatose patients with severe craniocerebral injury. It can reduce the level of inflammatory factors, improve cerebral blood flow and promote the recovery of cognitive function.
[1] ANSADO J, BLUNT A, CHEN J K, et al.Impact of non-invasive brain stimulation on transcallosal modulation in mild traumatic brain injury: a multimodal pilot investigation[J].Brain Inj,2019,33(8):1021-1031. [2] SIDDIQI S H,TRAPP N T,HACKER C D, et al.Repetitive transcranial magnetic stimulation with resting-state network targeting for treatment-resistant depression in traumatic brain injury: a randomized, controlled, double-blinded pilot study[J].J Neurotrauma,2019,36(8):1361-1374. [3] SIDDIQI S H, TRAPP N T, SHAHIM P, et al.Individualized connectome-targeted transcranial magnetic stimulation for neuropsyc hiatric sequelae of repetitive traumatic brain injury in a retired NFL player[J].J Neuropsychiatry Clin Neurosci,2019,31(3):254-263. [4] WILLIAM B R, Duncan W , Zant E, et al.The national brain injury rescue and rehabilitation study - a multicenter observational study of hyperbaric oxygen for mild traumatic brain injury with post-concussive symptoms[J].Med Gas Res,2019,9(1):1-12. [5] 焦保华, 赵宗茂.《第4版美国重型颅脑损伤诊疗指南》解读[J].河北医科大学学报,2018,39(2):125-128. [6] LEUNG A, SHUKLA S, FALLAH A, et al.Repetitive transcranial magnetic stimulation in managing mild traumatic brain injury-related headaches[J].Neuromodulation,2016,19(2):133-141. [7] 邱治春,王恩任. 早期高压氧治疗对中重型颅脑损伤患者临床预后及血清NSE,S100B的影响[J].临床外科杂志,2018,26(7):504-506. [8] RETI I M, SCHWARZ N, Bower A, et al.Transcranial magnetic stimulation: A potential new treatment for depression associated with traumatic brain injury[J].Brain Inj,2015,29(7-8):789-797. [9] GONZALES-PORTILLO B, LIPPERT T, NGUYE H.Hyperbaric oxygen therapy: A new look on treating stroke and traumatic brain injury[J].Brain Circ,2019,5(3):101-105. [10] LIPPERT T, BORLONGAN C V.Prophylactic treatment of hyperbaric oxygen treatment mitigates inflammatory response via mitochondria transfer[J].CNS Neurosci Ther,2019,25(8):815-823. [11] KOPACHKA M, TROSHINA E, SHAROVA E, et al.P222 Diagnostic and therapeutic possibilities of transcranial magnetic stimulation in patients after traumatic brain injury[J].Clin Neurophysiol,2017,128(9):e249-e250. [12] 徐磊, 林荣, 胡雅寒,等.针刺五心穴结合高压氧对颅脑外伤昏迷患者促醒作用的临床研究[J].中国中医急症, 2018, 27(012):2145-2147. [13] HOY K E,MCQUEEN S,ELLIOT D, et al.A pilot investigation of repetitive transcranial magnetic stimulation for post-traumatic brain injury depression: safety, tolerability, and efficacy[J].J Neurotrauma,2019,36(13):2092-2098. [14] DALY S, THORPE M, ROCKSWOLD S, et al.Hyperbaric oxygen therapy in the treatment of acute severe traumatic brain injury: a systematic review[J].J Neurotrauma,2018,35(4):623-629. [15] GUEDES V A,EVE D J,LISKA, M G, et al.Hyperbaric oxygen therapy effects on traumatic brain injury-associated behavioral impairments[J].Cell Transplant,2017,26(4):712.
2021, Vol. 38 
