CAJ | 학술논문

目的探讨脑深部电刺激(DBS)和脊髓电刺激(SCS)神经调控治疗对持续性植物状态患者的促醒作用. 方法自2011年7月至2012年12月北京军区总医院共收治持续性植物状态患者53例,筛选后入组42例.其中男27例,女15例;平均(42.9±5.47)岁.按照患者病情及家属意愿将其分为对照组20例,手术组22例.其中手术组采用DBS治疗5例,SCS治疗17例;对照组接受手术外的常规康复治疗.采用改良的昏迷恢复量表(CRS-R)作为评估手段,部分患者接受功能磁共振(fMRI)做进一步评估. 结果入组时2组患者性别、年龄、患病时间及意识评定差异无统计学意义(P＞0.05).获得随访37例(对照组17例,手术组20例),平均随访11.2月.手术组患者7例获得意识恢复,促醒率为35％;对照组1例患者获得意识恢复,促醒率为5.9％,差异有统计学意义(P＜0.05).且手术组患者CRS-R量表评定结果明显优于对照组,差异有统计学意义(P＜0.05);DBS与SCS治疗患者间CRS-R评分差异无统计学意义(P＞0.05).fMRI结果提示,静息态默认网络中关键脑区激活及功能连接程度与临床评定具有较好的一致性. 结论神经调控治疗能有效促进PVS患者的意识恢复,DBS与SCS之间未发现疗效差异.
목적 탐토뇌심부전자격(DBS)화척수전자격(SCS)신경조공치료대지속성식물상태환자적촉성작용. 방법 자2011년7월지2012년12월북경군구총의원공수치지속성식물상태환자53례,사선후입조42례.기중남27례,녀15례;평균(42.9±5.47)세.안조환자병정급가속의원장기분위대조조20례,수술조22례.기중수술조채용DBS치료5례,SCS치료17례;대조조접수수술외적상규강복치료.채용개량적혼미회복량표(CRS-R)작위평고수단,부분환자접수공능자공진(fMRI)주진일보평고. 결과 입조시2조환자성별、년령、환병시간급의식평정차이무통계학의의(P＞0.05).획득수방37례(대조조17례,수술조20례),평균수방11.2월.수술조환자7례획득의식회복,촉성솔위35％;대조조1례환자획득의식회복,촉성솔위5.9％,차이유통계학의의(P＜0.05).차수술조환자CRS-R량표평정결과명현우우대조조,차이유통계학의의(P＜0.05);DBS여SCS치료환자간CRS-R평분차이무통계학의의(P＞0.05).fMRI결과제시,정식태묵인망락중관건뇌구격활급공능련접정도여림상평정구유교호적일치성. 결론 신경조공치료능유효촉진PVS환자적의식회복,DBS여SCS지간미발현료효차이.
Objective To investigate the effect of neruomodulation treatment,including deep brain stimulation (DBS) and spinal cord stimulation (SCS),on patients under persistent vegetative state (PVS).Methods Fifty-three patients diagnosed as having PVS,admitted to our hospital from July 2011 to December 2012,were chosen in our study; after selection,42 patients were enrolled (27 males and 15 females,mean 42.9±5.47 years old) and prospectively divided into control group (n=20) and surgical group (n=22).Patients from surgical group received DBS (n=5) and SCS (n=17) treatments,while patients from control group underwent routine rehabilitation activities.Behavioral assessments were repeatedly performed using Revised Coma-Recovery Scale (CRS-R).Some patients underwent functional magnetic resonance imaging (fMRI) to further assess the outcomes.Clinical baseline values were collected and compared to follow-up data.Results No statistical significant differences of age,duration of coma and CRS-R scores were noted between the two groups before treatment.Thirty-seven patients (17 in control group and 20 in surgical group) got follow-up for 6-24 months (median 11.2 months); seven patients in the surgical group emerged from PVS to achieve consistent discemible behavioral evidence of consciousness with a recovery rate of 35 ％ (7/20),while only 1 from the control group with a recovery rate of 5.9％(1/17); significant difference was noted between the two groups (P＜0.05).Improvement in behavioral assessments (CRS-R scores) in the surgical group was significantly better than that in the control group (P＜0.05); however,no significant difference of CRS-R scores was noted between patients received DBS and SCS treatment (P＞0.05).The fMRI showed good consistency of activation of resting state default network key area and function connected degree with clinical assessment.Conclusion Neuromodulation therapy can effectively promote awareness of PVS patients based on rigorous selection criteria; DBS and SCS treatments show no difference in the clinical efficacy.