《中国康复理论与实践》

《中国康复理论与实践》 ›› 2025, Vol. 31 ›› Issue (3): 339-347.doi: 10.3969/j.issn.1006-9771.2025.03.011

• 应用研究 • 上一篇    下一篇

耳迷走神经电刺激对慢性意识障碍促醒的效果

化龙昂1, 赖海芳1, 杨威2, 刘勇2, 叶祥明2()   

  1. 1.上海交通大学医学院附属瑞金医院康复医学科，上海市 200025
    2.浙江省人民医院（杭州医学院附属人民医院）康复医学科，浙江杭州市 310014
  • 收稿日期:2024-12-05 修回日期:2025-02-05 出版日期:2025-03-25 发布日期:2025-03-25
  • 通讯作者: 叶祥明，E-mail：yexmdr@126.com
  • 作者简介:化龙昂(1992-)，男，汉族，上海市人，硕士，主管技师，主要研究方向：神经康复、老年病康复。
  • 基金资助:
    1.浙江省医药卫生科技项目(2023KY032);1.浙江省医药卫生科技项目(2024KY706);2.浙江省中医药科技计划项目(2023ZL238)

Effect of transcutaneous auricular vagus nerve stimulation on patients with prolonged disorders of consciousness

HUA Longang1, LAI Haifang1, YANG Wei2, LIU Yong2, YE Xiangming2()   

  1. 1. Department of Rehabilitation Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China
    2. Department of Rehabilitation Medicine, Zhejiang Provincial People's Hospital (Affiliated People's Hospital of Hangzhou Medical College), Hangzhou, Zhejiang 310014, China
  • Received:2024-12-05 Revised:2025-02-05 Published:2025-03-25 Online:2025-03-25
  • Contact: YE Xiangming, E-mail: yexmdr@126.com
  • Supported by:
    Zhejiang Medical and Health Technology Project(2023KY032);Zhejiang Medical and Health Technology Project(2024KY706);Zhejiang Traditional Chinese Medicine Science and Technology Project(2023ZL238)

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摘要：

目的 探讨耳迷走神经电刺激(ta-VNS)对慢性意识障碍(pDoC)患者意识水平恢复的影响。

方法 2023年1月至2024年8月，浙江省人民医院pDoC患者50例，随机分为对照组(n = 25)和观察组(n = 25)。两组均接受常规促醒治疗和醒脑开窍针法治疗，观察组在此基础上增加ta-VNS治疗，共4周。每组根据入组时修订版昏迷恢复量表(CRS-R)评分分为无反应觉醒综合征/植物状态(UWS/VS)、微小意识状态(MCS)两种类型，分别在治疗前、治疗4周后进行格拉斯哥昏迷量表(GCS)、CRS-R、脑电图(EEG)分级和上肢体感诱发电位(SSEP)评估。

结果 观察组3例，对照组5例因转院未能完成试验。治疗前，两组UWS/VS、MCS类型患者各项评估指标均无显著性差异(P > 0.05)；治疗后，观察组UWS/VS、MCS类型患者GCS评分(|t| > 16.000, P < 0.001)、CRS-R评分(|t| > 14.318, P < 0.001)、SSEP的N20振幅(|t| > 5.247, P < 0.05)均提高，EEG分级降低(Z > 2.264, P < 0.05)，SSEP的N20潜伏期缩短(|t| > 2.884, P < 0.05)，且均优于对照组同类型患者(|t| > 1.883, |Z| > 2.244, P < 0.05)。

结论 ta-VNS可促进pDoC患者从UWS/VS和MCS状态中觉醒，提升脑电活动和感觉运动传导通路的功能状态。

关键词: 慢性意识障碍, 耳迷走神经电刺激, 针法

Abstract:

Objective To investigate the effect of transcutaneous auricular vagus nerve stimulation (ta-VNS) on the recovery of consciousness in patients with prolonged disorders of consciousness (pDoC).

Methods From January, 2023 to August, 2024, 50 patients with pDoC in Zhejiang Provincial People's Hospital were randomly divided into control group (n = 25) and observation group (n = 25). Both groups received conventional wakefulness-promoting treatment and Xingnao Kaiqiao acupuncture, and the observation group added ta-VNS treatment on the basis of the control group, for four weeks. Each group was further divided into unresponsive wakefulness syndrome/vegetative state (UWS/VS) and minimally consciousness state (MCS) types based on their initial the score of Coma Recovery Scale-Revised (CRS-R). They were assessed with Glasgow Coma Scale (GCS), CRS-R, EEG grading and upper limb somatosensory-evoked potentials (SSEP) before and four weeks after treatment.

Results Three in the observation group and five in the control group dropped down for transferring to other hospitals. There was no significant difference in all the indexes between two groups before treatment (P> 0.05). After treatment, the GCS score (|t| > 16.000, P < 0.001), CRS-R score (|t| > 14.318, P < 0.001) and N20 amplitude of SSEP (|t| > 5.247, P < 0.05) improved, the EEG grading was reduced (Z > 2.264, P < 0.05), and the N20 latency of SSEP was shortened (|t| > 2.884, P < 0.05) in both UWS/VS and MCS type patients in the observation group; and they were better in the observation group than in the control group for the same type (|t| > 1.883, |Z| > 2.244, P < 0.05).

Conclusion ta-VNS can significantly promote the awakening of patients with pDoC from UWS/VS and MCS, and improve the functional status of electroencephalogram activities and sensorimotor conduction pathways.

Key words: prolonged disorders of consciousness, transcutaneous auricular vagus nerve stimulation, acupuncture

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