经颅直流电刺激不同刺激参数对颅脑损伤后最小意识障碍患者的疗效

王珊珊; 路伟; 李巧荣; 孙梁; 刘敏

doi:10.14188/j.1671-8852.2023.0378

您当前的位置：

首页 >

文章列表页 >

经颅直流电刺激不同刺激参数对颅脑损伤后最小意识障碍患者的疗效

基础及临床医学研究 | 更新时间：2026-11-05

- 经颅直流电刺激不同刺激参数对颅脑损伤后最小意识障碍患者的疗效
- Effect of transcranial direct current stimulation with different stimulation parameters on patients with minimal disturbance of consciousness after craniocerebral injury
- 武汉大学学报（医学版） 2025年46卷第4期页码：517-523
- 作者机构：
  
  山东省立第三医院重症康复科山东济南 250000
- 作者简介：
  
  王珊珊，女，1982—，医学博士生，副主任医师，副教授，主要从事慢性意识障碍的康复以及吞咽障碍的康复研究，E‑mail：15668319429@163.com
  刘敏，女，1974—，医学硕士，主任医师，教授，主要从事认知障碍康复的研究， E‑mail：35111972@qq.com
- 基金信息：
  
  山东省医药卫生科技发展计划(202020011024);山东省中医药科技项目(Q2022100)
- DOI：10.14188/j.1671-8852.2023.0378
  中图分类号： R493
- 收稿：2023-07-05，
  
  纸质出版：2025-04-25
- 稿件说明：
移动端阅览
王珊珊,路伟,李巧荣等.经颅直流电刺激不同刺激参数对颅脑损伤后最小意识障碍患者的疗效[J].武汉大学学报（医学版）,2025,46(04):517-523.

WANG Shanshan,LU Wei,LI Qiaorong,et al.Effect of transcranial direct current stimulation with different stimulation parameters on patients with minimal disturbance of consciousness after craniocerebral injury[J].Medical Journal of Wuhan University,2025,46(04):517-523.
王珊珊,路伟,李巧荣等.经颅直流电刺激不同刺激参数对颅脑损伤后最小意识障碍患者的疗效[J].武汉大学学报（医学版）,2025,46(04):517-523. DOI： 10.14188/j.1671-8852.2023.0378.

WANG Shanshan,LU Wei,LI Qiaorong,et al.Effect of transcranial direct current stimulation with different stimulation parameters on patients with minimal disturbance of consciousness after craniocerebral injury[J].Medical Journal of Wuhan University,2025,46(04):517-523. DOI： 10.14188/j.1671-8852.2023.0378.

摘要

目的

研究应用不同刺激参数经颅直流电刺激治疗颅脑损伤后最小意识障碍患者的临床疗效。

方法

将2020—2022年在山东省立第三医院重症康复科住院的慢性意识障碍患者，按照最小意识障碍（MCS）诊断标准纳入患者，按照随机对照数字表法，分为A组（1 mA，20 min，2 次•d

-1

）19例，B组（2 mA，20 min，2 次•d

-1

）21例，以及C组（假刺激组）20例，共60例患者。3组患者在治疗前以及治疗后第4周以及第8周由固定医师用昏迷恢复修订量表（CRS‑R）进行行为学评估以及脑电图检查。

结果

3组患者治疗前CRS‑R评分以及脑电图评分组间比较差异无统计学意义(

0.05)；治疗后，3组患者CRS‑R评分在治疗后每个时间点与上一个时间点的CRS‑R评分比较差异具有统计学意义（

0.05）；4周治疗后，B组与A组、C组比较差异有统计学意义（

0.05），但是A组与C组比较差异无统计学意义(

0.05)；8周治疗后，3组患者CRS‑R评分同时间点比较，差异具有统计学意义（

0.05）。B组每个时间点与组内前一个时间点的脑电图评分差异有统计学意义（

0.05）。第4周脑电图评分，A组以及C组与治疗前差异无统计学意义（

0.05），B组与C组比较差异有统计学意义(

0.05)。第8周各组脑电图评分与治疗前比较差异有统计学意义（

0.05），各组间比较差异有统计学意义（

0.05）。

结论

经颅直流电刺激可改善最小意识障碍患者的意识状态；2 mA、2 次•d

-1

的刺激参数，治疗最小意识患者的疗效最为明显。

Abstract

Objective

To study the clinical efficacy of transcranial direct current stimulation with different stimulation parameters in patients with minimal consciousness disturbance after brain injury.

Methods

Sixty patients with chronic disorders of consciousness hospitalized in the critical rehabilitation department of Shandong Provincial Third Hospital from 2020 to 2022 were included according to the diagnostic criteria for minimally conscious state (MCS) and were divided into three groups: group A (19 cases; 1 mA

20 min

twice per day)

group B (21 cases; 2 mA

20 min

twice per day)

and group C (20 cases; sham stimulation group). Behavioral assessments using the Coma Recovery Scale⁃Revised (CRS⁃R) and electroencephalogram (EEG) examinations were performed by fixed physicians before treatment and at the 4th and 8th weeks after treatment for all three groups of patients.

Results

There was no significant difference in the CRS⁃R scores and EEG scores before treatment among the three groups (

0.05). After treatment

the differences in CRS⁃R scores between each time point and the previous one within the three groups were statistically significant (

0.05). At 4 weeks after treatment

there was a statistically significant difference between Group B and Groups A and C (

0.05)

but there was no statistically significant difference between Group A and Group C (

0.05). At 8 weeks after treatment

the differences in CRS⁃R scores among the three groups were statistically significant (

0.05). There were statistically significant differences in EEG scores between each time point and the previous one within Group B (

0.05). There were no statistically s

ignificant differences in EEG scores between Group A and Group C at 4 weeks after treatment compared with baseline (

0.05)

but there was a statistically significant difference between Group B and Group C (

0.05). At 8 weeks after treatment

the EEG scores of all groups were statistically significantly different from baseline (

0.05)

and there were statistically significant differences among the groups (

0.05).

Conclusion

Transcranial direct current stimulation can improve the state of consciousness in patients with a MCS. Stimulation parameters of 2 mA applied twice daily were found to be most effective in patients with a MCS.

关键词

Keywords

references

何江弘 . 慢性意识障碍的体系构建 [J ] . 中华脑科疾病与康复杂志 (电子版), 2018 , 8 ( 1 ): 58 ‑ 60 .

HE J H . Constructing the system of disorders of consciousness [J ] . Chin J Brain Dis Rehabil Electron Ed , 2018 , 8 ( 1 ): 58 ‑ 60 .

XIA X Y , YANG Y , GUO Y K , et al . Current status of neuromodulatory therapies for disorders of consciousness [J ] . Neurosci Bull , 2018 , 34 ( 4 ): 615 ‑ 625 .

SCHNAKERS C , MONTI M M . Disorders of consciousness after severe brain injury: Therapeutic options [J ] . Curr Opin Neurol , 2017 , 30 ( 6 ): 573 ‑ 579 .

THIBAUT A , BRUNO M A , LEDOUX D , et al . tDCS in patients with disorders of consciousness [J ] . Neurology , 2014 , 82 ( 13 ): 1112 ‑ 1118 .

ANGELAKIS E , LIOUTA E , ANDREADIS N , et al . Transcranial direct current stimulation effects in disorders of consciousness [J ] . Arch Phys Med Rehabil , 2014 , 95 ( 2 ): 283 ‑ 289 .

ZHANG Y , SONG W Q , DU J B , et al . Transcranial direct current stimulation in patients with prolonged disorders of consciousness:Combined behavioral and event‑related potential evidence [J ] . Front Neurol , 2017 , 8 : 620 .

COLEMAN D . The minimally conscious state: Definition and diagnostic criteria [J ] . Neurology , 2002 , 58 ( 3 ): 506 ‑ 507 .

池林 , 李红玲 , 赵龙 , 等 . 经颅直流电刺激对意识障碍患者恢复的影响 [J ] . 中华物理医学与康复杂志 , 2018 , 40 ( 9 ): 652 ‑ 656 .

CHI L , LI H L , ZHAO L , et al . The clinical curative effect of transcranial direct current stimulation on patients with disorders of consciousness [J ] . Chin J Phys Med Rehabil , 2018 , 40 ( 9 ): 652 ‑ 656 .

HOCKADAY J M , POTTS F , EPSTEIN E , et al . Electroencephalographic changes in acute cerebral anoxia from cardiac or respiratory arrest [J ] . Electroencephalogr Clin Neurophysiol , 1965 , 18 : 575 ‑ 586 .

贾建平 , 陈生弟 , 崔丽英 . 神经病学 [M ] . 7版 . 北京 : 人民卫生出版社 , 2013 .

JIA J P , CHEN S D , CUI L Y . Neurology [M ] . People's Medical Publishing House , 2013 .

MONTI M M , LAUREYS S , OWEN A M . The vegetative state [J ] . BMJ , 2010 , 341 : c3765 .

GIACINO J T , FINS J J , LAUREYS S , et al . Disorders of consciousness after acquired brain injury: The state of the science [J ] . Nat Rev Neurol , 2014 , 10 ( 2 ): 99 ‑ 114 .

NACCACHE L . Minimally conscious state or cortically mediated state? [J ] . Brain , 2018 , 141 ( 4 ): 949 ‑ 960 .

BRUNO M A , VANHAUDENHUYSE A , THIBAUT A , et al . From unresponsive wakefulness to minimally conscious PLUS and functional locked‑in syndromes: Recent advances in our understanding of disorders of consciousness [J ] . J Neurol , 2011 , 258 ( 7 ): 1373 ‑ 1384 .

HIRSCHBERG R , GIACINO J T . The vegetative and minimally conscious states: Diagnosis, prognosis and treatment [J ] . Neurol Clin , 2011 , 29 ( 4 ): 773 ‑ 786 .

KRONBERG G , BRIDI M , ABEL T , et al . Direct current stimulation modulates LTP and LTD: Activity dependence and dendritic effects [J ] . Brain Stimul , 2017 , 10 ( 1 ): 51 ‑ 58 .

LIEBETANZ D , NITSCHE M A , TERGAU F , et al . Pharmacological approach to the mechanisms of transcranial DC‑stimulation‑induced after‑effects of human motor cortex excitability [J ] . Brain , 2002 , 125 ( Pt 10 ): 2238 ‑ 2247 .

BAI Y , XIA X Y , KANG J N , et al . TDCS modulates cortical excitability in patients with disorders of consciousness [J ] . Neuroimage Clin , 2017 , 15 : 702 ‑ 709 .

BAI Y , XIA X Y , KANG J N , et al . Evaluating the effect of repetitive transcranial magnetic stimulation on disorders of consciousness by using TMS‑EEG [J ] . Front Neurosci , 2016 , 10 : 473 .

DIMITRI D , DE FILIPPIS D , GALETTO V , et al . Evaluation of the effectiveness of transcranial direct current stimulation (tDCS) and psychosensory stimulation through DOCS scale in a minimally conscious subject [J ] . Neurocase , 2017 , 23 ( 2 ): 96 ‑ 104 .

李泓钰 , 宋鲁平 . 经颅直流电刺激在卒中后抑郁中的研究进展 [J ] . 中国老年保健医学 , 2018 , 16 ( 3 ): 61 ‑ 64 .

LI H Y , SONG L P . Research progress of transcranial direct current stimulation in post‑stroke depression [J ] . Chin J Geriatr Care , 2018 , 16 ( 3 ): 61 ‑ 64 .

王婕 , 刘津津 , 吴祖河 , 等 . 不同刺激条件下经颅直流电刺激的仿真 [J ] . 清华大学学报(自然科学版) , 2014 , 54 ( 9 ): 1225 ‑ 1229 .

WANG J , LIU J J , WU Z H , et al . Numerical simulations of electrode and current conditions during transcranial direct current stimulation [J ] . J Tsinghua Univ Sci Technol , 2014 , 54 ( 9 ): 1225 ‑ 1229 .

蔡缘邯 , 郝利霞 , 张琰 , 等 . 经颅直流电刺激对脑血流影响的研究进展 [J ] . 中国康复医学杂志 , 2022 , 37 ( 6 ): 840 ‑ 844 .

CAI Y H , HAO L X , ZHANG Y , et al . Research progress on the effect of transcranial direct current stimulation on cerebral blood flow [J ] . Chin J Rehabil Med , 2022 , 37 ( 6 ): 840 ‑ 844 .

ZHAO H C , QIAO L , FAN D Q , et al . Modulation of brain activity with noninvasive transcranial direct current stimulation (tDCS): Clinical applications and safety concerns [J ] . Front Psychol , 2017 , 8 : 685 .

MARTENS G , LEJEUNE N , O'BRIEN A T , et al . Randomized controlled trial of home‑based 4‑week tDCS in chronic minimally conscious state [J ] . Brain Stimul , 2018 , 11 ( 5 ): 982 ‑ 990 .

CAVALIERE C , AIELLO M , DI PERRI C , et al . Functional connectivity substrates for tDCS response in minimally conscious state patients [J ] . Front Cell Neurosci , 2016 , 10 : 257 .

LANDSNESS E , BRUNO M A , NOIRHOMME Q , et al . Electrophysiological correlates of behavioural changes in vigilance in vegetative state and minimally conscious state [J ] . Brain , 2011 , 134 ( Pt 8 ): 2222 ‑ 2232 .

SOUMYADEEP B . Paritritic analysis of paritritic b.awareness in vegetativestate [J ] . JPMS , 2012 , 2 ( 2 ): 43 .

BAGNATO S , BOCCAGNI C , SANT'ANGELO A , et al . EEG predictors of outcome in patients with disorders of consciousness admitted for intensive rehabilitation [J ] . Clin Neurophysiol , 2015 , 126 ( 5 ): 959 ‑ 966 .

浏览量

下载量

CSCD

文章被引用时，请邮件提醒。

提交

工具集

关联资源

ADAMTS4在急性肺损伤/急性呼吸窘迫综合征中的研究进展

胃癌前状态和癌前病变随访现状及影响因素研究进展

复合酸联合微针改善头皮脂溢性皮炎及白发的临床观察

腹腔镜下改良非网片髂耻韧带悬吊术治疗盆腔器官脱垂的有效性及安全性

亚甲蓝纳米颗粒的制备及其用于光动力疗法体外抑制红色毛癣菌的初步研究