【作者】 周航；

【导师】 王海明；

【作者基本信息】 郑州大学 ， 康复医学与理疗学（专业学位）， 2025， 硕士

【摘要】 背景创伤性脑损伤(Traumatic Brain Injury,TBI)广泛存在于各类交通事故、运动伤害和暴力事件中,不仅危及生命,还可能导致长期神经功能障碍,尤其是意识障碍(Disorders of consciousness,DOC)。针对TBI后的意识障碍,传统治疗手段包括药物治疗、常规康复治疗等,但效果往往有限,近年来,高压氧治疗(Hyperbaric Oxygen Therapy,HBOT)和重复经颅磁刺激——两种治疗手段因其显著的神经修复潜力而受到广泛关注。高压氧通过提高脑组织的氧供应,促进神经修复,已被用于多种神经系统疾病的治疗,重复经颅磁刺激则通过非侵入性的磁场作用,调节大脑皮层的活动,促进神经功能。尽管两者单独应用已显示出一定效果,但联合治疗的系统研究仍缺乏。目的本研究旨在探讨HBOT联合rTMS治疗TBI后意识障碍的临床疗效,并与单独rTMS治疗进行对比,评估联合治疗的优势。方法回顾性分析2021年6月至2024年6月郑州大学第一附属医院97例TBI意识障碍患者的临床资料,分为观察组(HBOT联合rTMS)和对照组(仅rTMS),其中观察组52例,对照组45例,通过SPSS25.0软件对观察组和对照组患者进行行1:1倾向评分匹配(Propensity score matching,PSM)以减少患者的选择偏倚,经过PSM,两组各有32例患者入组。并对PSM前P<0.05的变量采用多因素线性回归分析探究潜在影响因素与该变量之间的相关性。HBOT压力为1.8ATA,单次治疗100分钟,1周6次,2周为一个疗程,治疗4周。rTMS频率为6Hz,单次治疗20分钟,1周6次,2周为一个疗程,治疗4周。所有患者在治疗前、治疗2周后、治疗4周后进行昏迷恢复量表-修订版(CRS-R)、格拉斯哥昏迷量表(GCS)、Barthel指数、降钙素原(PCT)、C反应蛋白(CRP)、白介素-6(IL-6)检查。在治疗结束后6个月,对观察组和对照组的64例患者的意识状态及日常生活活动能力情况进行电话随访。数据分析采用SPSS 29.0,统计学显著性水平设定为P<0.05。结果(1)PSM后,两组基线资料差异无统计学意义(P>0.05)。(2)治疗2周后:CRS-R和GCS评分观察组显著高于对照组(P<0.05),表明联合治疗在意识恢复方面效果更佳;Barthel指数评分两组差异无统计学意义(P>0.05);PCT水平观察组显著低于对照组(P<0.05),CRP和IL-6水平无显著差异。(3)治疗4周后:CRS-R和GCS评分观察组继续显著高于对照组(P<0.05);Barthel指数评分两组较基线均有提高(P<0.05),但组间差异无统计学意义;PCT和CRP组间差异无统计学意义。(4)随访6个月后:CRS-R和GCS评分观察组显著高于对照组(P<0.05);Barthel指数评分观察组显著高于对照组(P<0.05),表明联合治疗对长期日常生活能力提升有积极作用。结论(1)HBOT联合rTMS治疗TBI意识障碍的疗效优于单独rTMS治疗。(2)HBOT联合rTMS治疗对患者半年后日常生活活动能力的提升具有积极作用。(3)HBOT联合rTMS治疗能降低TBI意识障碍患者PCT水平。更多还原

【Abstract】 BackgroundTraumatic brain injury(TBI)is widely present in various traffic accidents,sports injuries and violent incidents.It is not only life-threatening,but may also lead to long-term neurological dysfunction,especially disorders of consciousness(DOC).Traditional treatments for(DOC)after TBI include drug therapy and conventional rehabilitation therapy,but the effects are often limited.In recent years,hyperbaric oxygen therapy(HBOT)and repetitive transcranial magnetic stimulation(rTMS)have attracted widespread attention due to their significant potential for neural repair.Hyperbaric oxygen has been used to treat a variety of neurological diseases by increasing the oxygen supply to brain tissue and promoting neural repair.Repetitive transcranial magnetic stimulation regulates the activity of the cerebral cortex and promotes neural function through non-invasive magnetic fields.Although the use of both alone has shown certain effects,systematic research on combined treatment is still lacking.ObjectiveThis study aims to explore the clinical efficacy of HBOT combined with rTMS in the treatment of impaired consciousness after TBI,compare it with rTMS treatment alone,and evaluate the advantages of combined treatment.MethodsThe clinical data of 97 patients with TBI consciousness disorder in the First Affiliated Hospital of Zhengzhou University from June 2021 to June 2024 were retrospectively analyzed and divided into an observation group(HBOT combined with rTMS)and a control group(rTMS only),including 52 cases in the observation group and 45 cases in the control group.SPSS25.0 software was used to perform 1:1 propensity score matching(PSM)on the observation group and the control group to reduce the selection bias of patients.After PSM,32 patients were enrolled in each group.Multivariate linear regression analysis was used to explore the correlation between potential influencing factors and the variables with P<0.05 before matching.The HBOT pressure was 1.8ATA,a single treatment of 100 minutes,6 times a week,2 weeks as one course of treatment,and the treatment lasts for 4 weeks.The rTMS frequency was 6Hz,a single treatment of 20 minutes,6 times a week,2 weeks as one course of treatment,and the treatment lasts for 4 weeks.All patients underwent Coma Recovery Scale-Revised(CRS-R),Glasgow Coma Scale(GCS),Barthel Index,procalcitonin(PCT),C-reactive protein(CRP),and interleukin-6(IL-6)examinations before treatment,2 weeks after treatment,and 4 weeks after treatment.Six months after the end of treatment,the consciousness state and daily living activities of 64 patients in the observation group and the control group were followed up by telephone.SPSS 29.0 was used for data analysis,and the statistical significance level was set at P<0.05.Results(1)After propensity score matching(PSM)between the two groups,there was no significant difference in baseline data such as age,gender,smoking,and drinking between the two groups(P>0.05),and the two groups were comparable.(2)After 2 weeks of treatment:CRS-R and GCS scores in the observation group were significantly higher than those in the control group(P<0.05),indicating that combined treatment was more effective in recovering consciousness;there was no significant difference in Barthel index score between the two groups(P>0.05);PCT level in the observation group was significantly lower than that in the control group(P<0.05),and there was no significant difference in CRP and IL-6 levels.(3)After 4 weeks of treatment:CRS-R and GCS scores in the observation group continued to be significantly higher than those in the control group(P<0.05);Barthel index scores in both groups increased compared with baseline(P<0.05),but the difference between the two groups was not significant;PCT level in the observation group was significantly lower than that in the control group(P<0.05),and CRP level decreased compared with baseline,but the difference between the two groups was not significant.(4)After 6 months of follow-up:the CRS-R and GCS scores in the observation group were significantly higher than those in the control group(P<0.05);the Barthel index score in the observation group was significantly higher than that in the control group(P<0.05),indicating that combined treatment has a positive effect on improving long-term daily living ability.Conclusion(1)The efficacy of HBOT combined with rTMS in the treatment of TBI consciousness disorder is better than that of rTMS alone.(2)HBOT combined with rTMS has a positive effect on improving the patients’daily living activities after half a year.(3)HBOT combined with rTMS can reduce the PCT level in patients with TBI consciousness disorder.更多还原