Objective To explore the effect of early comprehensive rehabilitation therapy combined with continuous right median nerve stimulation therapy on the awakening process in coma patients with severe craniocerebral injury.Methods A total of 110 severe craniocerebral injury coma patients admitted to Cangzhou People's Hospital from May 2021 to May 2022 were selected,and were divided into control group and study group according to the random number table method,with 55 cases in each group.The patients in control group received continuous right median nerve stimulation therapy,and the research group chose to add the early comprehensive rehabilitation treatment of biological wave based on the control group.Recovery status,expression of plasma markers of brain injury,cerebral perfusion related indexes,Glasgow coma scale(GCS)score,Glasgow outcome scale(GOS)score,NIHSS score and prognosis of patients in two groups were analyzed.Results Compared with the control group wake rate(2 weeks:21.82%;4 weeks:45.45%),wake duration(27.39±4.63)d),the wake rate(2 weeks:54.55%,4 weeks:76.36%)increased and wake duration((21.47±3.35)d)decreased(P<0.05).The neuron-specific enolase(NSE),plasma human S100B protein(S-100B),myelin basic protein(MBP)level and the NIHSS score decreased,and cerebral blood volume(CBV),cerebral blood flow(CBF),GCS score and GOS score increased.The improvement degrees of the study group were higher than those of the control group(P<0.05).The overall clinical response rate of the study group(89.09%)was higher than the control group(70.91%),P<0.05.Conclusion Early comprehensive rehabilitation treatment by biological wave combined with continuous right median nerve stimulation therapy can effectively reduce NSE,S-100B and MBP levels in coma patients with severe craniocerebral injury,and play a positive role in improving cerebral blood perfusion in patients and accelerate the recovery.

目的 观察依达拉奉联合生物波早期综合康复对重型颅脑损伤昏迷患者昏迷评分及神经细胞因子水平的影响.方法 前瞻性选取2020年7月至2022年3月沧州市人民医院收治的80例重型颅脑损伤昏迷患者为研究对象,按照随机数字表法分为对照组38例和观察组42例.两组均给予常规治疗,对照组另给予生物波早期综合康复训练,观察组在对照组基础上联合依达拉奉进行治疗.比较两组格拉斯哥昏迷量表(GCS)评分、神经细胞因子[脑源性神经营养因子(BDNF)、胶质细胞原纤维酸性蛋白(GFAP)、胶质细胞原纤维酸性蛋白(GFAP)、泛素竣基末端水解酶-L1(UCH-L1)]及椎动脉血流速度水平变化,记录两组不良反应和预后情况.结果 治疗14、21d后,两组GCS评分均升高,且观察组GCS评分分别为(8.22±0.87)、(10.83±0.88)分,高于对照组[(7.21±1.02)、(9.77±0.74)分],差异均有统计学意义(P＜0.05).治疗21 d后,两组GFAP、NSE、UCH-L1水平均较治疗前降低,BDNF水平较治疗前升高,观察组 GFAP、NSE、UCH-L1 水平分别为(7.98±1.45)pg/mL、(17.05±3.23)μg/L、(0.83±0.21)ng/mL,均低于对照组[(14.45±2.12)pg/mL、(21.58±4.11)μg/L、(1.12±0.27)ng/mL],BDNF 为(18.77±2.25)pg/mL,高于对照组[(15.89±2.17)pg/mL],差异均有统计学意义(P＜0.05).治疗21 d后,两组双侧椎动脉平均血流速度(Vm)、收缩期血流速度(Vs)均升高,且观察组均高于对照组,差异均有统计学意义(P＜0.05).观察组的不良反应发生率为11.90％,高于对照组(2.63％),但差异无统计学意义(P＞0.05).观察组恢复瞳孔对光反射时间为(5.23±0.87)d,短于对照组[(6.58±1.44)d],4周内清醒率和3个月格拉斯哥预后评分(GOS)分别为64.29％、(3.31±0.74)分,均高于对照组[42.11％、(2.88±0.62)分],3个月病死率2.38％,与对照组(10.53％)比较,差异无统计学意义(P＞0.05).结论 依达拉奉联合生物波早期综合康复可促进重型颅脑损伤昏迷患者受损神经的修复,改善脑血流,促进苏醒,但用药期间应密切观察不良反应.

目的 观察温针灸联合绳带捆绑技术对脑卒中后痉挛型偏瘫病人运动耐力及痉挛程度的影响.方法 选取2018年1月—2020年1月沧州市人民医院收治的脑卒中后痉挛型偏瘫病人192例,依据随机数字表法分为研究组与对照组,各96例.对照组在常规干预基础上应用绳带捆绑技术,研究组在对照组基础上采取温针灸治疗.比较两组干预前后运动耐力及痉挛程度、运动功能及平衡功能、日常生活活动能力评分、肌张力分级、步速、步宽、步长、起立-行走(TUGT)测试结果和干预满意度.结果 干预后,研究组6 min步行距离长于对照组(P<0.05),临床痉挛指数(CSI)量表评分低于对照组(P<0.05);研究组Fugl-Meyer评定量表(FMA)、Berg平衡量表、功能独立行测评(FIM)评分高于对照组(P<0.05);研究组肌张力分级优于对照组(P<0.05);研究组步速、步宽、步长大于对照组(P<0.05).干预后两组TUGT较干预前缩短(P<0.05),且研究组短于对照组(P<0.05);研究组总满意度(94.79％)高于对照组(84.38％),差异有统计学意义(P<0.05).结论 采取绳带捆绑技术及温针灸对脑卒中后痉挛型偏瘫病人实施干预,可缓解其痉挛状态,恢复肢体功能,增强运动耐力,且病人对干预满意度较高.