| Background: In recent years,the incidence of persistent vegetative state(SPS)has increased significantly,resulting in huge family burden,social burden and medical resource consumption.In order to change this situation,many countries in the world are trying to explore new treatments.Among them,neuroelectrophysiological regulation has been developed rapidly in recent years.Deep brain stimulation(DBS),high cervical spinal cord stimulation(c SCS),vagal nerve stimulation(VNS)and other treatment methods have made considerable progress,more and more widely used in clinical,and achieved many surprising results.In recent years,functional neurosurgery,especially in the field of neuroelectrophysiological regulation,has entered a rapid development stage in China.However,in general,the treatment of PVS by c SCS is still in its infancy.There are no relevant criteria and basis for surgical indications,curative effect judgement and prognosis evaluation,and the curative effect is uneven.Objective: To observe and analyze the efficacy of c SCS in the treatment of PVS,and to determine its effectiveness.A case-control study was conducted to investigate the difference between the efficacy of the new method and that of the traditional treatment.The correlation between the changes of cerebral blood flow,brainstem auditory evoked potential,somatosensory evoked potential,electroencephalogram(EEG)characteristics and the improvement of consciousness was analyzed before and after operation,and the value of EEG in the prediction of preoperative curative effect and the judgement of postoperative curative effect was clarified.To study the feasibility of magnetic resonance diffusion tensor imaging(MRDTI)as a preoperative evaluation method for high cervical spinal cord electrical stimulation in the treatment of vegetative patients,and to find a relatively reliable index for evaluating the expected effect of surgery,so as to select surgical cases more reasonably.Method:The treatment group chooses 12 patients admitted in our hospital with the first cervical spinal cord electrostimulator implantation since 2013 in the control group,there were 24 PVS patients received comprehensive resuscitation treatment at the same time and Paired with a 1: 1 ratio.The clinical efficacy standard was made according to the clinical observation Standard of Nanjing versions in 2011 and the electrophysiological examination(EEG,SEP,BAEP).Each patient was inspected at least once a month according to the clinical curative standard.Patients in the CSCS group needs to be examined by CT perfusion imaging and CT scan at same time diffusion tensor imaging is required respectively within 2 weeks before surgery and 3 months after surgery and keep the record on the anisotropic fraction(FA)of cerebral cerebral blood flow(CBF)and mesencephalic reticular structure.According to scoring scale,comparision shall be made on the score differences and trends of treatment group and control group after 6 months treatment and wake-up effect and advantage of c SCS treating PVS.To analysis the results of preoperativeand postoperative 3 months,in partiular to study EEG,SEP,BAEP and cerebral blood flowing and the relationship between the FA value of Mesothelium network and the efficacy of c SCS.The above indicators can be used on SCS efficacy of preoperative and the value of postoperative evaluation.Result:There was no statistical difference between the two groups before and after the operation: t=0.442,the significant level of P=0.531 > 0.05;the highest score of the two groups had no statistical difference: t=2.468,the significant level of P=0.130 > 0.05;there was no statistical difference between the two groups before and after the difference:t =3.629,the significant level of P=0.070 > 0.05,but the difference between the two groups was not statistically significant.It has a critical significance.Of the 12 patients with plant status in the spinal cord electrical stimulation group,7 were effective,with an effective rate of 58.33%,5 out of plant state,41.67%,4 in the control group,34.78% in efficiency,1 in the plant state,8.70%.The difference between the two groups was obvious.After statistical analysis by SPSS22.0 statistical software,we found that the difference between the two groups did not have significant statistical significance(1.478;P value: 0.237;alpha < 0.05).The V wave latency and the I-V wave interval of BEAP were improved in 3 months after 3 months of treatment.The improvement of the score was positively correlated with the effectiveness,and the BEAP wave form before and after the operation had significant statistical differences: t value: 0.709,P value: 0.022< 0.05;N20 waveforms were all improved in varying degrees,and the improvement of the score was positively correlated with the effectiveness.After statistical analysis,we found that there were significant statistical differences in N20 waveforms before and after operation: t value: 0.632,P value: 0.050= 0.05;the alpha wave of EEG was significantly increased,and the improvement of the score was positively correlated with the effectiveness.After statistical analysis,we found that there was no significant difference in the alpha wave of EEG before and after the operation: t Value: 0.563,P value: 0.090 > 0.05;after c SCS treatment,the middle brain CBF was obviously improved,25%,among which the average increase of the patients separated from the plant state was 39%,and the average increase of the patients without the plant state was 21%.However,after statistical analysis,we did not find significant differences in CBF before and after surgery: t value:0.579,P value: 0.079 > 0.05.Compared with the ineffective group,there was a difference in the FA value of the mesencephalic reticular structure in the patients before the operation,and the effective group FA was higher,and the difference was statistically significant.There was no significant difference in FA between the two groups before and after the operation.Conclusion:CSCS is still effective for patients who have been awakened for more than half a year after comprehensive treatment and still can not get away from the vegetative state.It is asignificant advantage in comparing the curative effect of continued comprehensive conservative treatment.After c SCS treatment,most of the patients had improved cerebral blood flow,brainstem auditory evoked potential,somatosensory evoked potential and electroencephalogram,which was consistent with the trend of consciousness score of clinical observation patients.It could be used as a monitoring index for the effectiveness of c SCS treatment.But there was no significant difference between the effective group and the ineffective group before the operation,and it could not be used to predict the curative effect before the operation.There was no significant difference in the FA value of the mesencephalic reticular structure between the two groups before and after the treatment of c SCS,which could not be used as an indicator of the evaluation of the curative effect.The FA value of the mesencephalic reticular structure in the effective group before treatment is higher than that in the ineffective group,which can be used as a pre-operative index for the effectiveness of the c SCS treatment. |
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