正中神经电刺激联合脑蛋白水解物对颅脑损伤患者意识障碍的疗效及对Hcy NSE BDNF水平的影响

doi:10.3969/j.issn.1006-6233.2025.11.016

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摘要 目的: 分析正中神经电刺激联合脑蛋白水解物对颅脑损伤患者意识障碍的疗效及对同型半胱氨酸(Hcy)、神经元特异性烯醇化酶(NSE)、脑源性神经细胞营养因子(BDNF)水平的影响。方法: 选取2022.04~2024.10在我院就诊的颅脑损伤患者114例,采用随机数字表法分为脑蛋白组(单号,n=57)和电刺激组(双号,n=57),两组均予以常规治疗,脑蛋白组在常规治疗基础上予以脑蛋白水解物10mL与250mL 0.9%氯化钠注射液混匀治疗,电刺激组在脑蛋白组基础上加以正中神经电刺激治疗,两组均治疗4周。比较两组临床疗效,治疗前后两组肌电图、清醒率、昏迷情况、NIHSS评分,脑血流动力学指标[动脉平均血流速度(Vm)、脑血容量(CBV)、脑血流量(CBF)]、炎症因子及脂质过氧化物指标[白介素-6(IL-6)、丙二醛(MDA)、超氧化物歧化酶(SOD)],血清生物学指标(Hcy、NSE、BDNF)水平差异,统计两组在治疗期间的药物不良反应和电刺激不良事件。结果: 电刺激组疗效高于脑蛋白组(P<0.05);治疗后,两组潜伏期、M波潜伏期、MCV水平均显著改善,且电刺激组较脑蛋白组改善更明显(P<0.05);治疗后,电刺激组清醒率高于脑蛋白组(P<0.05),两组GCS和NIHSS评分均显著改善,且电刺激组较脑蛋白组改善更明显(P<0.05);治疗后,两组Vm、CBV及CBF水平均显著改善,且电刺激组较脑蛋白组改善更明显(P<0.05);治疗后,两组IL-6、MDA、SOD水平均显著改善,且电刺激组较脑蛋白组改善更明显(P<0.05);治疗后,两组Hcy、NSE、BDNF水平均显著改善,且电刺激组较脑蛋白组改善更明显(P<0.05);两组药物不良反应和电刺激不良事件比较无显著差异(P>0.05)。结论: 正中神经电刺激联合脑蛋白水解物对颅脑损伤患者意识障碍疗效明显,能改善神经缺损情况,减轻机体炎症因子,促进脑血流动力学水平和神经功能恢复,安全有效,值得临床推广。

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关键词 ：颅脑损伤, 正中神经电刺激, 脑蛋白水解物, 意识障碍

Abstract：Objective: To analyze the efficacy of median nerve electrical stimulation combined with cerebroprotein hydrolysate on disturbance of consciousness in patients with craniocerebral injury and its influence on the levels of homocysteine (Hcy), neuron-specific enolase (NSE), and brain-derived neurotrophic factor (BDNF). Methods: Totally 114 patients with craniocerebral injury admitted to the hospital from April 2022 to October 2024 were selected and divided into cerebroprotein group (single number, n=57) and electrical stimulation group (double number, n=57) by the random number table method. On the basis of conventional treatment, the cerebroprotein group was treated with a mixture of 10 mL of brain protein hydrolysate and 250 mL of 0.9% sodium chloride injection, and the electrical stimulation group was treated with median nerve electrostimulation on the basis of the cerebroprotein group. Both groups were treated for 4 weeks. The clinical efficacy, electromyography, awake rate, coma status, NIHSS score, cerebral hemodynamic indicators [mean arterial blood flow velocity (Vm), cerebral blood volume (CBV), cerebral blood flow (CBF)], inflammatory factors and lipid peroxide indicators [interleukin-6 (IL-6), malondialdehyde (MDA), superoxide dismutase (SOD)] and serum biological indicators (Hcy, NSE, BDNF) before and after treatment were compared between groups. The adverse drug reactions and adverse electrical stimulation events in the two groups were counted during treatment. Results: The total effective rate of treatment in electrical stimulation group was higher than that in cerebroprotein group (P<0.05). After treatment, the latency, M wave latency and MCV in the two groups were significantly improved, and the improvements in electrical stimulation group were more obvious than those in cerebroprotein group (P<0.05). The awake rate of electrical stimulation group after treatment was significantly higher than that of cerebroprotein group (P<0.05). The GCS score and NIHSS score in both groups were significantly improved, and the improvements were more obvious in electrical stimulation group (P<0.05). After treatment, the Vm, CBV and CBF were significantly improved in the two groups, and the improvements in electrical stimulation group were more significant compared to cerebroprotein group (P<0.05). After treatment, the levels of IL-6, MDA, and SOD in both groups were significantly improved, and the improvement was more pronounced in the electrical stimulation group than in the cerebroprotein group (P<0.05). After treatment, the levels of Hcy, NSE, and BDNF in both groups were also significantly improved, with the electrical stimulation group showing more significant improvement than the cerebroprotein group (P<0.05). There were no significant differences in the adverse drug reactions and adverse electrical stimulation events between groups (P>0.05). Conclusion: Median nerve electrical stimulation combined with cerebroprotein hydrolysate has obvious efficacy on disturbance of consciousness in patients with craniocerebral injury. It can improve the neurological deficit, relieve the body’ s inflammatory factors, promote the cerebral hemodynamics and neurological function recovery, and it is safe and effective.

Key words： Craniocerebral injury Median nerve electrical stimulation Cerebroprotein hydrolysate Disturbance of consciousness

基金资助:陕西省重点研发计划项目,(编号:2021QN-012)

通讯作者: 潘建萍

引用本文:

张静茹, 潘建萍, 汤文郁, 刘哲, 高涛涛, 马轩. 正中神经电刺激联合脑蛋白水解物对颅脑损伤患者意识障碍的疗效及对Hcy NSE BDNF水平的影响[J]. 河北医学, 2025, 31(11): 1855-1861.
ZHANG Jingru, PAN Jianping, TANG Wenyu, et al. Efficacy of Median Nerve Electrical Stimulation Combined with Cerebroprotein Hydrolysate on Disturbance of Consciousness in Patients with Craniocerebral Injury and Its Influence on Hcy NSE and BDNF Levels. HeBei Med, 2025, 31(11): 1855-1861.

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http://www.hbyxzzs.cn/CN/10.3969/j.issn.1006-6233.2025.11.016 或 http://www.hbyxzzs.cn/CN/Y2025/V31/I11/1855

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