Coma arousal effect of median nerve electrical stimulation on patients with traumatic brain injury: a meta-analysis

doi:10.3877/cma.j.issn.2095-9141.2022.05.003

Abstract

Abstract:

Objective

To systematic review coma arousal effect of median nerve electrical stimulation (MNS) on patients with traumatic brain injury (TBI).

Methods

Pubmed, Web of Science, Embase, The Cochrane Library, CNKI, China Biomedical Literature Database, Wanfang Database, and VIP Database were searched for randomised controlled trials of median nerve electrical stimulation therapy and conventional coma awakening therapy in the treatment of TBI. The search time was from the establishment of the database to March 2022. Two researchers conducted literature screening, data extraction and quality evaluation according to the inclusion and exclusion criteria. According to the different intervention measures, the patients were divided into conventional treatment group and MNS group. The conventional treatment group was treated with conventional treatment methods, and the MNS group was treated with MNS on the basis of conventional treatment methods. Stata 12.0 software was used to calculate the pooled effect size of meta-analysis, and to test for heterogeneity and publication bias.

Results

A total of 21 articles with a total of 1684 patients were included in our study. Meta-analysis results showed that, compared with conventional treatment, after 1, 2, 3, and 4 weeks of treatment, MNS therapy could improve the GCS score of patients (P<0.001), and the recovery rate was higher (OR=2.13, 95%CI: 1.56-2.91). The brain dysfunction score was lower than that in the conventional treatment group [SMD=-0.66, 95%CI: -0.96-(-0.36)], the motor performance score (SMD=0.25, 95%CI: 0.00-0.50), quality of life score (SMD=0.85, 95%CI: 0.53-1.18), EEG score (SMD=1.04, 95%CI: 0.23-1.86) in MNS therapy group were higher than those in the conventional treatment group.

Conclusion

MNS therapy can improve consciousness level within 4 weeks and have Coma arousal effect on patients with TBI.

Key words: Median nerve electrical stimulation, Traumatic brain injury, Coma arousal, Meta-analysis

Wenchen Li, Ri Li, Lin Han, Shuyan Zhang. Coma arousal effect of median nerve electrical stimulation on patients with traumatic brain injury: a meta-analysis[J]. Chinese Journal of Neurotraumatic Surgery(Electronic Edition), 2022, 08(05): 269-275.

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References 35

[1]	中华医学会神经外科学分会颅脑创伤专业组，中华医学会创伤学分会神经损伤专业组. 颅脑创伤长期昏迷诊治中国专家共识[J]. 中华神经外科杂志, 2015, 31(8): 757-760.
[2]	Yokoyama T, Kamei Y, Kanno T. Right median nerve stimulation for comatose patients[J]. Soc Treat Coma, 1996, 5: 117-125.
[3]	Cooper JB, Jane JA, Alves WM, et al. Right median nerve electrical stimulation to hasten awakening from coma[J]. Brain Inj, 1999, 13(4): 261-267.
[4]	徐彬彬，王中. 正中神经电刺激对颅脑损伤后昏迷病人促苏醒作用的临床研究[J]. 中国校医, 2006, 20(1): 14-17.
[5]	黄强，戴伟民，揭园庆, 等. 持续右正中神经刺激促进重型颅脑损伤昏迷患者恢复的前瞻性非随机同期病例对照研究[J]. 中国中西医结合急救杂志, 2011, 18(3): 138-141.
[6]	Lei J, Wang L, Gao G, et al. Right median nerve electrical stimulation for acute traumatic coma patients[J]. J Neurotrauma, 2015, 32(20): 1584-1589.
[7]	李成宇，胡武，郑飞, 等. 右侧正中神经电刺激对颅脑外伤昏迷患者的催醒治疗[J]. 医学信息, 2013, 26(12): 513.
[8]	李春雨. 右正中神经电刺激对重型脑外伤患者促醒作用的研究[J]. 现代中西医结合杂志, 2014, 23(19): 2109-2111.
[9]	梁文海. 右正中神经电刺激治疗颅脑创伤性昏迷的研究[J]. 中国临床新医学, 2016, 9(3): 197-201.
[10]	杨初燕，王亮，冯珍, 等. 正中神经电刺激对脑外伤后昏迷患者促醒作用的临床及机制研究[J]. 中国康复医学杂志, 2016, 31(11): 1195-1199, 1207.
[11]	卫晓红，袁晓冬，程月芳, 等. 右正中神经电刺激对创伤性脑损伤昏迷患者苏醒的影响[J]. 医学临床研究, 2017, 34(12): 2457-2458.
[12]	闻万顺，赵元元，叶祥明. 早期右正中神经刺激对颅脑外伤昏迷患者促醒作用的临床观察[J]. 浙江创伤外科, 2017, 22(3): 420-423.
[13]	杨虎银，蒋坤，方大钊, 等. 正中神经电刺激对脑损伤后昏迷患者血流动力学的影响[J]. 华中科技大学学报(医学版), 2017, 46(4): 462-465.
[14]	王振宁，叶嘉文，罗灼明, 等. 正中神经电刺激对重症颅脑损伤昏迷病人脑血流速度及脑血流量的影响[J]. 中西医结合心脑血管病杂志, 2019, 17(9): 1406-1410.
[15]	赵坤，刘爱贤. 右正中神经刺激对创伤性颅脑损伤所致意识障碍的影响[J]. 康复学报, 2020, 30(3): 192-196.
[16]	封苏平，黎萍，黄强, 等. 右正中神经电刺激对重型脑外伤患者促醒作用的临床观察[J]. 中华物理医学与康复杂志, 2008, 30(5): 327-328.
[17]	程晓午. 右正中神经电刺激对颅脑损伤昏迷促醒的效果分析[J]. 中国医药科学, 2021, 11(4): 180-182, 186.
[18]	薛亮，汪熙臻，陈业煌, 等. 正中神经电刺激对NICU重型颅脑损伤昏迷促醒的临床研究[J]. 中华神经创伤外科电子杂志, 2021, 7(1): 17-20.
[19]	叶红刚，罗妍. 探讨右正中神电刺激对重型脑外伤患者的促醒作用[J]. 医药与保健, 2015, 23(2): 36-37.
[20]	黄苏闽，蔡小琴. 右正中神经电刺激对颅脑损伤昏迷促醒的观察及护理[J]. 实用临床医药杂志, 2015, 19(24): 195-197.
[21]	王士强，麦浩坚，钟新云, 等. 右正中神经电刺激对脑损伤术后昏迷患者催醒的临床研究[J]. 热带医学杂志, 2015, 15(4): 527-529, 560.
[22]	葛东方，刘爱静. 右正中神经电刺激在颅脑损伤患者促醒中的应用及护理[J]. 中国临床研究, 2021, 34(10): 1438-1440.
[23]	Nekkanti S, Shaik R, Mondem S, et al. Effect of Right Median Nerve Stimulation on Level of Consciousness in Traumatic Brain Injury Subjects[J]. AJPRHC, 2016, 8(3): 67-71.
[24]	方龙君，冯珍. 不同参数的正中神经电刺激对意识障碍患者促醒的影响[J]. 中国康复医学杂志, 2021, 36(3): 305-309.
[25]	刘梦洋，杨俊生，梁矗, 等. 正中神经电刺激用于昏迷促醒的研究进展[J]. 世界最新医学信息文摘, 2020, 20(96): 44-45.
[26]	Wu X, Zhang C, Feng J, et al. Right median nerve electrical stimulation for acute traumatic coma (the Asia coma electrical stimulation trial): study protocol for a randomised controlled trial[J]. Trials, 2017, 18(1): 311.
[27]	Feller D, Vinante C, Trentin F, et al. The effectiveness of median nerve electrical stimulation in patients with disorders of consciousness: a systematic review[J]. Brain Inj, 2021, 35(4): 385-394.
[28]	廖诚诚，冯珍. 正中神经电刺激用于昏迷促醒的机制研究进展[J]. 中国康复医学杂志, 2017, 32(5): 588-591.
[29]	Cooper EB, Scherder EJ, Cooper JB. Electrical treatment of reduced consciousness; experience with coma and alzheimer's disease[J]. Neuropsychol Rehabil, 2005, 15(3-4): 389-405.
[30]	游文栋，唐琪临，王磊, 等. 右正中神经电刺激对颅脑创伤昏迷患者脑电活动的影响[J]. 中华创伤杂志, 2016, 32(2): 120-123.
[31]	陈祢，王俭，王宝兰, 等. 右侧正中神经电刺激促醒疗法对健康人脑功能影响的fMRI研究[J]. 中华物理医学与康复杂志, 2019, 41(2): 91-95.
[32]	雷晋，高国一，宋绍莉, 等. 右正中神经电刺激对颅脑创伤昏迷患者脑血流灌注的影响: SPECT-CT显像观察[J]. 中华神经外科杂志, 2012, 28(2): 112-115.
[33]	Feng Z, Zhong YJ, Wang L, et al. Resuscitation therapy for traumatic brain injury-induced coma in rats: mechanisms of median nerve electrical stimulation[J]. Neural Regen Res, 2015, 10(4): 594-598.
[34]	Zhong YJ, Feng Z, Wang L, et al. Wake-promoting actions of median nerve stimulation in TBI-induced coma: an investigation of orexin-A and orexin receptor 1 in the hypothalamic region[J]. Mol Med Rep, 2015, 12(3): 4441-4447.
[35]	Feng Z, Du Q. Mechanisms responsible for the effect of median nerve electrical stimulation on traumatic brain injury-induced coma: orexin-A-mediated N-methyl-D-aspartate receptor subunitNR1 upregulation[J]. Neural Regen Res, 2016, 11(6): 951-956.

纳入文献	发表时间	样本量		观察时间	平均年龄		性别（男/女）		治疗前GCS评分		结局指标	质量等级
纳入文献	发表时间	MNS组	常规治疗组	观察时间	MNS组	常规治疗组	MNS组	常规治疗组	MNS组	常规治疗组	结局指标	质量等级
Cooper等^[3]	1999	3	3	2周	32	24	-	-	7.30±0.60	7.00±0.00	①	A
徐彬彬与王中^[4]	2006	20	20	2周	37.8±10.4	35.2±11.2	12/8	11/7	6.45±1.64	6.54±1.77	①②③	B
黄强等^[5]	2011	28	28	4周	44.7±11.3	43.3±10.9	18/10	18/10	5.82±1.53	5.82±1.47	①	B
Lei等^[6]	2015	221	216	6个月	41.32	43.21	154/67	145/71	6.27±4.32	6.31±4.31	①⑥	B
李成宇等^[7]	2013	31	31	3个月	-	-	-	-	6.85±1.54	6.98±1.87	①②③	B
李春雨^[8]	2014	31	31	4周	44.6±10.6	43.8±11.2	20/11	19/12	5.81±1.54	5.83±1.49	①④⑤	B
梁文海^[9]	2016	46	43	3个月	48.4±8.3	48.0±8.0	28/18	28/15	8.67±2.30	9.11±3.40	①②	B
杨初燕等^[10]	2016	30	30	4周	36.7±12.5	35.3±11.1	16/14	18/12	7.02±1.45	6.94±1.63	①	B
卫晓红等^[11]	2017	41	41	2周	44.5±5.7	45.3±6.1	30/11	32/9	6.10±0.90	6.20±1.00	①	B
闻万顺等^[12]	2017	63	63	6个月	36.7±10.8	36.5±11.0	43/20	44/19	6.23±1.56	6.17±1.68	①⑥	B
杨虎银等^[13]	2017	28	28	2个月	35.8±12.9	36.7±14.0	34/22	38/18	5.20±1.80	5.40±2.00	①④	B
王振宁等^[14]	2019	31	31	4周	39.1±6.9	40.1±7.1	23/8	20/11	5.50±2.06	5.41±1.91	①④⑤	B
赵坤与刘爱贤^[15]	2020	46	46	4周	37.7±7.5	38.2±6.3	22/24	26/20	6.49±0.81	6.17±0.85	①⑥	B
封苏平等^[16]	2008	20	20	4周	36.1±10.3	34.6±9.3	13/7	14/6	6.53±1.64	6.55±1.45	①	B
程晓午^[17]	2021	30	30	3周	52.1±8.6	52.0±8.9	19/11	18/12	4.03±2.05	3.97±2.13	①	B
薛亮等^[18]	2021	42	41	2周	42.3±14.5	39.7±13.1	34/8	32/9	5.83±1.267	5.88±1.14	①	B
叶红刚与罗妍^[19]	2015	30	30	2个月	-	-	31/29		2.53±1.01	2.31±0.58	①②③	B
黄苏闽与蔡小琴^[20]	2015	40	40	1个月	45.3±2.2		45/35		6.77±1.02	6.82±1.11	①	B
王士强等^[21]	2015	26	26	2个月	-	-	-	-	5.33±0.82	5.24±0.91	①	B
葛东方与刘爱静^[22]	2021	30	29	2周	-	-	-	-	5.31±1.16	5.42±1.29	①	B
Nekkanti等^[23]	2016	10	10	4周	-	-	-	-	5.00±1.49	4.90±1.52	①	B

纳入文献	发表时间	样本量		观察时间	平均年龄		性别（男/女）		治疗前GCS评分		结局指标	质量等级
纳入文献	发表时间	MNS组	常规治疗组	观察时间	MNS组	常规治疗组	MNS组	常规治疗组	MNS组	常规治疗组	结局指标	质量等级
Cooper等^[3]	1999	3	3	2周	32	24	-	-	7.30±0.60	7.00±0.00	①	A
徐彬彬与王中^[4]	2006	20	20	2周	37.8±10.4	35.2±11.2	12/8	11/7	6.45±1.64	6.54±1.77	①②③	B
黄强等^[5]	2011	28	28	4周	44.7±11.3	43.3±10.9	18/10	18/10	5.82±1.53	5.82±1.47	①	B
Lei等^[6]	2015	221	216	6个月	41.32	43.21	154/67	145/71	6.27±4.32	6.31±4.31	①⑥	B
李成宇等^[7]	2013	31	31	3个月	-	-	-	-	6.85±1.54	6.98±1.87	①②③	B
李春雨^[8]	2014	31	31	4周	44.6±10.6	43.8±11.2	20/11	19/12	5.81±1.54	5.83±1.49	①④⑤	B
梁文海^[9]	2016	46	43	3个月	48.4±8.3	48.0±8.0	28/18	28/15	8.67±2.30	9.11±3.40	①②	B
杨初燕等^[10]	2016	30	30	4周	36.7±12.5	35.3±11.1	16/14	18/12	7.02±1.45	6.94±1.63	①	B
卫晓红等^[11]	2017	41	41	2周	44.5±5.7	45.3±6.1	30/11	32/9	6.10±0.90	6.20±1.00	①	B
闻万顺等^[12]	2017	63	63	6个月	36.7±10.8	36.5±11.0	43/20	44/19	6.23±1.56	6.17±1.68	①⑥	B
杨虎银等^[13]	2017	28	28	2个月	35.8±12.9	36.7±14.0	34/22	38/18	5.20±1.80	5.40±2.00	①④	B
王振宁等^[14]	2019	31	31	4周	39.1±6.9	40.1±7.1	23/8	20/11	5.50±2.06	5.41±1.91	①④⑤	B
赵坤与刘爱贤^[15]	2020	46	46	4周	37.7±7.5	38.2±6.3	22/24	26/20	6.49±0.81	6.17±0.85	①⑥	B
封苏平等^[16]	2008	20	20	4周	36.1±10.3	34.6±9.3	13/7	14/6	6.53±1.64	6.55±1.45	①	B
程晓午^[17]	2021	30	30	3周	52.1±8.6	52.0±8.9	19/11	18/12	4.03±2.05	3.97±2.13	①	B
薛亮等^[18]	2021	42	41	2周	42.3±14.5	39.7±13.1	34/8	32/9	5.83±1.267	5.88±1.14	①	B
叶红刚与罗妍^[19]	2015	30	30	2个月	-	-	31/29		2.53±1.01	2.31±0.58	①②③	B
黄苏闽与蔡小琴^[20]	2015	40	40	1个月	45.3±2.2		45/35		6.77±1.02	6.82±1.11	①	B
王士强等^[21]	2015	26	26	2个月	-	-	-	-	5.33±0.82	5.24±0.91	①	B
葛东方与刘爱静^[22]	2021	30	29	2周	-	-	-	-	5.31±1.16	5.42±1.29	①	B
Nekkanti等^[23]	2016	10	10	4周	-	-	-	-	5.00±1.49	4.90±1.52	①	B

结局指标	研究数量	I²值（%）	SMD（95%CI）或OR（95%CI）	采用模型	P值	P值（Egger's test）
苏醒情况	3	0.0	2.13（1.56~2.91）	固定效应	<0.001	0.349
脑功能障碍	3	0.0	-0.66（-0.96~-0.36）	固定效应	<0.001	0.480
运动功能	4	0.0	0.25（0.00~0.50）	固定效应	0.048	0.169
生活质量	3	0.0	0.85（0.53~1.18）	固定效应	<0.001	0.603
脑电波	2	78.1	1.04（0.23~1.86）	随机效应	<0.001	1.000

结局指标	研究数量	I²值（%）	SMD（95%CI）或OR（95%CI）	采用模型	P值	P值（Egger's test）
苏醒情况	3	0.0	2.13（1.56~2.91）	固定效应	<0.001	0.349
脑功能障碍	3	0.0	-0.66（-0.96~-0.36）	固定效应	<0.001	0.480
运动功能	4	0.0	0.25（0.00~0.50）	固定效应	0.048	0.169
生活质量	3	0.0	0.85（0.53~1.18）	固定效应	<0.001	0.603
脑电波	2	78.1	1.04（0.23~1.86）	随机效应	<0.001	1.000

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