本文選題：高壓氧治療　切入點(diǎn)：腦外傷　出處：《福建中醫(yī)藥大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：第一部分腦外傷后認(rèn)知功能障礙的DMN網(wǎng)絡(luò)研究目的:采用靜息態(tài)功能磁共振成像(rs-fMRI)技術(shù)結(jié)合獨(dú)立成分分析(ICA)方法探討腦外傷后認(rèn)知功能障礙患者的DMN網(wǎng)絡(luò)的改變。方法:將40例符合納入標(biāo)準(zhǔn)的腦外傷后認(rèn)知功能障礙患者(TBI組)和30例健康對(duì)照組(NC組)進(jìn)行量表評(píng)定和靜息態(tài)功能磁共振的掃描。使用GIFT軟件分離出DMN網(wǎng)絡(luò),再用DPABI對(duì)網(wǎng)絡(luò)進(jìn)行單樣本t檢驗(yàn),最后對(duì)兩組予兩獨(dú)立樣本t檢驗(yàn),比較NC組和TBI組兩組間DMN網(wǎng)絡(luò)圖像的差異。結(jié)果:與NC組比較,TBI組aDMN的左前額皮質(zhì)外側(cè)部(BA6、44)、PC-R(BA7、18)、左梭狀回(BA36)和pDMN的右額上回背外側(cè)(BA9)、右扣帶回中部(BA32)、PC-R(BA5)、左頂下小葉(BA40)區(qū)域在DMN網(wǎng)絡(luò)中功能連接顯著降低。TBI組aDMN的 MPFC-L(BA45、47)、ACC-R(BA32)、右顳中回(BA21、37)、右海馬(BA27、30)和pDMN的MPFC(BA10、47)、左枕中回(BA19)區(qū)域在DMN網(wǎng)絡(luò)中功能連接顯著增強(qiáng)。結(jié)論:腦外傷后認(rèn)知功能障礙患者DMN網(wǎng)絡(luò)中PCC/PC、前額葉背外側(cè)、梭狀回、頂下小葉等區(qū)域的功能連接降低可能是直接影響認(rèn)知功能的因素。MPFC、ACC、顳中回、海馬、枕中回等區(qū)域的功能連接增強(qiáng)可能是在早期的腦外傷患者中出現(xiàn)了一種功能代償。第二部分高壓氧治療腦外傷后認(rèn)知障礙的DMN網(wǎng)絡(luò)研究目的:大量研究表明高壓氧能夠改善腦外傷后的認(rèn)知功能,但其對(duì)改善腦外傷后認(rèn)知功能的中樞機(jī)制尚不清楚。課題通過(guò)對(duì)入組志愿者進(jìn)行量表評(píng)定,證實(shí)高壓氧作用。同時(shí),觀察高壓氧治療前后腦功能的變化,從而推斷高壓氧治療改善腦外傷后認(rèn)知功能的中樞效應(yīng)機(jī)制。方法:招募合格腦外傷認(rèn)知障礙患者,根據(jù)隨機(jī)數(shù)字法分為高壓氧組(HBO組)和非高壓氧組(NHBO組),HBO組予HBO治療+常規(guī)認(rèn)知康復(fù)+常規(guī)外科治療,NHBO組予常規(guī)認(rèn)知康復(fù)+常規(guī)外科治療。兩組志愿者治療前后均予臨床量表評(píng)定和功能磁共振掃描。利用DPABI軟件對(duì)兩組志愿者的DMN網(wǎng)絡(luò)圖像分別進(jìn)行治療前后配對(duì)t檢驗(yàn)。根據(jù)圖像的差異探索高壓氧治療的中樞機(jī)制。結(jié)果:與治療前相比,治療后MMSE、MoCA均升高。且高壓氧組較非高壓氧組效果更好。HBO組中,治療后較治療前功能連接增強(qiáng)的有:左內(nèi)側(cè)額上回(BA10)、右顳中回(BA21/22)、PCC-L(BA23)、右島葉(BA47)、左/右舌回(BA17、18);功能連接降低的有:右額上回(BA10)、額上回眶部(BA11)、右梭狀回(BA19)、右頂下小葉(BA39)、左枕葉(BA18/37)、右輔助運(yùn)動(dòng)區(qū)(BA6)。結(jié)論:1、高壓氧治療能夠改善腦外傷后認(rèn)知障礙患者的認(rèn)知功能,與常規(guī)認(rèn)知康復(fù)訓(xùn)練有機(jī)的結(jié)合更有利于恢復(fù)。2、高壓氧治療能夠改善腦外傷后認(rèn)知功能障礙的中樞機(jī)制可能是HBOT促進(jìn)PC/PCC、額葉、顳葉等節(jié)點(diǎn)在DMN網(wǎng)絡(luò)中功能連接。
[Abstract]:Part I: DMN Network study on Cognitive dysfunction after brain injury objective: to investigate the changes of DMN network in patients with cognitive impairment after brain injury using resting functional magnetic resonance imaging (fMRI) technique combined with independent component analysis (ICA). Methods: 40 patients with cognitive impairment after traumatic brain injury and 30 healthy controls were assessed with the scale and the rest functional magnetic resonance imaging (fMRI). The DMN network was separated by GIFT software. Then DPABI is used to carry out a single sample t test for the network, and finally two groups of independent samples t test are given. Results: compared with NC group, the difference of DMN network images between NC group and TBI group. Results: compared with NC group, the left prefrontal cortex lateral part of aDMN in aDMN group was compared with that in the control group. The left frontal cortex of aDMN was 44.The left fusiform gyrus (BA36) and the right suprafrontal gyrus dorsolateral gyrus (BA9), the right cingulate gyrus (BA32), the right cingulate gyrus (BA32), and the left inferior parietal lobules (BA40) were compared with those in the NC group. The functional connections of MPFC-LBA447, right middle temporal gyrus, right middle temporal gyrus, right hippocampus, right hippocampus, BA2730) and pDMN's MPFC-LBA45, BA19) were significantly increased in the DMN network. Conclusion: DMN in patients with cognitive impairment after traumatic brain injury is significantly enhanced. The functional connections of MPFC-LBA447 and left occipital gyrus BA19) in patients with cognitive impairment after traumatic brain injury are significantly enhanced in the DMN network (P < 0.05). Conclusion: in patients with cognitive impairment after traumatic brain injury, the functional connections of MPFC-LBA447, right middle temporal gyrus, right hippocampus, and pDMN are significantly increased. PCC / PC in the network, dorsolateral prefrontal lobe, Decreased functional connections in areas such as fusiform gyrus, inferior parietal lobule, etc., may be the factors directly affecting cognitive function. The enhancement of functional connections in areas such as the middle occipital gyrus may be a kind of functional compensation in early brain trauma patients. Part 2 DMN network study of hyperbaric oxygen in the treatment of post-traumatic cognitive impairment objective: a large number of studies have shown that high blood pressure is present in patients with post-traumatic cognitive impairment. Oxygen can improve cognitive function after brain injury. However, its central mechanism for improving cognitive function after brain injury is not clear. The subjects were assessed by the volunteers in the study to confirm the effect of hyperbaric oxygen. At the same time, the changes of brain function were observed before and after hyperbaric oxygen treatment. Therefore, the mechanism of central effect of hyperbaric oxygen therapy on the improvement of cognitive function after brain injury was inferred. Methods: qualified patients with cognitive impairment of brain injury were recruited. According to the random number method, the HBO group was divided into hyperbaric oxygen group (HBO group) and non hyperbaric oxygen group (NHBO group). The HBO group was given conventional cognitive rehabilitation routine surgical treatment and the NHBO group received conventional cognitive rehabilitation routine surgical treatment before and after treatment. The DMN network images of the two groups of volunteers were tested by paired t test before and after treatment with DPABI software. The central mechanism of hyperbaric oxygen therapy was explored according to the difference of the images. :: compared with pre-treatment, MMSE MoCA increased after treatment, and the effect of hyperbaric oxygen group was better than that of non-hyperbaric oxygen group. The enhanced functional connections after treatment were: left medial superior frontal gyrus BA10, right middle temporal gyrus 21 / 22 PCC-LT BA23, right insular lobes BA47, left / right lingual gyrus BA1718; functional connections decreased in right superior frontal gyrus BA10, suprafrontal gyrus orbit, right fusiform gyrus 19, right inferior parietal lobules BA39. Occipital lobes BA18 / 37, right auxiliary motor area BA6. Conclusion: hyperbaric oxygen therapy can improve the cognitive function of patients with cognitive impairment after brain injury. Combined with conventional cognitive rehabilitation training, hyperbaric oxygen therapy can improve cognitive dysfunction after traumatic brain injury. The central mechanism of hyperbaric oxygen therapy may be that HBOT promotes the functional connection of PC-PCC, frontal lobe and temporal lobe in DMN network.
【學(xué)位授予單位】：福建中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R651.15;R445.2

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 Changbo Lu;Tao Yang;Huan Zhao;Ming Zhang;Fancheng Meng;Hao Fu;Yingli Xie;Hui Xu;;Insular Cortex is Critical for the Perception, Modulation,and Chronification of Pain[J];Neuroscience Bulletin;2016年02期

2 丁政;唐朝正;彭慧平;;高壓氧醫(yī)學(xué)與康復(fù)醫(yī)學(xué)的協(xié)同發(fā)展[J];醫(yī)學(xué)與哲學(xué)(B);2014年10期

3 張祥根;姜正林;王國(guó)華;李永財(cái);王勇;李霞;沈洪妹;;高壓氧治療創(chuàng)傷性腦損傷的效用及機(jī)制研究[J];中國(guó)應(yīng)用生理學(xué)雜志;2012年01期

4 張方;張劍戈;左傳濤;郭萬(wàn)華;王成;;基于葡萄糖代謝的大腦功能網(wǎng)絡(luò)的小世界特性研究[J];中國(guó)醫(yī)療器械雜志;2011年03期

5 張祥根;王國(guó)華;李永財(cái);王勇;姜正林;;高壓氧療法對(duì)創(chuàng)傷性腦損傷大鼠氧化應(yīng)激指標(biāo)及促/抗炎細(xì)胞因子水平的影響[J];中國(guó)應(yīng)用生理學(xué)雜志;2010年03期

6 柯銘;沈輝;胡德文;;基于fMRI的靜息狀態(tài)腦功能復(fù)雜網(wǎng)絡(luò)分析[J];國(guó)防科技大學(xué)學(xué)報(bào);2010年01期

7 劉明;高如生;吳光輝;蔡智基;;537例顱腦損傷流行病學(xué)特點(diǎn)分析[J];中國(guó)實(shí)用醫(yī)藥;2010年03期

8 劉輝;孫善全;楊美;邱國(guó)平;余維華;卓飛;;水通道蛋白4在大鼠輕度腦外傷后腦水腫形成中的作用[J];解剖學(xué)雜志;2009年01期

9 傅杰青;核磁共振——獲得諾貝爾獎(jiǎng)次數(shù)最多的一個(gè)科學(xué)專題[J];自然雜志;2003年06期

10 施小燕,湯宗泉,熊冰,包建秀,孫達(dá),張?jiān)魄?姚瑜;Cerebral perfusion SPECT imaging for assessment of the effect of hyperbaric oxygen therapy on patients with postbrain injury neural status[J];Chinese Journal of Traumatology;2003年06期

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