本文選題：嚴(yán)重意識(shí)障礙　切入點(diǎn)：植物狀態(tài)　出處：《杭州師范大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:對(duì)于大多數(shù)經(jīng)驗(yàn)豐富的臨床醫(yī)生來說,準(zhǔn)確評(píng)估嚴(yán)重意識(shí)障礙患者的意識(shí)依然是一個(gè)很大的挑戰(zhàn)。作為一種潛在的臨床工具,f MRI技術(shù)能夠在不需要患者表現(xiàn)出任何行為反應(yīng)的情況下,檢測(cè)到嚴(yán)重意識(shí)障礙患者的意識(shí)跡象。在這里,我們采用了一種簡(jiǎn)單可行的主動(dòng)f MRI運(yùn)動(dòng)范式(抬手)來檢測(cè)患者的殘留意識(shí)。方法:本研究共入組15名健康被試和30名嚴(yán)重腦損傷患者(VS/UWS患者21名,MCS患者8名,EMCS患者1名)。我們分析了15名健康被試的遵囑反應(yīng),找出可靠的動(dòng)作執(zhí)行的穩(wěn)定指標(biāo)證據(jù),用該證據(jù)來對(duì)患者的數(shù)據(jù)進(jìn)行分析。結(jié)果:在30名嚴(yán)重腦損傷患者中,有5名患者(2名VS/UWS,2名MCS,1名EMCS)在抬手任務(wù)狀態(tài)下能夠調(diào)節(jié)他們的大腦活動(dòng),同時(shí)運(yùn)動(dòng)相關(guān)區(qū)域出現(xiàn)激活(喚名任務(wù)狀態(tài)下運(yùn)動(dòng)相關(guān)區(qū)域未見激活)�？v向行為評(píng)估追蹤顯示,在功能磁共振成像掃描時(shí)運(yùn)動(dòng)相關(guān)區(qū)域出現(xiàn)激活的2名VS/UWS患者都恢復(fù)成了MCS,運(yùn)動(dòng)相關(guān)腦區(qū)未見激活的19名VS/UWS患者,其中10名仍處于VS/UWS,2名不幸去世,7名在觀察期結(jié)束時(shí)已過渡至MCS或EMCS。運(yùn)動(dòng)皮層激活的2名MCS患者,其中1名好轉(zhuǎn)成為MCS+,另外腦區(qū)未見激活的6名患者,有3名未見好轉(zhuǎn)維持原狀態(tài),其余3名恢復(fù)至EMCS。結(jié)論:主動(dòng)f MRI抬手任務(wù)能夠引發(fā)嚴(yán)重意識(shí)障礙患者產(chǎn)生與15名健康志愿者相似的腦部激活。基于f MRI的運(yùn)動(dòng)相關(guān)腦區(qū)的活動(dòng)可以作為高水平認(rèn)知功能的一個(gè)指標(biāo),而傳統(tǒng)行為評(píng)估卻無法實(shí)現(xiàn)。
[Abstract]:Objective: for most experienced clinicians, Accurate assessment of awareness in patients with severe consciousness disorders remains a major challenge. As a potential clinical tool, MRI technology can be used without requiring any behavioral response from patients. Detects signs of consciousness in patients with severe disorders of consciousness. Here, We used a simple and feasible active f MRI exercise paradigm to detect residual awareness in patients. Methods: in this study, 15 healthy subjects and 30 patients with severe brain injury were enrolled in the study. There were 21 patients with VS / UWS and 8 patients with VS- / UWS. We analyzed the compliance responses of 15 healthy subjects. The evidence was used to analyze patient data. Results: in 30 patients with severe brain injury, Five patients, two VS / UWSU, two MCSs, one EMCSA, were able to regulate their brain activity under the hand lifting task, while the motion-related areas were activated. Two VS/UWS patients with activation of motion-related areas on functional magnetic resonance imaging (fMRI) recovered to MCSs, while 19 VS/UWS patients with no activation in motion-related brain areas were found. Of these, 10 were still in the VS / UWSU, 2 were unfortunately dead and 7 were MCS patients who had transitioned to MCS or EMCS.Activation of the motor cortex at the end of the observation period, one of them became MCS, and the other 6 patients were not activated in the brain region. Three of them did not see any improvement in the status quo ante. Conclusion: the active f MRI lifting task can induce brain activation similar to that of 15 healthy volunteers with severe consciousness disorder. The activity of motor related brain area based on f MRI can be regarded as a high level. A measure of cognitive function, But the traditional behavior evaluation cannot be realized.
【學(xué)位授予單位】：杭州師范大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R445.2;R749.1
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本文編號(hào)：1596575