fMRI抬手范式在严重意识障碍患者中的诊断价值研究

发布时间：2018-03-11 04:26

  本文选题：严重意识障碍　切入点：植物状态　出处：《杭州师范大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:对于大多数经验丰富的临床医生来说,准确评估严重意识障碍患者的意识依然是一个很大的挑战。作为一种潜在的临床工具,f MRI技术能够在不需要患者表现出任何行为反应的情况下,检测到严重意识障碍患者的意识迹象。在这里,我们采用了一种简单可行的主动f MRI运动范式(抬手)来检测患者的残留意识。方法:本研究共入组15名健康被试和30名严重脑损伤患者(VS/UWS患者21名,MCS患者8名,EMCS患者1名)。我们分析了15名健康被试的遵嘱反应,找出可靠的动作执行的稳定指标证据,用该证据来对患者的数据进行分析。结果:在30名严重脑损伤患者中,有5名患者(2名VS/UWS,2名MCS,1名EMCS)在抬手任务状态下能够调节他们的大脑活动,同时运动相关区域出现激活(唤名任务状态下运动相关区域未见激活)。纵向行为评估追踪显示,在功能磁共振成像扫描时运动相关区域出现激活的2名VS/UWS患者都恢复成了MCS,运动相关脑区未见激活的19名VS/UWS患者,其中10名仍处于VS/UWS,2名不幸去世,7名在观察期结束时已过渡至MCS或EMCS。运动皮层激活的2名MCS患者,其中1名好转成为MCS+,另外脑区未见激活的6名患者,有3名未见好转维持原状态,其余3名恢复至EMCS。结论:主动f MRI抬手任务能够引发严重意识障碍患者产生与15名健康志愿者相似的脑部激活。基于f MRI的运动相关脑区的活动可以作为高水平认知功能的一个指标,而传统行为评估却无法实现。
[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.
【学位授予单位】：杭州师范大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R445.2;R749.1
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