摘要目前,意识障碍患者的意识恢复过程仍然不是很清楚。大多数相关研究采用组间比较方法,而意识恢复不仅是一个动态过程,而且会涉及不同脑区间的相互作用。因此,阐明意识恢复机制需要从时间和空间两个维度对大脑活动进行跟踪。利用脑电图的时空分辨率优势,跟踪41例意识障碍患者,共采集161例脑电信号。之后,比较不同意识恢复阶段患者脑电信号的非线性动力学参数,包括近似熵(ApEn)、样本熵(SampEn)和Lempel-Ziv复杂度(LZC)。在时间维度上,在患者意识恢复期间,全脑非线性动力学参数表现出非单调变化模式(LZC:0.299±0.053,0.295±0.060,0.279±0.049,0.302±0.053,0.307±0.069,0.326±0.049,0.334±0.046;P<0.05),且当患者从植物状态恢复到最小意识状态时,所有参数都出现拐点。在空间维度上,随着意识恢复,损伤区和非损伤区的非线性动力学参数也呈非单调变化模式,且不同脑区的非单调变化模式呈非同步。在脱离最小意识状态时,两区域差异呈极显著(损伤区 vs非损伤区:ApEn为0.608±0.042 vs 0.63±0.030,LZC为0.317±0.054 vs 0.351±0.039,SampEn为0.581±0.058 vs 0.615±0.043;P<0.01)。意识恢复过程在时间维度上呈非单调变化模式,在空间维度上呈非同步变化模式。这一发现有助于进一步阐明意识恢复机制,并且对临床上治疗意识障碍患者提供理论依据。
Abstract：The recovery of consciousness in patients with disorder of consciousness has not been well understood. Most previous studies usedcross-sectional design, as consciousness recovery is not only dynamic but also involves interactions between various brain regions. Elucidating the mechanism of recovery requires tracking brain activity both in temporal and in spatial dimensions. In this study we took advantage of the high temporal resolution and good spatial resolution of EEG to examine 41 patients with disorder of consciousness, analyzing a total of 161 resting-state EEG measurements. We compared the changes in EEG nonlinear dynamic features of brain activity among the patients in different stages of consciousness recovery, including approximate entropy, sample entropy, and Lempel-Ziv complexity. In the temporal dimension, EEG nonlinear dynamic features for the whole brain showed a non-monotonic trend during recovery (LZC: 0.299±0.053, 0.295±0.060, 0.279±0.049, 0.302±0.053, 0.307±0.069, 0.326±0.049, 0.334±0.046; P<0.05). When patients progressed from vegetative state to minimally conscious state, there was an inflection point in the EEG features. In the spatial dimension, changes in EEG features in injured and uninjured areas were also non-monotonic during consciousness recovery, and the non-monotonic changes in the two areas were non-synchronized. In emergence from minimally conscious state, the difference between the two regions was extremely significant (injured vs uninjured: ApEn: 0.608±0.042 vs 0.63±0.030; LZC: 0.317±0.054 vs 0.351±0.039; SampEn: 0.581±0.058 vs 0.615±0.043; P<0.01). The consciousness recovery pattern was non-monotonic in the temporal and asynchronous in the spatial dimension. These findings provided insights into the mechanisms of consciousness recovery following brain injury and could serve as a basis for the treatment and rehabilitation of patients with disorder of consciousness.
雷灵, 杨勇, 侯娜, 刘克洪, 吴莉, 程琪琪, 董腾飞, 胡晓华. 基于非线性时空动力学的意识障碍患者脑电图研究[J]. 中国生物医学工程学报, 2021, 40(1): 60-70.
Lei Ling, Yang Yong, Hou Na, Liu Kehong, Wu Li, Cheng Qiqi, Dong Tengfei, Hu Xiaohua. EEG Study of Patients with Disorder of Consciousness Based on Nonlinear Spatiotemporal Dynamics. Chinese Journal of Biomedical Engineering, 2021, 40(1): 60-70.
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