Department of Neurosurgery, Jinjiang Municipal Hospital, Jinjiang, China -
Department of Neurosurgery, Jinjiang Municipal Hospital, Jinjiang, China.
J Neurosurg Sci. 2024 Apr;68(2):186-194. doi: 10.23736/S0390-5616.21.05236-X. Epub 2021 Mar 11.
Diffuse axonal injury (DAI) accounts for 30-40% of total neurotrauma cases, and the majority among them manifest with consciousness disturbance. At present, the understanding of the treatment of coma and awakening in patients with DAIs is still limited. This study is characterized by the use of electroacupuncture along with conventional Western medicine to promote consciousness more effectively in comatose patients with DAIs, shorten their time spent in a coma, and gain time for more favorable treatments during follow-up rehabilitation in order to improve the cure rate, reduce the morbidity rate, and achieve better therapeutic effects.
In this randomized controlled study, 145 comatose patients with DAIs (type III) were divided into the treatment group (N.=71) and control group (N.=74). The patients in the control group were treated with conventional Western medicine, while those in the treatment group were treated with both electroacupuncture and conventional treatment. The Glasgow Coma Scale (GCS) scores and consciousness-promotion rates of both groups were observed before treatment as well as 10, 20, and 30 days after treatment. Meanwhile, serum acetylcholinesterase E (AchE) concentrations in both groups were measured with ELISA, while AchE activity was determined with the rate method. Correlations between GCS score, AchE concentration, and AchE activity in the treatment group were analyzed by using the stepwise multiple regression method.
The GCS scores in the treatment group showed significant increases after the first, second, and third courses of treatment when compared to the pre-treatment scores (P<0.05). After 1 course of treatment, the GCS scores in the control group were not statistically significantly different compared to the pre-treatment scores (P>0.05), whereas after 2 and 3 courses of treatment, the differences were of greater statistical significance (P<0.05). Statistically significant differences between the two groups were found in GCS scores in the same course of treatment (P<0.05). The consciousness-promotion rates between the two groups after the same treatment course were statistically significantly different (P<0.05). Both the standardized regression coefficients and partial correlation coefficients showed that AchE concentration had a certain influence on GCS score (|Beta|=0.3601; r
Conventional Western medicine combined with electroacupuncture treatment may promote the consciousness of patients with DAIs and shorten the amount of time they spend comatose. Furthermore, the neurotransmitter AchE may play a role in the pathophysiological mechanism of consciousness promotion.
弥漫性轴索损伤（DAI）占总神经创伤病例的 30-40%，其中大多数表现为意识障碍。目前，对 DAI 患者昏迷和觉醒治疗的认识仍然有限。本研究的特点是使用电针对昏迷的 DAI 患者进行更有效的意识促进，缩短昏迷时间，并为后续康复治疗争取更有利的治疗时间，以提高治愈率，降低发病率，并获得更好的治疗效果。
在这项随机对照研究中，145 例 DAI 昏迷患者（III 型）分为治疗组（N=71）和对照组（N=74）。对照组采用常规西药治疗，治疗组采用电针加常规治疗。观察两组患者治疗前及治疗后 10、20、30 天的格拉斯哥昏迷量表（GCS）评分和意识促醒率。同时，采用 ELISA 法测定两组患者血清乙酰胆碱酯酶 E（AchE）浓度，速率法测定 AchE 活性。采用逐步多元回归法分析治疗组 GCS 评分与 AchE 浓度、AchE 活性的相关性。
与治疗前相比，治疗组在第一、第二和第三疗程后 GCS 评分均有显著升高（P<0.05）。治疗 1 疗程后，对照组 GCS 评分与治疗前无统计学差异（P>0.05），而治疗 2、3 疗程后差异有统计学意义（P<0.05）。同一疗程两组间 GCS 评分差异有统计学意义（P<0.05）。同一疗程两组意识促醒率差异有统计学意义（P<0.05）。标准化回归系数和偏相关系数均显示 AchE 浓度对 GCS 评分有一定影响（|Beta|=0.3601；r
常规西药联合电针治疗可能促进 DAI 患者的意识，并缩短昏迷时间。此外，神经递质 AchE 可能在意识促进的病理生理机制中发挥作用。
