电针刺激对急性脑损伤昏迷患者早期促醒的作用

Effects of electroacupuncture stimulation on early promoting resuscitation of patients with acute brain injury coma

目的探讨电针刺激对急性脑损伤昏迷患者的早期促醒作用。方法采用前瞻性研究方法，将江苏省江阴市中医院脑外科2013年3月至2014年6月收治的符合条件的32例急性颅脑损伤和高血压脑出血患者按随机信封法分为观察组和对照组，每组16例。对照组患者给予常规治疗；观察组在常规治疗的基础上选取人中穴、百会穴、内关穴、足三里穴位进行电针刺激治疗，刺激参数为脉冲宽度0．2ms，刺激频率为2—30Hz，波形为疏密波，持续时间30rain，每天1次。两组均连续治疗14d后，观察两组治疗1、3、7、13d格拉斯哥昏迷评分（GCS）；治疗1、3、5、7、9、11、13dB-内啡肽（B-EP）、强啡肽（Dyn—A）1-13、D-二聚体、纤维蛋白原（Fib）的变化；用格拉斯哥预后评分（GOS）评价患者的预后。结果两组治疗后GCS评分逐渐升高，治疗13d达峰值，且观察组明显高于对照组（分：9．25±3．96比8．04±2．44，P〈0．05）。观察组从治疗1d起B-EP水平即明显高于对照组（ug/L：2．32±0．20比1．08±0．27），持续到治疗13d时仍处于高于对照组水平（ug／L：2．57±2．00比0．90±0．56，P〈0．05）。两组治疗各时间点Dyn—A1-β，水平（ug/L）比较差异均无统计学意义（观察组1、3、5、7、9、11、13d时Dyn—A1-β分别为0．45±0．28、0．50±0．26、0．48±0．16、0．41±0．16、0．52±0．18、0．43±0．23、0．47±0．21，对照组分别为0．40±0．19、0．51±0．18、0．46±0．14、0．47±0．15、0．43±0．14、0．43±0．22、0．36±0．20，均P〉0．05）。观察组治疗3d起D-二聚体水平即明显低于对照组（ug／L：9．52±8．21比16．04±17．41，P〈0．05），并持续到治疗13d（ug/L：4．60±3．53比6．19±5．30，P〈0．05），治疗1d起观察组Fib水平明显低于对照组（g／L：2．36±0．81比3．01±0．86），到治疗7d时观察组和对照组Fib水平接近（4．20±0．99比4．20±1．11），治疗9d起观察组明显高于对照组（4．71±0．58比3．90±1．27），持续到治疗13d（4．76±0．59比3．75±0．68）。研究终点观察组GOS评分明显高于对照组（分：4．00±1．03比3．06±1．23，P〈0．05）。结论EA对急性脑损伤昏迷患者早期有一定促醒作用，其机制可能与改善凝血功能有关，早期促醒对患者的预后有一定积极意义。

Objective To observe the curative effects of electroacupuncture stimulation on the early promoting resuscitation of patients with acute brain injury coma. Methods A prospective study was conducted, 32 eligible patients with acute craniocerebral injury and hypertensive cerebral hemorrhage admitted to the Department of Brain Surgery of Jiangyin Hospital of Traditional Chinese Medicine from March 2013 to June 2014 were enrolled, and they were randomly divided into observation group and control group, 16 cases in each group. The patients in control group were given routine treatment, and patients in observation group were given electroacupuncture stimulation at Renzhong, Baihui, Neiguan and Zusanli acupoints on the basis of routine treatment, the stimulation was given once a day for 30 minutes, the stimulation parameters were pulse width 0.2 ms, stimulation frequency 2 - 30 Hz and wave form dilatational. In the two groups, after the treatment persisted for 14 days, the changes of Glasgow coma score （GCS） were assessed on 1, 3, 7, 13 days; the changes of β -endorphin （ β -EP）, Dynorphin1-β （Dyn-A1-β）, D-dimer and fibrinogen （Fib） were observed on 1, 3, 5, 7, 9, 11, 13 days after treatment; Glasgow prognostic score （GOS） was used to evaluate the prognosis of patients. Results The GCS of these two groups were gradually increased and reached the peak after treatment for 13 days, and the GCS of observation group was significantly higher than that of the control group （9.25 ± 3.96 vs. 8.04 ± 2.44, P 〈 0.05）. The 13 -EP level of observation group was significantly higher than the control group after treatment for 1 day （ug/L： 2.32 ± 0.20 vs. 1.08 ±0.27）, the situation persisting to β days after treatment （ug/L： 2.57± 2.00 vs. 0.90 ± 0.56, P 〈 0.05）. There was no significant difference in Dyn-Al-β level （ug/L） between the two groups at each time point （the Dyn-A1-3 levels of observation group in 1, 3, 5, 7, 9, 11, 13 days respectively were 0.45 ± 0.28, 0.50 ± 0.26, 0.48 ± 0.16, 0.41 ± 0.16, 0.52 ± 0.18, 0.43 ± 0.23, 0.47 ± 0.21, and the control group respectively were 0.40 ± 0.19, 0.51 ± 0.18, 0.46 ± 0.14, 0.47± 0.15, 0.43 ± 0.14, 0.43 ± 0.22, 0.36 ± 0.20, all P 〉 0.05）.The D-dimer level of observation group was significantly lower than that of the control group after treatment for 3 days （ug/L： 9.52 ± 8.21 vs. 16.04± 17.41, P 〈 0.05）, and still lower than the control group after treatment for β days （ug/L： 4.60 ±3.53 vs. 6.19 ± 5.30, P 〈 0.05）, the Fib level of observation group was significantly lower than the control group after treatment for 1 day （g/L： 2.36±0.81 vs. 3.01±0.86）, and the levels of two groups approximately approached after treatment for 7 days （4.20 ± 0.99 vs. 4.20 ± 1.11）, the level of observation group became higher than the control group after treatment for 9 days （4.71 ± 0.58 vs. 3.90 ± 1.27）, and continued higher after β days （4.76 ± 0.59 vs. 3.75 ± 0.68）. The GOS in observation group was significantly higher than that in the control group at the endpoint of this study （4.00 ± 1.03 vs. 3.06 ± 1.23, P 〈 0.05）. Conclusions The EA stimulation has certain early action to promote resuscitation of patients with acute brain injury coma, its mechanism is related to improving the coagulation function and it has a certain positive significance in the prognosis of such patients.