Abstract:

Objective　To observe the effects of transcutaneous acupoint electrical stimulation (TEAS) on coma score and brain electrophysiological activity level in patients with disturbance of consciousness due to craniocerebral trauma. Methods　This study was a randomized controlled trial. A total of 90 patients with disturbance of consciousness due to craniocerebral trauma admitted to Shaanxi Provincial Hospital of Traditional Chinese Medicine and Xi'an Encephalopathy Hospital of Traditional Chinese Medicine from December 2021 to October 2023 were selected and were divided into two groups by the random number table method. In the conventional group, there were 28 males and 17 females, aged (47.86±10.59) years; the Glasgow Coma Scale (GCS) score was (5.74±1.46) points; the injury types were open injury in 31 cases and closed injury in 14 cases; the causes of injury were traffic injury in 19 cases, falling injury in 14 cases, head injury in 9 cases, and other in 3 cases. In the TEAS group, there were 25 males and 20 females, aged (48.11±10.13) years; the GCS score was (5.69±1.52) points; the injury types were open injury in 28 cases and closed injury in 17 cases; the causes of injury were traffic injury in 18 cases, falling injury in 15 cases, head injury in 10 cases, and other in 2 cases. The conventional group was treated with conventional treatment regimen, and the TEAS group was treated with conventional treatment regimen combined with TEAS (30 min/time, once a day, resting for 1 d after 6 d of continuous treatment). Both groups were treated for 4 weeks. The Coma Recovery Scale-Revised (CRS-R) scores, electroencephalogram (EEG) scores, GCS scores, latent periods and amplitudes of the P300 wave, nerve cytokines, and radionuclide count values of the regions of interest in different brain regions were compared between the two groups before and after treatment, and the time to restore pupillary reflex to the light and rates of wakefulness, cerebral vasospasm, pulmonary infection, and deep vein thrombosis within 4 weeks were analyzed. t test and χ² test were used for statistical analysis. Results　The CRS-R scores [(8.41±1.23) and (9.83±1.09) points], EEG scores [(1.51±0.26) and (1.93±0.31) points], and GCS scores [(9.52±1.36) and (11.14±1.51) points] in the conventional group and the TEAS group after treatment were higher than those before treatment, and those in the TEAS group were higher than those in the conventional group (all P<0.05). The amplitudes of the P300 wave [(5.74±0.54) µV and (6.31±0.61) µV] in the conventional group and the TEAS group after treatment were higher than those before treatment, and that in the TEAS group was higher than that in the conventional group (all P<0.05). The latent periods of the P300 wave [(321.43±19.87) ms and (313.04±17.44) ms] in the conventional group and the TEAS group after treatment were shorter than those before treatment, and that in the TEAS group was shorter than that in the conventional group (all P<0.05). The levels of glial cell progenitor fibrillary acidic protein (GFAP) [(14.04±2.06) ng/L and (8.12±1.25) ng/L], neuropeptide Y (NPY) [(232.85±40.51) ng/L and (195.25±35.06) ng/L], S100β [(1.48±0.36) ng/L and (1.07±0.31) ng/L], ubiquitin completion terminal hydrolase-L1 (UCH-L1) [(1.11±0.27) μg/L and (0.82±0.23) μg/L] in the conventional group and the TEAS group after treatment were lower than those before treatment, and those in the TEAS group were lower than those in the conventional group (all P<0.05). The radionuclide count values of the regions of interest in the cortex (13.54±1.96 and 14.93±2.21) and thalamus (10.04±1.36 and 12.01±1.42) in the conventional group and the TEAS group after treatment were higher than those before treatment, and those in the TEAS group were higher than those in the conventional group (all P<0.05). The time to restore pupillary reflex to the light in the TEAS group was shorter than that in the conventional group [(5.41±1.06) d vs. (6.89±1.31) d], the rate of wakefulness within 4 weeks was higher than that in the conventional group [66.67% (30/45) vs. 44.45% (20/45)], and the rate of cerebral vasospasm was lower than that in the conventional group [2.22% (1/45) vs. 15.56% (7/45)] (all P<0.05). Conclusion　TEAS can increase the coma score, improve the electrophysiological activity, increase the blood perfusion volume in the cortex and thalamus, promote wakefulness, and reduce cerebral vasospasm in patients with disturbance of consciousness due to craniocerebral trauma.

Key words:

Disturbance of consciousness, Craniocerebral trauma, Transcutaneous acupoint electrical stimulation, Brain electrophysiological activity, Electroencephalography, Blood perfusion volume

摘要：

目的　观察经皮穴位电刺激（TEAS）对颅脑外伤致意识障碍患者昏迷评分及脑电生理活动水平的影响。方法　本研究为随机对照试验。选取2021年12月至2023年10月陕西省中医医院及西安中医脑病医院收治的因颅脑外伤致意识障碍患者90例，采用随机数字表法分为两组。常规组男28例，女17例；年龄（47.86±10.59）岁；格拉斯哥昏迷量表（GCS）评分（5.74±1.46）分；损伤类型：开放性损伤31例，闭合性损伤14例；受伤原因：交通伤19例，坠落伤14例，头击伤9例，其他3例。TEAS组男25例，女20例；年龄（48.11±10.13）岁；GCS评分（5.69±1.52）分；损伤类型：开放性损伤28例，闭合性损伤17例；受伤原因：交通伤18例，坠落伤15例，头击伤10例，其他2例。常规组采用常规治疗方案，TEAS组采用常规治疗方案联合TEAS（30 min/次，1次/d，连续治疗6 d休息1 d）。两组均治疗4周。比较两组治疗前后改良国际昏迷恢复量表（CRS-R）评分、脑电图（EEG）评分、GCS评分、P300的潜伏期和幅度、神经细胞因子、不同脑区感兴趣区放射性核素计数值，统计两组恢复瞳孔对光反射时间及4周内清醒率、脑血管痉挛率、肺部感染率、深静脉血栓率。采用t检验、χ²检验进行统计学分析。结果　常规组与TEAS组治疗后CRS-R评分［（8.41±1.23）分和（9.83±1.09）分］、EEG评分［（1.51±0.26）分和（1.93±0.31）分］、GCS评分［（9.52±1.36）分和（11.14±1.51）分］高于治疗前，且TEAS组高于常规组（均P<0.05）。常规组与TEAS组治疗后P300幅度［（5.74±0.54）µV和（6.31±0.61）µV］大于治疗前，且TEAS组大于常规组（均P<0.05）；常规组与TEAS组治疗后P300潜伏期［（321.43±19.87）ms和（313.04±17.44）ms］短于治疗前，且TEAS组短于常规组（均P<0.05）。常规组与TEAS组治疗后胶质细胞原纤维酸性蛋白（GFAP）［（14.04±2.06）ng/L和（8.12±1.25）ng/L］、神经肽Y（NPY）［（232.85±40.51）ng/L和（195.25±35.06）ng/L］、S100β［（1.48±0.36）ng/L和（1.07±0.31）ng/L］、泛素竣基末端水解酶-L1（UCH-L1）［（1.11±0.27）μg/L和（0.82±0.23）μg/L］低于治疗前，且TEAS组低于常规组（均P<0.05）。常规组与TEAS组治疗后皮质区（13.54±1.96和14.93±2.21）与丘脑区（10.04±1.36和12.01±1.42）感兴趣区放射性核素计数值高于治疗前，且TEAS组高于常规组（均P<0.05）。TEAS组恢复瞳孔对光反射时间短于常规组［（5.41±1.06）d比（6.89±1.31）d］，4周内清醒率高于常规组［66.67%（30/45）比44.45%（20/45）］、脑血管痉挛率低于常规组［2.22%（1/45）比15.56%（7/45）］（均P<0.05）。结论　TEAS可提高颅脑外伤致意识障碍患者昏迷评分，改善脑电生理活动，增加皮质区、丘脑区血流灌注量，促进患者清醒，减少脑血管痉挛。

关键词:

意识障碍, 颅脑外伤, 经皮穴位电刺激, 脑电生理活动, 脑电图, 血流灌注量