电针对重型颅脑损伤昏迷患者促醒作用的临床观察

目的:观察电针对重型颅脑损伤昏迷患者的促醒作用。方法:90例重型颅脑外伤患者随机分为对照组、电针组及纳络酮组,各30例。对照组予常规西医治疗;纳络酮组在常规西医治疗基础上加静脉滴注纳络酮;电针组在常规西医治疗基础上加用电针治疗,针刺百会、水沟、风府透哑门、合谷和涌泉,疏密波,频率1Hz/50Hz,强度1～4mA。各组治疗均每天1次,共治疗14d。观察各组患者在治疗前后及治疗结束后1个月的格拉斯哥昏迷评分(GCS)变化,比较各组患者在治疗结束后1个月格拉斯哥预后分级(GOS)及清醒率。结果:各组患者治疗后的GCS评分较治疗前均明显改善(P<0.05),且治疗结束1个月的GCS评分较治疗结束时继续提高(P<0.05)。纳络酮组及电针组在治疗结束及结束后1个月的GCS评分及GOS分级都明显优于对照组(均P<0.05),电针组与纳络酮组之间比较差异无统计学意义(P>0.05)。治疗结束后1个月,电针组及纳络酮组清醒率均优于对照组(P<0.05),电针组与纳络酮组之间差异无统计学意义(P>0.05)。结论:早期电针干预可提高重型颅脑损伤患者的GCS评分、GOS分级及清醒率,促进神经功能的恢复,对重型颅脑损伤昏迷患者具有促醒及改善预后的作用。

Clinical Observation on Electroacupuncture for Arousing Consciousness of Comatose Patients with Severe Trauma Brain Injury

Objective To observe the arousal effect of electroacupuncture(EA) stimulation of Baihui(GV 20),Shuigou(GV 26),etc.on severe craniocerebral injury patients.Methods A total of 90 cases of severe craniocerebral injury were randomly allocated to routine medication,naloxone and EA groups,with 30 cases in each group.For patients of the routine medication group,mild hypothermia therapy,medicines for dehydration,hormonal therapy,vascular dilation,cerebral nutrition suppor-ting,anti-inflammation,etc.were given.For patients of the naloxone group,intravenous drip of naloxone 0.4 mg/kg in the first 3 days,0.2 mg/kg for 7 days and 0.1 mg/kg afterwards.For patients of the EA group,EA(1 Hz/50 Hz) was given for 30 min once daily.All the treatments were conducted once a day for 14 days.The Glasgow Coma Scale(GCS) and Glasgow Outcome Scale(GOS) were used for assessing the therapeutic effect.Results In comparison with pre-treatment in each one of the routine medication,naloxone and EA groups,GCS scores were all obviously increased in the 3 groups following the treatment,and one month's follow-up(P<0.05).The GCS scores of both naloxone and EA groups were significantly higher than those of the routine medication group(P<0.05).No significant difference was found between the naloxone group and EA group in GCS scores(P>0.05).According to the GOS,one month's follow-up showed that of the three 30 cases in the routine medication,naloxone and EA groups,6,12 and 14 were improved,8,10 and 10 moderate handicap,8,3 and 2 severe handicap,5,3 and 2 vegetative state,and 3,2 and 2 dead,with the arousal rates being 46.66%,73.33% and 80.00%,respectively.The therapeutic effects of both naloxone and EA groups were significantly superior to those of the routine medication group(P<0.05).Conclusion EA intervention at early stage can promote the recovery of neurological function,accelerate the consciousness from coma and improve the outcomes of patients with severe traumatic brain injury.