| ObjectiveThrough clinical randomized controlled trials,to observe the efficacy of the acupuncture therapy of dredging governor meridian and regulatlng mentallty to improve consciousness recovery,neurological function defect and prognosis in patients with consciousness disorders caused by acute cerebral stroke,and explore the acupuncture scheme of dredging governor meridian and regulatlng mentallty for the treatment of consciousness disorders caused by acute cerebral stroke.MethodsA prospective randomized controlled trial design carried out in Neurological Intensive Care Unit,Guangdong Hospital of TCM in August 2020-January 2021.40 participants with disturbance of consciousness caused by acute ischemic stroke randomly divided into two groups:(1)treatment group.20 cases were treated with acupuncture therapy of dredging governor meridian for regulatlng mentallty addition to the basic western medicine treatments.Main points Baihui(GV20),Shenting(GV24),Yintang(GV24),Shuigou(GV26),Chengjing(CV24),Lianquan(CV23),Laogong(PC8),Yongquan(KI1)and auxiliary points selected on syndrome differentiation were selected once a day with 30 minute retention including needle manipulation per 15 minutes,5 times as a course of treatment,a total of 2 courses,2 days rest between courses,at least 8 times of treatment;(2)Control group.20 cases were treated with Western medicine basic treatment,and the plan was formulated according to the Guidelines for the Prevention and Treatment of Cerebrovascular Diseases in China(2005)and the Consensus on the Management of Severe Cerebrovascular Diseases in China 2015.Before treatment,at the end of 1 course of treatment,and at the end of 2 courses of treatment,the National Institutes of Health Stroke Scale(NIHSS)scores were adopted to evaluate neurologic impairment,the reduced Glasgow Coma Scale(GCS)score and Full Outline of Unresponsiveness Score(FOUR)to evaluate the level of consciousness.The wakefulness rate and wakefulness time at the end of 2 courses of the treatment were evaluated.The Glasgow outcome scale(GOS)to evaluate the prognosis 1 month after treatment by telephone.In addition,before and after treatment,cranial Doppler(TCD)was used to detect the average blood flow velocity(Vm)of the vertebral basilar artery to evaluate the cerebral blood flow,and the continuous EEG was used to evaluate the changes in brain function.ResultsEach of the two groups lost 1 subject,and the final number of cases was 38.It was comparable among the two groups in gender,age,duration of consciousness disorders,clinical classification of cerebral infarction,TCM syndrome types,Whether having surgery or interventional therapy was performed before inclusion,whether there was a history of hypertension,diabetes,atrial fibrillation,the level of consciousness before inclusion,the NIHSS score,NIHSS consciousness score,reduced GCS score,FOUR score,Level state of consciousness and average vertebral-basilar artery blood flow velocity(P>0.05).1.Main outcome indicators(1)Changes in NIHSS score①Comparison within the groups:The NIHSS scores of the treatment group at the end of the first course of treatment and at the end of the second courses were lower than before treatment(P<0.01),and the NIHSS score at the end of 2 courses was lower than that at the end of the first course of treatment(P<0.0 1),the NIHSS score at the end of the first course of treatment in the control group did not decrease significantly compared with before treatment(P>0.05),the NIHSS score at the end of 2 courses did not change much compared with the NIHSS score at the end of 1 course(P>0.05).At the end of the treatment course,the NIHSS score was lower than before treatment(P<0.05),suggesting the tendency that the acupuncture group has a better effect on improving neurological deficits and has a faster onset.②Comparison between groups:The reduction of NIHSS scale score in the treatment group at the end of the first course of treatment was similar to that of the control groupP>0.05).At the end of the second course of treatment,the treatment group had a better improvement effect on the NIHSS scale score(P<0.01),suggesting the tendency that the treatment group has an advantage over the control group in improving neurological deficits,but it requires accumulation of treatment.(2)Changes in the score of NIHSS consciousness level①Comparison within the group:The NIHSS consciousness level score of the treatment group was significantly lower than before treatment at each observation point(all P<0.01),while the NIHSS scale consciousness score of the control group did not decrease significantly at the end of the first course of treatment(P>0.05).At the end of the second course of treatment,the NIHSS scale consciousness level score decreased significantly compared with that before treatment(P<0.05),suggesting the tendency that the acupuncture method of dredging governor meridian and regulatlng mentallty has a better effect on improving consciousness and has a faster onset.②Comparison between groups:The improvement in the level of awareness of the NIHSS scale in the treatment group at the end of the first course of treatment was similar to that of the control group(P>0.05),and the improvement in the level of consciousness in the NIHSS scale was shown at the end of the second course of treatment.The effect is better on improvement(P<0.05).2.Secondary outcome indicators(1)Reduced GCS scale score①Comparison within the group:In the treatment group,the reduced GCS scale score at the end of the first course of treatment was similar to that before treatment(P>0.05),and the reduced GCS scale score at the end of the second course was significantly higher than that of the first course of treatment and before treatment(all P<0.01).The control group showed no significant changes in the reduction of GCS scores at each observation point compared with before treatment(all P>0.05),indicating that the treatment group has significantly improved the reduced GCS scores,but the onset of action requires a certain number of treatments.The reduced GCS score of control group at the two time points was no obvious change.②Comparison between groups:With the increase of treatment time,the increasing trend of reduced GCS score in the treatment group was obvious,while the increase in the control group was more gentle.The two groups showed little difference in the reduced GCS score at the end of the first course of treatment(P>0.05);at the end of the second course of treatment,the reduced GCS score of the treatment group increased more significantly than that of the control group(P<0.05),suggesting the tendency that the treatment group had better improvement of reduced GCS score than the control group.(2)Changes in FOUR scores①Comparison within the group:At the end of the first course of treatment,the FOUR scale score of the treatment group was not significantly higher than that before the treatment(P>0.05),and at the end of the second course of treatment,it was significantly higher than that of the first course of treatment and before treatment(P<0.05,P<0.01),the control group did not show significant changes in the FOUR scale score at each observation point(all P>0.05),suggesting the tendency that the treatment group has better effect on eye opening,exercise response,brainstem reflex and breathing,while the improvement of the control group is not obvious.②Comparison between groups:the two groups had the same effect on the improvement of FOUR scale score at the end of the first course of treatment(P>0.05),and the improvement of the treatment group on the FOUR scale score was better than that of the control group at the end of the second course of treatment(P<0.05),suggesting the tendency that the treatment group is better than the control group in improving eye opening,motor response,brainstem reflex and breathing,but it requires accumulation of treatment.(3)Comparison of consciousness levelAt the end of the first course of treatment,the two groups had similar effects on the improvement of the level of consciousness(P>0.05).At the end of the second course of treatment,the level of consciousness of the treatment group was mainly awake and lethargy.The improvement effect of the consciousness level state of treatment group is better than that of control group(P<0.05).(4)Average blood flow velocity of vertebral-basal arteryAt the end of the second courses of treatment,the difference in the average blood flow velocity of the left vertebral artery,right vertebral artery and basilar artery between the two groups was not significant compared with that before treatment(all P>0.05).At the end of the second courses of treatment,there was little difference in the average blood flow velocity of the vertebral-basal artery between the two groups(all P>0.05),suggesting the tendency that the two groups have similar effects on the improvement of posterior circulation cerebral blood flow in patients with impaired consciousness caused by acute cerebral infarction.(5)GOS gradingFollow-up was conducted 1 month after the treatment.The rehabilitation of the treatment group was mainly concentrated in the GOS grade Ⅲ-Ⅴ,while the rehabilitation of the treatment group was mainly concentrated in the GOS grade Ⅱ-Ⅳ,indicating the tendency that the prognosis of the treatment group was better than that of the control group(P<0.05).3.Overall efficacy evaluation(1)Wakefulness comparisonThe awake rate in the treatment group was 68.4%and the average awake time was(5.15±2.27)days at the end of the second course of treatment,and the awake rate in the control group was 42.1%,and the average awake time was(5.88±2.70)days.The improvement effect of the awake rate and waking time of the patients with consciousness disorder was similar(both P>0.05),but the number of awake patients and the awake rate of the treatment group showed a higher trend than the control group,suggesting that the acupuncture group maybe better than the conventional treatment group for the promotion of consciousness recovery.(2)The comparison of the therapeutic effect of nerve function recoveryAt the end of the second course of treatment,the total effective rate of the treatment group was 89.5%,and that of the control group was 52.6%.The therapeutic effect of the treatment group maybe better than that of the control group in promoting the recovery of neurological function in patients with consciousness disorder caused by acute cerebral infarction(P<0.05).4.Complication analysisAt the end of two courses of treatment,the two groups were compared for complications,pneumonia,venous thrombosis and urinary tract infection and other complications in the treatment group were less than those in the control group,suggesting that the acupuncture method of dredging governor meridian and regulating mentality may have certain efficacy in preventing the occurrence of related complications in patients with consciousness disorders caused by acute cerebral infarction.ConclusionThe acupuncture method of dredging governor meridian and regulating mentality caused by acute cerebral infarction shows a trend that can effectively improve the patient’s level of consciousness,neurological deficits and prognosis.It may have a certain effect on the prevention of related complications.It’s helpful for the next step of rehabilitation,and will improve the ability of daily living and enable patients to return to society as soon as possible,which has good promotion significance. |
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