| ObjectiveTo explore the epidemiological characters,injury causes,injury types and other clinical data of traumatic brain injury(TBI)patients hospitalized in Guangdong 999 Brain Hospital,so as to provide reference for reducing the incidence of TBI injury and improving the treatment rate of TBI patients.To clarify the advantage of acupuncture combined with medicine and modern rehabilitation in the treatment of patients with TBI,especially in wakening the coma patients after TBI.And to judge the improvement of acupuncture combined with conventional treatment on patients with coma in acute stage after TBI,so as to provide objective basis for the application of acupuncture in the treatment of such diseases.Methods1.Meta-analysis of clinical effect of acupuncture on coma patients after TBIRandomized controlled trials of acupuncture treatment for coma patients after TBI were conducted by Meta-analysis.The treatment group were treated with western medicine plus acupuncture,The control group were treated with western medicine simple.Chinese and English databases were searched,without the acupoint selection,reinforcing reducing manipulation,needle retention time and course of treatment.In accordance with the inclusion criteria and exclusion criteria,articles were screened,finally,the data of included articles were extracted,including the sample size,randomized method,treatment options,outcome indicators,treatment time,course of disease,follow-up and so on.Meta analysis was performed by the RevMan version 5.4 software provided by Cochrane collaboration website.2.Disease characteristics and scales score analysis of patients with TBIRetrospective study was conducted to collect the general and clinical information of TBI patients admitted to Guangdong 999 Brain Hospital from May 2015 to June 2020.The basic information(gender,age,education level,occupation,etc.),injury cause,main diagnosis,treatment,scale scores before and after treatment were recorded.SAS9.4 statistical analysis software was used for data analysis.3.Clinical study on the effect of acupuncture on awaking coma patients in acute stage after TBIIn the clinical study,63 patients with coma in the acute stage after TBI were selected as the study subjects.The control group(32 cases)were treated with conventional treatment,and the experimental group(31 cases)were treated with conventional treatment plus Xingnao-kaiqiao Acupuncture,the acupuncture treatment was provided by experienced acupuncturist at Neiguan(PC6),Renzhong(DU26),Sanyinjiao(SP6),Jiquan(HT1),Chize(LU5)and Weizhong(BL40).the acupoints were selected according to the method of Xingnao-Kaiqiao by academician Shi Xue-min.After the manipulation,the needles were retained for 30 minutes.Patients in acupuncture group were treated once a day,six times a week,the whole treatment procedure continued for 4 weeks,(4 weeks per course,3 course).GCS score was used as the main outcome index,CRS-R score,recovery rate,recovery time and effective rate were used as secondary indexes to evaluate the efficacy and safety of the two groups.SPSS 22.0 software was performed to analyze and compare the results of the two groups.ResultsMeta analysis results of literatureA total of 894 articles were searched in all databases,and 13 randomized controlled studies involving 861 comatose patients after TBI were included.Meta analysis showed that the total effective rate,GCS score and recovery rate of acupuncture combined with medicine were better than those of medicine alone,and the difference was statistically significant(P<0.05).2.Results of disease characteristics and scales score analysis of patients with TBIResults of disease characteristics of patients with TBI:A total of 2376 patients with TBI were included in this study.Male patients were about 4.2 times as many as female patients.The patients from adolescence to late youth(14-45 years old)constituted 52.9%of the all.The patients" main occupation was worker,accounting for 49.62%,and the number of patients with educational level below junior high school was the most,accounting for 79.5%.The main cause of TBI was traffic accident,accounting for 91.16%.In terms of injury types,space-occupying hematoma accounted for the highest proportion(37.3%),following by contusion and laceration of brain,subarachnoid hemorrhage,diffuse axonal injury,skull fracture,etc.;nearly 50%of patients had two or more injury types at the same time.During the acute phase after TBI,42.5%of the patients had brain operations,44.2%had tracheal intubation or tracheotmy,63%had gastric intubation,and 48.4%had urinary intubation.More than 86.48%of the patients got better while about 13.51%had no progress when they discharged.Results of scales score analysis of 2376 patients with TBI on admission:There were significant differences in the score of the timed "up&go",Holden Functional Ambulation Category Scale(FAC),Postural Assessment Scale for Stroke Patients(PASS),Berg Balance Scale(BBS)and Mini-mental State Examination(MMSE)between different genders(P<0.05).There were significant differences in the score of Barthel index of ADL(BI),the timed "up&go",Holden Functional Ambulation Category Scale(FAC),Postural Assessment Scale for Stroke Patients(PASS),Berg Balance Scale(BBS)and Mini-mental State Examination(MMSE)among patients of different ages(P<0.05).There was no significant difference in the scores of all scales among different occupations(P>0.05).There were significant differences in the score of Glasgow Coma Scale(GCS)about Eye opening,Glasgow Coma Scale(GCS)about Motor response,Glasgow Coma Scale(GCS),Barthel index of ADL(BI),Holden Functional Ambulation Category Scale(FAC),Postural Assessment Scale for Stroke Patients(PASS),Berg Balance Scale(BBS)and Mini-mental State Examination(MMSE)among patients with different causes(P<0.05).There were significant differences in the score of Postural Assessment Scale for Stroke Patients(PASS)and Mini-mental State Examination(MMSE)among patients with different education levels(P<0.05).There were statistically significant differences in the scores of all scales in patients with different course of brain injury(P<0.05).Results of scales score difference analysis of 1084 patients before and after treatment:There was a statistically significant difference in the difference between the scales before and after treatment in patients with TBI(P<0.05).There was no significant difference in the scores of the scales before and after treatment among the hospitalized patients with TBI of different gender,occupation and education level(P>0.05).There were statistically significant differences in the score of Glasgow Coma Scale(GCS)about Verbal response,Glasgow Coma Scale(GCS)about Motor response,Barthel index of ADL(BI)and Mini-mental State Examination(MMSE)among hospitalized patients of different ages before and after treatment(P<0.05).There were statistically significant differences in the score of Glasgow Coma Scale(GCS)about Verbal response,Glasgow Coma Scale(GCS)about Motor response and Glasgow Coma Scale(GCS)before and after treatment in patients with TBI of different causes(P<0.05).Results of the analysis at score of Glasgow Coma Scale(GCS)of 832 patients with consciousness disorder after TBI before and after treatment:There were statistical differences in Glasgow Coma Scale(GCS)scores of patients with consciousness disorder after TBI before and after treatment(P<0.05).There were significant differences in Glasgow Coma Scale(GCS)scores before and after treatment among patients with consciousness disorder after mild,moderate and severe TBI(P<0.05).3.The result of clinical researchThe clinical study showed that:1.At the beginning of the experiment,there was no significant difference in the comparison of basic data(age,gender,course of disease,etc.)between the experimental group and the control group(P>0.05).2.After the intervention,the GCS score and effective rate of the two groups were statistically significant before and after treatment(P<0.05),and the comparison between the experimental group and the control group was significantly different(P<0.05).3.After the intervention,the CRS-R score was significantly different before and after treatment(P<0.05),but the comparison between the experimental group and the control group was not statistically significant(P>0.05).4.After the intervention,the recovery rate of the experimental group was higher than that of the control group,but the recovery rate was not statistically significant(P>0.05),the recovery time of the experimental group was less than that of the control group,and the recovery time was statistically significant(P<0.05).Conclusion1.Male,young and middle-aged patients were the majority in Guangdong 999 Brain Hospital.Workers were the main occupation,the education level was mainly under junior middle school,and traffic accident was the main cause of TBI.Therefore,road safety publicity should be increased for young and middle-aged male groups under junior high school.Most patients were in severe situation during the acute phase and had many complications.2.Acupuncture could not only treat the sequelae like limb dysfunction and cognitive impairment after TBI,but also had a clear advantage on awakening the coma patients after TBI.3.Acupuncture can improve the effect of awakening in patients with coma in the acute phrase after TBI,also can improve the survival rate,reduce the complications,improve the quality of life,with no obvious side effects,which had a good clinical application value. |
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