Clinical Study Of Wakening On Severe Traumatic Brain Injury Coma Patients By Call Stimulation

ObjectiveThe coma incidence is very high after severe traumatic brain injury(sTBI).More complications,disability incidence,and hospitalization costs are caused by coma.Shorten times which patients are in coma status are benefit to decrease hospitalization costs,increase the survival rate and improve living quality of these patients.This study used familiar call stimulation as a way to awake coma patients.After analyzed the changes of Glasgow coma scale(GCS),blood flow velocity of internal carotid artery(ICA)and middle cerebral artery(MCA),class of electroencephalogram(EEG)and brainstem auditory evoked potential(BAEP),and parts of neurotransmitters in cerebral spinal fluid(CSF)before and after stimulation,to assess the clinic effectiveness and feasibility of call stimulation and to provide theoretical basis in terms of call stimulation to wake coma patients caused by sTBI.Materials and MethodsThis study included coma patients caused by sTBI in the third military medical university XinQiao hospital between June 2014 and June 2015.All subjects were randomly divided into stimulation group(13 cases)and control group(7 cases).All patients were accepted same basal treatment method,while stimulation group received familiar call stimulation external.Gained GCS of all patients every day,measured the blood velocity of ICA and MCA by transcranial doppler(TCD)before the first stimulus and 1st,2st and 4st weekend after familiar call stimulation at 17:30;monitored electroencephalogram(EEG)and brainstem auditory evoked potential(BAEP)before and after stimulation;measured content of serotonin(5-TH),dopamine(DA),norepinephrine(NE)and acetylcholine(Ach)in CSF with enzyme-linked immunoassay(ELISA).SPASS20.0 was used to analysis data.Results1.Before stimulation,GCS of stimulation group was 5.62+/-0.77,and it was 6.29+/-1.26 in control group;There was no significant different between two groups(P > 0.05).At the end of observation,GCS score of stimulate group was obviously higher than that of control group(11.85 + /-2.58 vs.9.14 +/-2.85,P < 0.05);2.ICA and MCA blood velocity were increased to peak at the 1st weekend during stimulation,and then gradually declined and closed to normal.ICA(F = 7.867,P = 0.012)and MCA(F = 19.492,P = 0.000)of stimulation group improved significantly than the control group;3.After stimulation,the consciousness of patients whose EEG class and BAEP class were ? grade both in stimulation group and control group;the consciousness of patients whose EEG class were level ? has not significantly improved.After stimulation,the EEG level ?b(spindles coma)improved to ?a and come to sleepiness from coma statues in the patient;4.The contents of DA,ACh and NE in cerebrospinal fluid have increased in varying degrees in two groups compared with before stimulation.When end of the 4 weeks,the content of DA,ACh and NE in stimulated group were significantly higher compared with the control group(P < 0.05);however,the content of 5-HT was gradually decreased in the stimulation process but there is no obvious statistical difference between two groups(P > 0.05)Conclusions1.Call stimulation was a method to arousal coma patients caused by sTBI;2.The mechanism of call stimulation might improve the cerebral blood flow and promote the release of some neurotransmitters(like NE),but the conclusion has yet to accumulate more cases in future.