Clinical Study Of Acupuncture Combined With Median Nerve Electrical Stimulation On Awakening In Coma Patients With Early Severe Traumatic Brain Injury

Objective:To observe the effect of early acupuncture combined with median nerve electrical stimulation on wakefulness in patients with severe traumatic brain injury and to explore the possible mechanism of its wake-up effect by studying on nerve injury and neurotrophy indexes.Methods:Seventy-five coma patients with severe traumatic brain injury were selected in the department of neurosurgery of our hospital from december 2016 to december 2017.Those patients were randomly divided into acupuncture group(19 cases),MNS group(18 cases),acupuncture combined with MNS group(18 cases)and control group(20 cases).On the basis of routine treatment,the patients in acupuncture group started acupuncture at:Shuigou,Neiguan,Quchi,Hegu,Yintang,Zusanli,Weizhong,Sanyinjiao,Taichong,Yongquan,patients in nerve stimulation group performed median nerve electrical stimulation,patients in acupuncture combined with the median nerve electrical stimulation group were treated with acupuncture and median nerve electrical stimulation,from the 3rd day after injury.The control group received only routine treatment.The GCS scores were recorded before treatment,after 2w,and 1 month after treatment in four groups of patients respectively.At the same time,the levels of and glial fibrillary acidic protein(GFAP)and ubiquitin carboxyl terminal hydrolase L1(UCH-L1),brain-derived neurotrophic factor(BDNF)in the blood of four groups patients were by enzyme-linked immunosorbent assay(ELISA)technique before and after treatment of two weeks,In the end,all the indicators were compared between four groups.Results:(1)The results of GCS scores showed that the level of consciousness was improved in different degrees after treatment in four groups,the GCS scores in the acupuncture group,MNS group,and acupuncture combined with MNS group were significantly higher than those in the control group(P<0.05).The change rate of acupuncture combined with MNS group was significantly higher than that of acupuncture group and MNS group(P<0.05).(2)The results of nerve injury index GFAP and UCH-L1 in plasma showed that the serum levels of GFAP and UCH-L1 in plasma of the four groups were decreased in different degrees,and the decrease of the serum levels of glial fibrillary acidic protein(GFAP)and the ubiquitin carboxyl terminal hydrolase L1(UCH-L1)in the acupuncture group,MNS group and the acupuncture combined MNS group was significantly higher than that of the control Group(P<0.05),and the rate of change and acupuncture combined with MNS group were significantly higher than those of acupuncture group and MNS group(P<0.05).(3)The results of neurotrophic index BDNF content in plasma showed that the serum levels of BDNF in the four groups were elevated in different degrees,and the increase of the serum levels of BDNF in the acupuncture group,the MNS group and the acupuncture combined with the MNS group was significantly higher than that of the control group(P<0.05),and the rate of the acupuncture combined with MNS group was significantly higher than that of the acupuncture group and the MNS group(P<0.05).Conclusions:Acupuncture and median nerve electrical stimulation have certain curative effects on wakefulness in patients with severe traumatic brain injury.They have a synergistic effect.Early combination of the two methods is safe and effective for severe traumatic brain injury with coma.it can improve the neurotrophic state,reduce the nerve injury and promote the recovery of nerves.It has a certain value and prospects for rehabilitation.