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Journal of Neurosurgical Sciences 2021 Mar 11

DOI: 10.23736/S0390-5616.21.05236-X


language: English

Preliminary study of the consciousness-promotion mechanism of electroacupuncture in comatose patients with diffuse axonal injuries

Weichuan DAI 1 , Xieli GUO 1, Wenhua CAI 1, Yanfei ZHENG 1, Yingxian CHEN 1, Yuyan ZHU 1, Xiayang TIAN 2

1 Department of Neurosurgery, Jinjiang Municipal Hospital, Fujian Province, China; 2 Department of Rehabilitation, Jinjiang Municipal Hospital, Fujian Province, China


BACKGROUND: Diffuse axonal injury (DAI) accounts for 30-40% of total neurotrauma,majority among them manifest with consciousness disturbance.At present, the understanding of the treatment of coma and awakening in patients with DAIs is still limited.This study is characterized by the use of electroacupuncture along with conventional Western medicine to promote consciousness more effectively in comatose patients with DAIs, shorten their time spent in a coma, and gain time for more favorable treatments during follow-up rehabilitation in order to improve the cure rate, reduce the morbidity rate, and achieve better therapeutic effects.
METHODS: In this randomized controlled study, 145 comatose patients with DAIs (type III) were divided into the treatment group (n = 71) and control group (n = 74). The patients in the control group were treated with conventional Western medicine, while those in the treatment group were treated with both electroacupuncture and conventional treatment. The Glasgow Coma Scale (GCS) scores and consciousness-promotion rates of both groups were observed before treatment as well as 10, 20, and 30 days after treatment. Meanwhile, serum acetylcholinesterase E (AchE) concentrations in both groups were measured with ELISA, while AchE activity was determined with the rate method. Correlations between GCS score, AchE concentration, and AchE activity in the treatment group were analyzed by using the stepwise multiple regression method.
RESULTS: The GCS scores in the treatment group showed significant increases after the first, second, and third courses of treatment when compared to the pre-treatment scores (P <0.05). After 1 course of treatment, the GCS scores in the control group were not statistically significantly different compared to the pre-treatment scores(P >0.05), whereas after 2 and 3 courses of treatment, the differences were of greater statistical significance (P <0.05). Statistically significant differences between the 2 groups were found in GCS scores in the same course of treatment (P <0.05). The consciousness-promotion rates between the 2 groups after the same treatment course were statistically significantly different (P <0.05). Both the standardized regression coefficients and partial correlation coefficients showed that AchE concentration had a certain influence on GCS score (|Beta| = 0.3601; r Y2.1 = 0.726).
CONCLUSIONS: Conventional Western medicine combined with electroacupuncture treatment may promote the consciousness of patients with DAIs and shorten the amount of time they spend comatose. Furthermore, the neurotransmitter AchE may play a role in the pathophysiological mechanism of consciousness promotion.

KEY WORDS: Diffuse axonal injury; Coma; Electroacupuncture; Consciousness; Acetylcholine

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