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OBJECTIVE@#To observe the awakening effect and safety of Xingnao Kaiqiao (regaining consciousness and opening orifices) acupuncture on consciousness disorder in children with early severe traumatic brain injury (STBI) based on western medicine treatment.@*METHODS@#A total of 62 children with STBI were randomly divided into an observation group (31 cases,1 case dropped off) and a control group (31 cases, 1 case dropped off). The control group was treated with routine rehabilitation therapy (6 times a week for 30 days), and intravenous drip of cattle encephalon glycoside and ignotin injection (once a day for 28 days). On the basis of the treatment in the control group, the observation group was treated with Xingnao Kaiqiao acupuncture at Neiguan (PC 6), Shuigou (GV 26), Yintang (GV 24+), Baihui (GV 20), Sanyinjiao (SP 6), Zusanli (ST 36), etc., and supplementary acupoints according to clinical symptoms, once a day, 6 times a week for 30 days. The scores of Glasgow coma scale (GCS), coma recovery scale-revised (CRS-R) and modified Barthel index (MBI) were observed before treatment and 10, 20 and 30 d into treatment. Electroencephalogram (EEG) grading before and after treatment was observed in the two groups, and safety was evaluated.@*RESULTS@#After 10, 20 and 30 days of treatment, the scores of GCS, CRS-R and MBI in the two groups were increased compared before treatment (P<0.05), and those in the observation group were higher than the control group (P<0.05). After treatment, EEG grading of both groups was improved compared with that before treatment (P<0.05), and the observation group was better than the control group (P<0.05). There were no adverse events or adverse reactions in the two groups during treatment.@*CONCLUSION@#On the basis of western medicine treatment, Xingnao Kaiqiao acupuncture plays a remarkable role in wakening the early STBI children, can improve the level of consciousness disorder and daily living ability, and it is safe and effective.
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Humans , Child , Acupuncture Points , Acupuncture Therapy , Brain , Brain Injuries, Traumatic/therapy , Consciousness Disorders/therapyABSTRACT
Objective:To investigate the factors affecting postoperative short-term improvement of consciousness level in patients with prolonged disorders of consciousness after severe traumatic brain injury (sTBI).Methods:A case-control study was conducted to analyze the clinical data of 55 patients with prolonged disorders of consciousness after sTBI admitted to Beijing Tiantan Hospital Affiliated to Capital Medical University and Seventh Medical Center of PLA General Hospital from September 2021 to September 2022. There were 33 males and 22 females, with the age range of 13-68 years [(43.0±15.5)years]. All patients were assessed for the consciousness level using the coma recovery scale-revision (CRS-R) preoperatively and within 48 hours postoperatively. A total of 33 patients were observed in vegetative state and 22 in minimally conscious state preoperatively. The consciousness level was found to be improved in 26 patients (consciousness- improved group), but not improved in the remaining 29 patients (consciousness-unimproved group). Indicators were documented including gender, age, cause of injury, Glasgow coma score (GCS) on admission, course of injury, preoperative consciousness level, operation mode, operation time, intraoperative fluid replenishment, intraoperative urine volume, intraoperative bleeding volume, American Society of Anesthesiologists grade, analgesic regimen and sedation maintenance drugs. A univariate analysis was conducted first to assess those indicators′ correlation with postoperative short-term improvement of consciousness level in patients with prolonged disorders of consciousness after sTBI. Multivariate Logistic regression analysis was then used to determine the independent risk factors for their postoperative short-term improvement of consciousness level.Results:Univariate analysis showed that GCS on admission, course of injury, preoperative consciousness level and analgesic regimen were correlated with short-term improvement of postoperative consciousness level in patients with prolonged disorders of consciousness after sTBI (all P<0.05), whereas gender, age, cause of injury, operation mode, operation time, intraoperative fluid replenishment, intraoperative urine volume, intraoperative bleeding volume, American Society of Anesthesiologists grade and sedation maintenance drugs showed no relation to the improvement of postoperative consciousness level (all P>0.05). Multivariate Logistic regression analysis showed that the GCS ≥7 points on admission ( OR=0.06, 95% CI 0.01, 0.36, P<0.01), preoperative minimally conscious state ( OR=0.09, 95% CI 0.02, 0.40, P<0.01) and intraoperative use of Sufentanil combined with Remifentanil ( OR=0.07, 95% CI 0.01, 0.43, P<0.01) were significantly correlated with postoperative improvement of consciousness level. Conclusion:The GCS on admission (≥7 points), preoperative minimally conscious state and intraoperative use of Sufentanil combined with Remifentanil are independent risk factors affecting short-term postoperative improvement of consciousness level in patients with prolonged disorders of consciousness after sTBI.
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Pitolisant is an orally active histamine H
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Objective:To investigate wake-promoting effects of transcranial direct current stimulation (tDCS) on brain injury-induced coma and the possible mechanism.Method:Fifty-four adult SD rats were randomly divided into three groups with 18 rats in each group.They were blank group,traumatic brain injury-induced coma (TBI) group and tDCS group.Using classical free fall method to create brain injury-induced coma and then treated rats with tDCS,consciousness level of rats were assessed at 6h,12h,24h time points.After consciousness level evaluation,rats were put to death and then the prefrontal cortex (PFC) and hippocampus of rats were extracted.Western Blot method was used to determine the expression of brain-derived neurotrophic factor (BDNF) in three groups.Result:Eighteen rats in control group,6 rats in TBI group and 11 rats in tDCS group awakened.BDNF expression in TBI group was higher than that in blank group in PFC and hippocampus.More over,at 12h in PFC and at 6h in hippocampus,BDNF expression in tDCS group was higher than that in TBI group with statistically significant difference(P ＜ 0.05).Conclusion:tDCS can improve the consciousness level of coma rats following TBI and the mechanism may be related to upregulation of BDNF expression in the PFC and hippocampus of rats.
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Objective To compare the effects of median nerve electrical stimulation on coma patients after traumatic brain injury with different settings. Methods From 2013 to 2015, 161 patients with traumatic brain injury were randomly divided into control group (n=40), experimental group 1 (n=41), experimental group 2 (n=39) and experimental group 3 (n=41). The control group received routine conscious-ness-promoted methods, and the experimental groups received median nerve electrical stimulation with 200μs and 30 Hz, 100 Hz and 50 Hz in sequence, 60 minutes a day for 90 days. They were assessed with Glasgow Coma Scale (GCS) and Coma Recovery Scale-Revised (CRS-R) before, 30 days and 90 days after treatment. Results There was significant difference in the scores of CCS and CRS-R, times of treatment, number of sobered patients and coma time among groups (P0.05). The experimental group 3 was better than the experimental groups 1 and 2 (P<0.05). Conclusion Median nerve electrical stimulation with 200μs, 50 Hz could promote co-ma patients to wake up optimally.
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Objective To investigate the clinical efficacy of Changqin No. 1 combined with Western therapy for severe traumatic brain injury and its effects on prognosis. Methods Totally 65 cases of severe traumatic brain injury were randomly divided into the treatment group (n=32) and the control group (n=33). The control group was treated with basic Western therapy (dehydration reduction of intracranial pressure, nutrition nerve, scavenging oxygen free radicals, improve cerebral circulation, nutritional support and maintain the internal environment stability, anti-infection, prevention and treatment of complications, hyperbaric oxygen). The treatment group was treated with Changqin No. 1 plus the basis of routine treatment, 1 dosage per day, 2 times stomach tube nasal feeding or blunt, for 14 d. One month after treatment, awake rate, awake time, the incidence of complications and MMSE in both groups were compared. Three months after treatment, the prognosis of two groups were compared by GOS. Results One month after treatment, the awake rate in treatment group was 77.4% (24/31) and 53.1% (17/32) in the control group, with statistical significance (χ2=4.089, P=0.043), and the death rate was 0. The awake time in the treatment group was significantly shorter than that of the control group (t=2.458, P=0.017). The incidence of pulmonary infection in the treatment group was lower than the control group (P=0.001). There was no statistical significance in urinary tract infection, epilepsy, liver and kidney dysfunction rate of the two groups (P>0.05). The number of awake case was 24 in the treatment group and 17 in the control group. The number of normal MMSE cognitive function was 3 in the treatment group and 2 in the control group, and the treatment group was better than the control group (Z=-2.205, P=0.027). Three months after treatment, the good prognosis was 58.08% (18/31) in the treatment group and 28.12%(9/32) in the control group, with statistical significance (χ2=5.763, P=0.016). Conclusion Changqin No. 1 combined with Western basic treatment can help patients with severe traumatic head injury awake early, reduce pulmonary infection complications, and improve the cognitive function of sober patients and improve the prognosis.
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Objective To investigate the wake-promoting effect of vagus nerve stimulation (VNS) on coma rats after traumatic brain in-jury (TBI), and the related mechanism. Methods A total of 168 healthy Sprague-Dawley rats were randomly divided into blank group, TBI group, antagonist group and VNS group, 42 rats in each group. The latter three groups were established TBI model with impact, and the rats in coma at least 30 minutes were included. VNS group accepted VNS, the antagonist group were injected intralateroventricularly Orexin A receptor 1 (OXR1) antagonist SB334867, and TBI group accepted sham VNS. Their behaviors were observed to determine the level of con-sciousness six, twelve and 24 hours after intervention, while the expression ofγ-aminobutyric acid b1 receptor (GABAb1R) in prefrontal cortex was detected with immunohistochemistry and Western blotting. Results There were 42 rats in the blank group, 11 rats in TBI group, 13 rats in the antagonist group, and 28 rats in VNS group awakened finally. The expression of GABAb1R in prefrontal cortex ranged as TBI group, antagonist group, blank group and VNS group from more to less twelve and 24 hours after intervention under Western blotting (F>60.412, P<0.001), and it ranged as TBI group, antagonist group, VNS group and blank group under immunohistochemistry (H=15.121, P=0.002), with no significant difference among time points (H=3.028, P=0.220). Conclusion VNS can promote waking from coma in rats after TBI, which may relate with the decrease of GABAb1R in prefrontal cortex that induced by Orexin A.
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Objective To investigate the wake-promoting action of median nerve electrical stimulation(MNES) in coma rats induced by traumatic brain injury(TBI) and its influence on the expression of α1-adrenergic receptor(α1 R) in the prefrontal contex (PFC).Methods Seventy-two healthy Sprague Dawley(SD) rats were randomly divided into the control group,sham-stimulated group(TBI),stimulated group (TBI+ MNES) and antagonist group(TBI+ OX1R antagonist +MNES).The control group had no any treatment.The TBI coma rat models were prepared in the other 3 groups.The sham stimulated group had no treatment.The antagonist group was injected with orexin receptor-l(OX1R) antagonist SB334867 into lateral ventricle,and both the antagonist group and stimulated group received MNES treatment.Then the behavior changes of rats in each group were observed and the α1 R expression level in PFC was detected by using the immunohistochemistry technique.Results Thirteen rats in the stimulated group and 8 rats in the antagonist group revived,while only 4 rats in the TBI group.The α1R levels from low to high were the blank control group,sham-stimulated group,antagonist group and stimulated group,showing the increasing trend,and the difference was statistically significant(P＜0.05).Conclusion MNES can improve the rat consciousness level after TBI coma,and its mechanism may be related with up-regulating the α1 R expression level in PFC area,moreover Orexin-A participates in this regulation process.
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Objective To determine the effects of early taste stimulation care in comatose patients with severe traumatic brain injury (STBI). Methods Sixty patients with severe STBI who had been in coma for more than 6 hours and Glasgow Coma Scale (GCS) scored 5-8,were divided into two groups according to random digit table. The control group received conventional care, while the taste stimulation group received both conventional care and early taste stimulation intervention.They were assessed according to GCS at 10, 20 and 30 days after treatment. Results After the intervention, the GCS scores in the taste stimulation group were higher than those of the control group after 20 days (10.70±0.48 vs 8.65±0.58, t=2.714, P<0.05) and 30 days (11.70 ± 0.49 vs 9.60 ± 0.57, t=2.792, P<0.05). Conclusions Early taste stimulation care has a certain wake-promoting effect on comatose patients with STBI.
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Objective To investigate the effects of modafinil,a new wake-promoting agent,on simulated flight performance during 48 h sleep deprivation(SD).Method Six male healthy young volunteers were exposed to two periods of 48 h continuous wakefulness during the crossover experiment.In one period,three 200 mg doses of modafinil were given and in the other,separated by two weeks,matching placebos were administered.The SD time started from 8:00 of the first day to 8:00 of the third day.Drug was given at 0:00,16:00 of the second day and 0:00 of the third day.Flight performance in J7-E flight simulator was tested at 21:00 of the first day and 1,3,5,7 h after each drug administration.Result The scores of simulated flight performance in the placebo group decreased with time during SD and became significant at 1:00～7:00 of the third day.Numbers of errors increased with time during SD,especially in the left ascending turn stage and the descending & landing stages.Compared with the placebo,flight performance was significantly increased after the third administration of modafinil.Numbers of errors during 48 h SD and at 1:00～7:00 of the third day in modafinil group was 19% and 40% lower than those in placebo group respectively.Conclusion Simulated flight performance during 48 h SD is significantly improved after repeated administration of modafinil,especially when the impacts of SD and the circadian trough are combined.
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Objective To investigate the effects of modafinil,a new wake-promoting agent, on vestibular function during 24 h sleep deprivation(SD). Method Eight male healthy young volunteers were exposed to two 24 h periods of continuous wakefulness during the crossover experiment. In one period, 200 mg doses of modafinil were given and in the other, separated by one week, matching placebos were administered. The SD time started from 8:00 of the first day to 8:00 of the second day. Drugs was given at 0:00 of the second day. Vestibular function was tested at 21:00 of the first day and 1 ,3,5,7 h after drug administration. Result The accuracy of saccade tracking and the gains of VVOR(visual-vestibular optokinetic reflex)and OKN(optokinetic nystagmus)in the placebo group decreased during 24 h SD, especially at 1: 00～5:00 of the second day, while OKN gains in the modafinil group was increased significantly. There were no significant differences of other vestibular function between modafinil group and placebo group. Conclusion Twenty four SD can influence vestibular function in certain degree,but optokinetic nystagmus can be improved by modafinil.