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 Table of Contents  
ORIGINAL ARTICLE
Year : 2018  |  Volume : 3  |  Issue : 4  |  Page : 75-78

Investigating the efficacy of electroacupuncture and hyperbaric oxygen therapies on the awakening of coma patients with severe brain trauma


Department of Neurosurgery, The Second Hospital Affiliated to Nantong University, Nantong University, Nantong, Jiangsu, China

Date of Submission31-Oct-2018
Date of Acceptance10-Dec-2018
Date of Web Publication26-Dec-2018

Correspondence Address:
Dr. Xuejian Wang
Department of Neurosurgery, The Second Hospital Affiliated to Nantong University, Nantong University, Nantong, Jiangsu 226000
China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ts.ts_14_18

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  Abstract 

Aim: To investigate the effect of electroacupuncture and hyperbaric oxygen therapies on the awakening of coma patients with severe brain trauma. Methods: One hundred and twenty severe brain injury patients were enrolled and randomly divided into four groups: conventional treatment group, electroacupuncture treatment group, adjuvant hyperbaric oxygen treatment group, and adjuvant electroacupuncture plus hyperbaric oxygen treatment group, with 30 patients in each group. The changes in Glasgow Coma Scale (GCS) and Glasgow Outcome Scale were recorded posttreatment. Results: Posttreatment, the GCS of all the four groups was increased. The GCSs of electroacupuncture treatment group, hyperbaric oxygen treatment group, and electroacupuncture plus hyperbaric oxygen treatment group were significantly higher than control group (P < 0.05). There was no significant difference in GCSs between electroacupuncture group and hyperbaric oxygen group (P > 0.05). Further, combining electroacupuncture and hyperbaric oxygen treatment made no significant improvement in GCS over individual treatments (P > 0.05). Conclusion: In addition to conventional treatment, the use of electroacupuncture and hyperbaric oxygen therapies may have a beneficial effect on patients' nervous system and thus aid in the awakening of coma patients.

Keywords: Awakening, coma, efficacy, electroacupuncture, hyperbaric oxygen, severe brain trauma


How to cite this article:
Wang X, Chen Y, Wang Z. Investigating the efficacy of electroacupuncture and hyperbaric oxygen therapies on the awakening of coma patients with severe brain trauma. Transl Surg 2018;3:75-8

How to cite this URL:
Wang X, Chen Y, Wang Z. Investigating the efficacy of electroacupuncture and hyperbaric oxygen therapies on the awakening of coma patients with severe brain trauma. Transl Surg [serial online] 2018 [cited 2019 Aug 23];3:75-8. Available from: http://www.translsurg.com/text.asp?2018/3/4/75/248611


  Introduction Top


Severe brain injuries can keep the patient in coma for a long time, seriously affecting the patient's survival and increasing the burden on society. Such coma patients stay in bed for long period and may require lifesaving invasive procedures such as tracheotomy, which may lead to a variety of complications, thus increasing the morbidity and mortality rates.[1] Therefore, any efforts toward awakening coma patients with severe brain trauma have a great practical significance. With the development of technology, more and more therapeutic options are available for coma patients. In addition to drug treatment, acupuncture and hyperbaric oxygen therapies are available as rehabilitation measures.[2],[3],[4] However, it is still unclear whether the acupuncture or hyperbaric oxygen adjuvant therapies are beneficial, thus making it hard to choose treatment strategies. In this study, we studied the therapeutic effects of acupuncture and/or hyperbaric oxygen adjuvant therapies in coma patients due to severe brain trauma.


  Methods Top


Ethics committee approval and consent to participate

This research has been approved by the Ethics Committee of the Second Hospital Affiliated to Nantong University (2016002). This investigation was conducted according to the Declaration of Helsinki, and written informed consent was obtained from all patients.

General materials

A total of 120 patients with severe brain trauma admitted to the hospital between January 2013 and December 2015 were prospectively enrolled and divided into four groups: conventional treatment group, adjuvant electroacupuncture treatment group, adjuvant hyperbaric oxygen treatment group, and adjuvant electroacupuncture plus hyperbaric oxygen treatment group, with 30 patients in each group [Table 1].
Table 1: General data comparison in of four groups of patients

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Inclusion criteria

Patients with the following conditions were included into the study: (1) patients with severe brain trauma and in coma for 2–10 days poststabilization, with their Glasgow Coma Scale (GCS) more than 8 points; (2) aged between 20 and 65 years; and (3) family members' consent to participate in the study by signing informed consent form.

Exclusion criteria

Patients with the following conditions were excluded from the study: (1) mental and conscious disability, if the patient has a history of previous brain disease and/or surgery; (2) disease in other organs that would affect the recovery of consciousness, such as heart disease or chronic lung disease; (3) associated injury that could affect their judgment and consciousness, such as spinal cord injury; (4) irreversible brain stem injury; and (5) female patients with pregnancy/gestation.

Treatments

Conventional treatment group

Conventional therapeutic procedures were followed, including surgery if required. The patients were treated as follows: dehydration management, anti-infection, prevention of epilepsy, nerve nourishment, acid suppression, stomach care, drug awakening, and nutrition support. Tracheotomy was performed in patients with excessive phlegm.

Adjuvant electroacupuncture treatment group

In addition to conventional treatment, the patients received electroacupuncture adjuvant therapy, once per day, 10 times as one treatment course.

We connected G6805 type 2 electroacupuncture apparatus to the patients at Shuigou, Neiguan, Laogong, Shenmen, Sanyinjiao, and Yongquan acupoints and gave them intermittent wave stimulation, at a rate of 18–24 times/min. The output intensity was adjusted according to the patient's muscle jitter. The needle retention time was 30–40 min, adjusted according to the patient's condition.

Adjuvant hyperbaric oxygen treatment group

In addition to conventional treatment, the patients received hyperbaric oxygen treatment. We used our large hyperbaric oxygen cabin to increase the pressure of cleaned compressed air, up to 0.25 MPa. The patients wore a mask to inhale pure oxygen for 30–40 min, and then rested for 10 min inhaling the air in chamber, followed by another 30–40 min oxygen inhalation. At last, the patients were taken out of chamber after 30 min of decompression. The treatment was once per day, 10 times as one treatment course. The total treatment courses were usually 2–3, depending on the patient's condition.

Adjuvant electroacupuncture plus hyperbaric oxygen treatment group

In addition to conventional treatment, the patients received both electroacupuncture and hyperbaric oxygen treatment as described above.

Statistical analysis

Main observation indexes include patients' GCS and Glasgow Outcome Scale (GOS) before and after treatment. SPSS 10.0 (IBM, Chicago, USA) was used for statistical analysis, the patients' score was expressed as –x ± s, and Kruskal–Wallis test was used to compare between groups.


  Results Top


A total of 120 patients were enrolled into the study and divided into four groups, with 30 patients per group. There was no significant difference in age, gender, and geographical origin among groups, and the GCSs were all <8 points at admission. Before treatment, the GCS and GOS were similar among all groups. Posttreatment, the GCS for conventional treatment group was 6.06 ± 2.06 and GOS was 4.06 ± 0.76; for the adjuvant electroacupuncture treatment group, GCS was 6.57 ± 2.38 and GOS was 4.67 ± 0.91; for adjuvant hyperbaric oxygen treatment group, GCS was 6.60 ± 1.88 and GOS was 4.42 ± 0.58; and for adjuvant electroacupuncture plus hyperbaric oxygen treatment group, GCS was 6.95 ± 1.76 and GOS was 4.76 ± 0.64. The results are shown in [Table 2]. Compared to conventional treatment group, the adjuvant therapy groups had significantly better efficacy (P < 0.05), as per GCS and GOS. There was no significant difference in treatment efficacy among the adjuvant treatment groups (P > 0.05).
Table 2: Glasgow Coma Scale and Glasgow Outcome Scale results of every groups before and after treatment (x + s)

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  Discussion Top


Coma is the reconstruction sequelae of brain injury in neurosurgery. It severely affects the patient's survival and increases the social burden.[2] The coma after brain trauma is due to primary or secondary brain damage inducing brain tissue hypoxia, necrosis, and loss of function, which affects the awakening function of brainstem reticular structure, thus leading to coma. Brain cell necrosis is irreversible. The current treatment is mainly targeted to provide functional compensation and promote reconstruction of existing neural networks. Therefore, the conventional treatment alone has limited effect. Only through the combined different treatment methods can promote and accelerate the functional recovery. So far, it is widely accepted that electroacupuncture and hyperbaric oxygen therapies can promote the awakening of coma patients.[2],[5],[6],[7]

Animal studies have shown that electroacupuncture treatment can significantly improve the condition of blood vessel of cerebral cortex microcirculation.[8] Electroacupuncture is further shown to reduce the Ca2+ influx in nerve cells via regulating bcl-2 and bax expression, thus protecting the nervous system.[9] In addition, it has been found that the electroacupuncture stimulation of Shuigou, Neiguan, and Sanyinjiao acupoints could relieve cerebral vasospasm; increase cerebral blood flow; and improve the activity of superoxide dismutase, thus reducing free radical damage and achieving therapeutic effect on brain.[10],[11],[12] Brown et al.[13] found that hyperbaric oxygen could significantly increase the oxygen supply in damaged brain tissue, mainly by increasing the oxygen capacity in plasma, shrinking cerebral blood vessel, and reducing encephaledema. Holbach et al.[14] as well as Sukoff and Ragatz[15] showed that the hyperbaric oxygen could improve the cell glucose metabolic rate of damaged brain tissue and improve the reperfusion of injured area, thus contributing to the functional recovery of cells in damaged brain tissues. Neubauer et al.[16] found that hyperbaric oxygen showed significant effect in the awakening of coma patients with brain injury. The acupuncture treatment can dilate the blood vessels to certain extent and improve the supply of oxygen and blood flow.[2],[6] In addition, acupuncture can activate the functioning of brainstem reticular awakening system and improve the excitability of nerve cells, thus promoting the awakening.[2],[11],[12]

Brain is the organ that needs and consumes most of the oxygen in the body, accounting for about 20% of the total oxygen consumption. After brain injury, due to the edema and bleeding in damaged tissues, their blood supply is reduced and oxygen consumption is decreased, which leads to improper functioning of the nervous system. The hyperbaric oxygen therapy can increase the oxygen content and oxygen partial pressure in artery. Under 0.2 MPa of oxygen partial pressure, arterial oxygen partial pressure can go up to 186.7 KPa, which is 14 times the normal atmosphere pressure. Furthermore, the increase in oxygen saturation can help with the recovery of brain tissue oxygen metabolism and promote the synthesis of adenosine triphosphate and aerobic respiration, thus giving brain more energy supply, facilitating the brain function recovery in the damaged area.[17],[18],[19]

Therefore, as discussed above, the electroacupuncture and hyperbaric oxygen therapies may function through different mechanisms to promote the brain function recovery. Our results showed that the electroacupuncture treatment group, hyperbaric oxygen treatment group, and electroacupuncture plus hyperbaric oxygen treatment group, in adjuvant to conventional treatment, had significantly better effects compared to conventional treatment group alone (P < 0.05). However, there was no significant difference among the adjuvant groups (P > 0.05). These results further confirm the above analysis that both electroacupuncture and hyperbaric oxygen therapies can enhance the treatment efficacy to a similar degree, and the combination of these two has no additive effects in further improving the awakening of coma patients.

There are many factors involved in the awakening of coma patients, including the degree of damage and range of damage, which need to be studied further. For the awakening treatment of coma patients, our results show that, in addition to conventional treatment, the use of electroacupuncture or hyperbaric oxygen therapies can improve the recovery of patients' nervous systems, thus promoting the outcome.

Financial support and sponsorship

This research supported by (1) the Young Medical Project of Nantong City Health Bureau (WQ2014016); (2) the Traditional Chinese Medicine Science and Technology Project in Jiangsu Province (No. YB2015113); (3) the Science and Technology Program of Nantong City (No. MS12015016).

Conflicts of interest

There are no conflicts of interest.

 
  References Top

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Zhou HG. Epidemiological analysis of traumatic brain injury patients. Zhongguo Shi Yong Yi Yao 2011;6 (21):45-6.  Back to cited text no. 1
    
2.
Tu XH, He ZY, Fu X, Chen YH, Chen YL, Kang SJ. Brain arousal dysfunction in severe craniocerebral injury treated with acupuncture. Zhongguo Zhen Jiu 2010;30 (12):974-6.  Back to cited text no. 2
    
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Niklas A, Brock D, Schober R, Schulz A, Schneider D. Continuous measurements of cerebral tissue oxygen pressure during hyperbaric oxygenation–HBO effects on brain edema and necrosis after severe brain trauma in rabbits. J Neurol Sci 2004;219 (1-2):77-82.  Back to cited text no. 3
    
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Chua KS, Ng YS, Yap SG, Bok CW. A brief review of traumatic brain injury rehabilitation. Ann Acad Med Singapore 2007;36 (1):31-42.  Back to cited text no. 4
    
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Bu CL, Li YB, Meng H. Treatment of 80 cases of urine retention following spinal and craniocerebral injuries by acupuncture. J Acupunct Tuina Sci 2007;5 (3):180-1.  Back to cited text no. 8
    
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Guo J, Li R, Zhao P, Cheng J. Effect of taurine in combination with electroacupuncture on neuronal damage following transient focal cerebral ischemia in rats. Acupunct Electrother Res 2002;27 (2):129-36.  Back to cited text no. 9
    
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Lai XS, Huang Y. Comparative study on the effect of Baihui(GV20), Shuigou(GV 26) and Shenmen(HT 7) On cognition of patients with vascular dementia. J Acupunct Tuina Sci 2005;3 (5):20-3.  Back to cited text no. 10
    
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Wiseman-Hakes C, Murray B, Moineddin R, Rochon E, Cullen N, Gargaro J, Colantonio A. Evaluating the impact of treatment for sleep/wake disorders on recovery of cognition and communication in adults with chronic TBI. Brain Inj 2013;27 (12):1364-76.  Back to cited text no. 11
    
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Wu ZT. Clinical applications of acupoints Baihui(GV 20) and Sishencong (Ex-HN 1). J Acupunct Tuina Sci 2010;8 (6):394-6.  Back to cited text no. 12
    
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Brown J, Preul MC, Taha A. Hyperbaric oxygen in the treatment of elevated intracranial pressure after head injury. Pediatr Neurosci 1988;14 (6):286-90.  Back to cited text no. 13
    
14.
Holbach KH, Caroli A, Wassmann H. Cerebral energy metabolism in patients with brain lesions of normo- and hyperbaric oxygen pressures. J Neurol 1977;217 (1):17-30.  Back to cited text no. 14
    
15.
Sukoff MH, Ragatz RE. Hyperbaric oxygenation for the treatment of acute cerebral edema. Neurosurgery 1982;10 (1):29-38.  Back to cited text no. 15
    
16.
Neubauer RA, Gottlieb SF, Pevsner NH. Hyperbaric oxygen for treatment of closed head injury. South Med J 1994;87 (9):933-6.  Back to cited text no. 16
    
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Cao BF, Zhang C, Liang WH, Chen L. Effects of early acupuncture combined with exercise therapy on the consciousness-regaining treatment of coma patients in neurosurgery. Zhongguo Zhen Jiu 2011;31 (2):121-3.  Back to cited text no. 17
    
18.
Rockswold GL, Ford SE, Anderson DC, Bergman TA, Sherman RE. Results of a prospective randomized trial for treatment of severely brain-injured patients with hyperbaric oxygen. J Neurosurg 1992;76 (6):929-34.  Back to cited text no. 18
    
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