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[Early acupuncture for traumatic intracerebral hematoma: a randomized controlled trial].

OBJECTIVE
To observe the effect of early acupuncture intervention on brain edema in patients with traumatic intracerebral hematoma and explore its mechanism on the basis of conventional western medicine.


METHODS
With stratified block randomization, sixty-four patients with glasgow coma scale (GCS) of 6 to 12 were divided into an acupuncture combined with medicine group (a combination group) and a western medication group, 32 cases in each one. In the western medication group, dehydration to reduce intracranial pressure and nutritional nerves were given as the basic treatment. In the combination group, on the basis of the treatment as the western medication group, acupuncture was applied at Xuehai (SP 10), Taixi (KI 3), Fenglong (ST 40), Yinlingquan (SP 9), Zusanli (ST 36), etc. The treatment was given once every day, for 6 times as one course; there was an interval of 1 day between two courses; a total of 4 courses were required. GCS score and recovery time were recored before treatment and on the 7 th, 14 th and 28 th days. 90 days follow-up after treatment, the GOS was observed, and the mortality and effective survival rate were calculated. The Barthel index (BI) score was evaluated before treatment and on the 14th, 21st, 28th days and 90 days follow-up after treatment. Before treatment and 3rd, 7th, 14th, 21st, 28th days, cranial CT or MR scan was performed to calculate the brain edema index (BEI); Plasma interleukin-6 (6IL-6), neuropeptide Y (NPY) and nitric oxide (NO) were measured before treatment and on the 3rd, 7th and 14th days after treatment.


RESULTS
(1) The GCS scores increased gradually in the two groups during treatment, and there was significant difference between the 28th days and before treatment (both P<0.05). There were no significant difference between the two groups about GCS score and average recovery time on the 28th days treatment (all P>0.05). (2) The mortality rate of the combination group was 6.3% (2/32) on 90 days follow-up, 9.4% (3/32) in the western medication group (P>0.05). The effective survival rate was 81.3% (26/32) in the combination group, which was higher than 59.4% (19/32) in the western medication group (P<0.05). (3) The BI score was significantly higher than that before treatment on the 28th days and 90 days follow-up in the two groups (all P<0.05), and the result in the combination group was superior to that in the western medication group (both P <0.05). (4) The BEI decreased on the 14th, 21st and 28th days in the two groups (all P<0.05), and on the 14th day, the BEI decreased more significantly in the combination group than that in the western medication group (P<0.05). (5) The levels of IL-6, NPY and NO decreased on the 7th and 14th days in the two groups (all P<0.05), and decreased more significantly in the combination group than that in the western medication group on the 7th day (P<0.05).


CONCLUSION
On the basis of conventional western medicine, early acupuncture can reduce cerebral edema and improve the prognosis of patients, and acupuncture combined with medicine are superior to western medicine alone. Acupuncture mechanism may be related to reducing the expression of inflammatory response.