关键词: 弥散张量成像, 颅脑损伤, 昏迷, 促醒

Abstract:

Objective Based on the diffusion tensor imaging （DTI） technique， this study aims to analyze the impact of early acupuncture intervention on the microstructure of brain white matter fibers， explore the brain mechanisms underlying the arousal effect of acupuncture intervention in comatose patients after traumatic cerebral injury， so as to provide a theoretical basis for early awakening promotion. Methods This study enrolled 32 comatose patients with traumatic brain injury admitted to the Department of Acupuncture and Rehabilitation with a disease course ranging from 10 to 30 days. Participants were randomly allocated into a control group （n = 16） and an acupuncture group （n = 16） using a random number table method. Both groups received conventional awakening-promoting rehabilitation treatment，while the acupuncture group additionally treated with the Xingnao Kaiqiao acupuncture therapy. Before and after the treatment，the Glasgow Coma Scale （GCS） scores and DTI examination were conducted respectively to assess the awakening rate and measure FA values. Explore the correlation between FA values within the acupuncture group and the GCS scores for the regions where inter-group differences occur after treatment. Results After 28 days of treatment in both groups， the awakening rate in the acupuncture group reached 75.00%，significantly higher than that in the control group （43.75%） （P = 0.047）. After treatment，FA values showed a significant increase compared to baseline levels in both groups （P < 0.05）. The acupuncture group exhibited a significantly greater increase in FA values in the midbrain， pons， thalamus， posterior limb of the internal capsule，and the splenium of the corpus callosum compared to the control group （P < 0.05）， while no statistically significant between-group differences were observed in the regions of anterior limb of the internal capsule， genu of the corpus callosum，and the semioval center （P > 0.05）. Correlation analysis revealed FA values in the midbrain， pons， thalamus， posterior internal capsule， and splenium were significantly positively correlated with GCS scores in the acupuncture group after treatment， particularly in the midbrain （r = 0.785） and thalamus （r = 0.739）. Conclusions Acupuncture combined with conventional awakening therapy can effectively improve the consciousness state of comatose patients with TBI. The midbrain， pons， thalamus， posterior limb of the internal capsule， and splenium of the corpus callosum may be the key regions affected by acupuncture. The underlying mechanism may be related to promoting the repair and remodeling of white matter fibers in these critical areas.

Key words: diffusion tensor imaging, traumatic brain injury, coma, wake-promoting