目的 本研究基于弥散张量成像（DTI）技术，通过分析早期针刺干预对脑白质纤维微结构的影响，探讨针刺干预对颅脑损伤后昏迷患者促醒作用的脑效应机制，为早期促醒提供理论依据。 方法 纳入本院针灸康复科收治的32例创伤性颅脑损伤昏迷患者，病程10 ~ 30 d，通过随机数字表法将研究对象分为对照组（n = 16）与针刺组（n = 16）。两组均接受常规促醒康复治疗，针刺组在常规治疗基础上联合醒脑开窍针刺治疗。于治疗前后分别进行格拉斯哥昏迷量表（GCS）评分及DTI检查，评估患者苏醒率并测量各向异性分数（FA）值。针对治疗后组间出现差异的部位，进一步分析针刺组FA值与GCS评分的相关性。 结果 两组患者治疗28 d后，针刺组苏醒率达75.00%，显著高于对照组的43.75%（P = 0.047）；两组治疗后FA值均较基线水平显著升高（P < 0.05），针刺组在中脑、桥脑、丘脑、内囊后肢及胼胝体压部的FA值显著高于对照组（P < 0.05），而内囊前肢、胼胝体膝部及半卵圆中心FA值两组比较差异无统计学意义（P > 0.05）。相关性分析显示，治疗后针刺组在中脑、桥脑、丘脑、内囊后肢及胼胝体压部的FA值与GCS评分呈显著正相关（P < 0.05），以中脑（r = 0.785）与丘脑（r = 0.739）区域相关性最为显著。 结论 针刺联合常规促醒治疗可有效改善颅脑损伤昏迷患者的意识状态，中脑、桥脑、丘脑、内囊后肢及胼胝体压部可能是针刺作用关键区域，其作用机制可能与促进关键区域白质纤维修复和重塑相关。

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.