Observation on therapeutic effect of combined acupuncture for stress gastric mucosal injury after traumatic brain injury / 中华危重病急救医学

ABSTRACT

Objective To observe the therapeutic effect of combined acupuncture combined with omeprazole on patients with craniocerebral trauma complicated with stress gastric mucosal injury. Methods Patients with stress gastric mucosal injury after cerebral trauma admitted to neurology of Brain Hospital, Affiliated Hospital of Logistics University from June 2016 to July 2017 were enrolled, with the inclusion criteria within 24 hours after injury at admission, and Glasgow coma scale (GCS) less than 12. Patients were divided into omeprazole group, acupuncture group and acupuncture plus omeprazole combined treatment group according to random number table method. All patients in the three groups were given symptomatic treatment in time after admission. After diagnosis, omeprazole group was injected intravenously omeprazole, 40 mg each time, one dose in 12 hours for 7 days; acupuncture group was acupunctured at bilateral Zusanli point and Zhongwan point, 20 minutes for needle retention, once a day for 7 days;combined treatment group was given acupuncture and omeprazole at the same time. The GCS score and the occult stool test were performed at admission and treatment of 7 days; the pH of gastric juice, the levels of serum neurotensin (NT) and endothelin-1 (ET-1) were measured at admission and treatment 1, 3, 5, 7 days. At the same time, 10 healthy persons were selected as the control. Results Finally, 90 patients were selected, 30 in each group. GCS score at 7 days after treatment in omeprazole group, acupuncture group and combined treatment group were significantly higher than those at admission, but there was no statistical difference among the groups (9.46±2.81, 10.26±2.24, 10.52±2.50, F = 2.010, P = 0.141). For treatment of 7 days, the incidence of occult stool in the combined treatment group was significantly lower than that in the omeprazole group and acupuncture group (13.3% vs. 36.7%, 40.0%, both P < 0.05). The pH value of gastric excretion was increased gradually after treatment in the three groups. The pH value of gastric excretion in the combined treatment group was significantly higher than that in the omeprazole group and acupuncture group at 5 days of treatment (4.58±0.53 vs. 4.20±0.52, 4.28±0.43, both P < 0.05). The levels of serum NT in the three groups were both bi-directional the level of NT at admission was significantly higher than that in the healthy control group, then decreased significantly, and the treatment of 3 days was significantly lower than that in the healthy control group and then rise gradually. The level of NT at treatment 5 days in the combined treatment group was significantly higher than that of the omeprazole group and the acupuncture group (ng/L 45.88±8.03 vs. 36.15±11.54, 37.32±7.79, both P < 0.05), and had returned to normal level on the 7th day after treatment (ng/L 56.88 ±12.54). The level of serum ET-1 in the three groups showed a bimodal change the level of ET-1 at admission was significantly higher than that of the healthy control group. The treatment of 1 day to the normal range was gradually increased, and the peak of 5 days appeared again and then decreased slowly. The level of ET-1 at treatment of 7 days in the combined treatment group was significantly lower than that of the omeprazole group and acupuncture group (ng/L 53.25±7.60 vs. 63.74±9.05, 65.50±12.73, both P <0.05), and had been restored to normal. Conclusion Combined acupuncture at points of Zusanli and Zhongwan for the treatment of stress gastric mucosal injury after traumatic brain injury, can reduce gastric acid secretion, promote the level of NT in serum, reduce the secretion of ET-1 level, help to repair the gastric mucosa, and the effect of combined with omeprazole is more significant.