March 22, 2023 is the third World Coma Day, with the slogan "Skilled in medical skills, sincere in medical ethics". In clinical practice, coma is a very serious consciousness disorder caused by many reasons. If the coma lasts for more than three months, we call it vegetative state, which is what we call a vegetative state. In fact, many patients with traumatic brain injury and cerebral hemorrhage undergo early awakening treatment after coma. If timely treatment and appropriate awakening methods are used, most patients will not be in a long-term coma. So, what are the methods for waking up from a coma? Below, I will introduce it to everyone.
There are several methods to promote wakefulness, including:
1. Drug induced wakefulness
including Xingnaojing, naloxone, anti free radical, mitochondrial protective drugs, etc. Some neuropharmaceuticals such as brain protein hydrolysate, ganglioside, and mouse nerve growth factor can also be used. In addition, some traditional Chinese medicine can also be used for treatment.
2、 Hyperbaric oxygen therapy refers to the treatment method of intermittent inhalation of 100% oxygen in a hyperbaric oxygen chamber with a pressure greater than 1 standard atmosphere. Clinical practice has proven that hyperbaric oxygen can: ① correct cerebral hypoxia and maintain energy supply to nerve cells. ② Reduce intracranial pressure and alleviate brain edema. ③ Improve cerebral microcirculation. ④ Improving the function of the brainstem reticular activating system has the effect of promoting coma awakening. At present, it is believed that the earlier hyperbaric oxygen therapy begins, the better the effect, but attention should be paid to the safety of patients during the treatment process.
3、 Rehabilitation therapy to promote awakening
There are mainly the following therapies:
(1) Exercise therapy: mainly involves passive movement of limbs, but attention should be paid to the full range of movement of each joint;
(2) Acupuncture and moxibustion: Acupuncture at Renzhong and Shaochong, together with Baihui, Hegu, Neiguan and other acupoints.
(3) Sensory stimulation therapy: stimuli such as sound, light, touch, pain, temperature, taste, smell, proprioception, etc., while emphasizing the call of family members. This belongs to sound stimulation, which means calling the patient or talking about familiar people or things in the patient's ear, or playing the patient's favorite songs or music.
4、 Electrical stimulation for awakening
Electrical stimulation includes transcutaneous electrical stimulation, transcranial electrical stimulation, median nerve electrical stimulation, spinal cord electrical stimulation, deep brain electrical stimulation, etc. At present, it is believed to have certain therapeutic effects on awakening long-term comatose patients, and it is worth trying as long as the condition requires and allows it.
(1) Median nerve electrical stimulation: Median nerve electrical stimulation is a type of electrical stimulation therapy in which electrodes are placed 2cm above the median nerve point on the palmar wrist crease of the wrist joint. Generally, the right median nerve is used for electrical stimulation, mainly for the treatment of various coma induced awakenings. It has the advantages of non invasiveness, no complications, easy operation, and low cost, and is widely used.
Possible mechanism: (1) By increasing cerebral blood flow, improving blood supply to the lesion site, improving necrotic nerves, and promoting self repair of brain tissue. (2) By activating the ascending reticular system of the patient's brainstem, the cerebral cortex is excited, enhancing brain electrical activity and improving neurophysiology, thereby improving brain function. (3) Electrical stimulation can increase the levels of dopamine and acetylcholine in cerebrospinal fluid, thereby altering the levels of neurotransmitters in the body and achieving wakefulness.
(2) Spinal cord electrical stimulation: Spinal cord electrical stimulation is an advanced method of treating diseases by placing electrodes into the spinal canal and stimulating spinal nerves with pulsed current. Electrical stimulation of the high cervical spinal cord can increase cerebral blood flow and activate the cholinergic ascending reticular system. This can not only improve cerebral circulation and reduce ischemic lesions, but also stimulate the cerebral cortex and promote patient consciousness.
(3) Deep brain electrical stimulation, commonly known as a brain pacemaker, is a high-frequency electrical stimulation that is implanted into the brain to control key nuclei of consciousness (such as the central nucleus of the thalamus, paraventricular nucleus, etc.), activate brain networks, and achieve wakefulness.
In short, due to the different causes and duration of coma, not all comatose patients can be awakened through the above treatment methods. Currently, there is no definite and effective method for awakening comatose patients. Therefore, it requires long-term joint efforts from patients' families and doctors to strive for early awakening and ultimately return to their families and society.