三重刺激技术评价化痰通络颗粒对前循环脑梗死神经功能及皮质脊髓束的影响
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摘要
目的:应用三重刺激技术(triple stimulation technique, TST)观察化痰通络颗粒治疗急性前循环脑梗死的疗效及对皮质脊髓束损伤修复的影响。方法:将65例风痰瘀阻型急性脑梗死(acute cerebral infrarction, ACI)患者,按照随机数字表法随机分配为观察组33例与对照组32例;对照组给予常规基础治疗,观察组在对照组基础上加用化痰通络颗粒治疗,疗程均为14 d;于治疗前、治疗21 d后分别运用TST检测两组患者皮质脊髓束损伤程度的变化,并采用NIHSS量表、简化Fugl-Meyer运动功能量表(F-M)、Barthel指数(MBI)评定患者神经功能、运动功能及日常生活活动能力,分析NIHSS评分、F-M评分、MBI评分与TST test测试结果的相关性。另选取健康体检者30例为健康组。结果:治疗前、治疗21 d后,观察组和对照组的TST test/TST control波幅比率和面积比率均较健康组明显增高(P<0.05);治疗前观察组与对照组NIHSS评分、F-M评分、MBI评分及TST test测试结果比较差异无统计学意义(P>0.05);治疗21 d后,观察组NIHSS评分、TST test测试结果明显低于对照组(P<0.05),F-M评分、MBI评分明显高于对照组(P<0.05)。相关性分析显示,治疗前TST test测试结果与NIHSS评分呈正相关(r分别为0.648、0.652,P<0.05),与F-M评分呈负相关(r分别为-0.536、-0.538,P<0.05)。治疗前TST test测试结果与治疗21 d后MBI评分呈负相关(r分别为-0.876、-0.894,P<0.05)。结论:TST能定量反映ACI患者神经功能缺损程度,较客观、准确评估患者皮质脊髓束功能;化痰通络颗粒能促进风痰瘀阻型ACI患者皮质脊髓束的修复,改善肢体运动功能,显著促进神经功能恢复。
Objective:The effects of Huatan Tongluo Granule on cortical spinal cord injury and neuromotor function recovery in patients with anterior circulating cerebral infarction were studied by triple stimulation technique(TST). Methods:Sixty-five patients with phlegm and stasis resistance type of ACI,according to that random digital table method,were randomly divided into observation group and control group. The control group was given routine basic treatment and the observation group was treated with Huatan Tongluo Granule on the basis of the control group for 14 days. Before and 21 days after treatment, TST technique was used to detect the degree of cortical spinal cord injury in the observation group and control group. The NIHSS scale was used to evaluate the neurological function and motor function of the patients. The correlation of NIHSS scores, fugl-meyer scores, and TST test results were analyzed respectively. Results:NIHSS score, fugl-meyer score and TST test results showed no significant difference between the pretreatment group and the control group(P>0.05). Correlation analysis showed that the TST test results were positively correlated with NIHSS score(P<0.05), and were negatively correlated with fugl-meyer score(P<0.05). The pre-treatment TST test level was negatively correlated with the Barthel index score 21 days after treatment(P<0.05). Conclusion: TST can quantitatively reflect the degree of neurological impairment in patients with acute cerebral infarction, and evaluate the function of corticospinal tract in patients objectively and accurately. It can promote repairing of corticospinal cord bundle in the patients with wind-phlegm stagnation type of ACI, improve the function of limb motion and promote the restoration of nerve functio.
Objective:The effects of Huatan Tongluo Granule on cortical spinal cord injury and neuromotor function recovery in patients with anterior circulating cerebral infarction were studied by triple stimulation technique(TST). Methods:Sixty-five patients with phlegm and stasis resistance type of ACI,according to that random digital table method,were randomly divided into observation group and control group. The control group was given routine basic treatment and the observation group was treated with Huatan Tongluo Granule on the basis of the control group for 14 days. Before and 21 days after treatment, TST technique was used to detect the degree of cortical spinal cord injury in the observation group and control group. The NIHSS scale was used to evaluate the neurological function and motor function of the patients. The correlation of NIHSS scores, fugl-meyer scores, and TST test results were analyzed respectively. Results:NIHSS score, fugl-meyer score and TST test results showed no significant difference between the pretreatment group and the control group(P>0.05). Correlation analysis showed that the TST test results were positively correlated with NIHSS score(P<0.05), and were negatively correlated with fugl-meyer score(P<0.05). The pre-treatment TST test level was negatively correlated with the Barthel index score 21 days after treatment(P<0.05). Conclusion: TST can quantitatively reflect the degree of neurological impairment in patients with acute cerebral infarction, and evaluate the function of corticospinal tract in patients objectively and accurately. It can promote repairing of corticospinal cord bundle in the patients with wind-phlegm stagnation type of ACI, improve the function of limb motion and promote the restoration of nerve functio.
引文
[1] 陈君逸,徐迎胜,樊东升.三重刺激技术临床应用及研究进展[J].北京医学,2017,39(5):523-525.
[2] Groppa S, Oliviero A, Eisen A, et al. A practical guide to diagnostic transcranial magnetic stimulation: report of an IFCN committee[J].Clin Neurophysiol, 2012,123:858-882.
[3] 苏红军,谢炳.用三重刺激技术评估急性脑梗死患者的预后[J].临床神经电生理学杂志,2008,17(3):133-137.
[4] 张云玲,王永炎,齐治家. 运用化痰通络汤、化痰通腑汤治疗中风中经证的临床及实验研究[J].中国中医急症,1995,4(2):55-57.
[5] 黄任锋,余尚贞,石青,等.化痰通络汤对风痰阻络型缺血性中风患者神经功能与肿瘤坏死因子-α表达的影响[J].新中医,2016,42(2):11-13.
[6] 方美凤,谭峰.化痰通络颗粒对脑梗死患者外周血细胞因子信号转导抑制因子-3及肿瘤坏死因子-α的影响[J].中国中西医结合杂志,2010,11(30):1142-1145.
[7] 桑德春,纪树荣,张缨,等.Fugl- Meyer 量表在社区脑卒中康复疗效评定中的应用[J].中国康复医学杂志,2007, 22(3):264-265.
[8] 朱镛连. 神经康复学[M]. 北京: 人民军医出版社,2001:183-184.
[9] R?sler KM,Roth DM,Magistris MR.Trial-to-trial size variability of motor-evoked potentials.A study using the triple stimulation technique[J].Exp Brian Res,2008,187:51-59.
[10] 王悦,崔丽英.三重刺激技术的原理和临床应用[J].中华神经科杂志,2009,42(12):852-854.
[11] Hess CW, Mills KR, Murray NM,et al.Magnetic brain stim-ulation: central motor conduction studies in multiple sclerosis[J]. Ann Neurol,1987,22: 744-752.
[12] Farmer SF, Harrison LM, Mayston MJ, et al. Abnormalcortex-muscle interactions in subjects with X-linked Kall-mann’s syndrome and mirror movement[J]. Brain, 2004,127:385-397.
[13] 王永炎.中医内科学[M].上海:上海科学技术出版社,1997:131.
[14] 窦祖林,廖家华,宋为群.经颅磁刺激技术基础与临床应用[M].北京:人民卫生出版社,2012.
[15] 张玮玮,郑菊阳,徐迎胜,等.三重磁刺激技术对上运动神经元损伤的评价作用[J].中国神经免疫学和神经病学杂志,2012,19(4):256-259.
[16] 黄婷婷,谭峰.电针对中医不同证型急性脑梗死患者皮质脊髓束功能的影响[J].广东医学,2015,36(5):789-791.
[17] 谭峰,王学文,詹杰,等.三重刺激技术评估电针对急性脑梗死患者皮质脊髓束损伤的影响[J].中国中西医结合急救杂志,2016,23(6):561-564.
[18] 王含,王悦,崔丽英.三重刺激技术定量评价多系统萎缩患者重复经颅磁刺激治疗效果二例分析[J].中国现代神经疾病杂志,2017,17(6):434-438.
[19] 郑菊阳,徐迎胜,樊东升.三重刺激技术在中国汉族人群中的正常参考值[J].中华神经科杂志,2011,44(11):739-741.
[20] 林敏婷,黎鸣,杨轩,等.重复经颅磁刺激对脑卒中患者中枢运动传导功能的影响[J].中国当代医药,2017,24(25):45-47.
[2] Groppa S, Oliviero A, Eisen A, et al. A practical guide to diagnostic transcranial magnetic stimulation: report of an IFCN committee[J].Clin Neurophysiol, 2012,123:858-882.
[3] 苏红军,谢炳.用三重刺激技术评估急性脑梗死患者的预后[J].临床神经电生理学杂志,2008,17(3):133-137.
[4] 张云玲,王永炎,齐治家. 运用化痰通络汤、化痰通腑汤治疗中风中经证的临床及实验研究[J].中国中医急症,1995,4(2):55-57.
[5] 黄任锋,余尚贞,石青,等.化痰通络汤对风痰阻络型缺血性中风患者神经功能与肿瘤坏死因子-α表达的影响[J].新中医,2016,42(2):11-13.
[6] 方美凤,谭峰.化痰通络颗粒对脑梗死患者外周血细胞因子信号转导抑制因子-3及肿瘤坏死因子-α的影响[J].中国中西医结合杂志,2010,11(30):1142-1145.
[7] 桑德春,纪树荣,张缨,等.Fugl- Meyer 量表在社区脑卒中康复疗效评定中的应用[J].中国康复医学杂志,2007, 22(3):264-265.
[8] 朱镛连. 神经康复学[M]. 北京: 人民军医出版社,2001:183-184.
[9] R?sler KM,Roth DM,Magistris MR.Trial-to-trial size variability of motor-evoked potentials.A study using the triple stimulation technique[J].Exp Brian Res,2008,187:51-59.
[10] 王悦,崔丽英.三重刺激技术的原理和临床应用[J].中华神经科杂志,2009,42(12):852-854.
[11] Hess CW, Mills KR, Murray NM,et al.Magnetic brain stim-ulation: central motor conduction studies in multiple sclerosis[J]. Ann Neurol,1987,22: 744-752.
[12] Farmer SF, Harrison LM, Mayston MJ, et al. Abnormalcortex-muscle interactions in subjects with X-linked Kall-mann’s syndrome and mirror movement[J]. Brain, 2004,127:385-397.
[13] 王永炎.中医内科学[M].上海:上海科学技术出版社,1997:131.
[14] 窦祖林,廖家华,宋为群.经颅磁刺激技术基础与临床应用[M].北京:人民卫生出版社,2012.
[15] 张玮玮,郑菊阳,徐迎胜,等.三重磁刺激技术对上运动神经元损伤的评价作用[J].中国神经免疫学和神经病学杂志,2012,19(4):256-259.
[16] 黄婷婷,谭峰.电针对中医不同证型急性脑梗死患者皮质脊髓束功能的影响[J].广东医学,2015,36(5):789-791.
[17] 谭峰,王学文,詹杰,等.三重刺激技术评估电针对急性脑梗死患者皮质脊髓束损伤的影响[J].中国中西医结合急救杂志,2016,23(6):561-564.
[18] 王含,王悦,崔丽英.三重刺激技术定量评价多系统萎缩患者重复经颅磁刺激治疗效果二例分析[J].中国现代神经疾病杂志,2017,17(6):434-438.
[19] 郑菊阳,徐迎胜,樊东升.三重刺激技术在中国汉族人群中的正常参考值[J].中华神经科杂志,2011,44(11):739-741.
[20] 林敏婷,黎鸣,杨轩,等.重复经颅磁刺激对脑卒中患者中枢运动传导功能的影响[J].中国当代医药,2017,24(25):45-47.