电针联合常规疗法对弥漫性轴索损伤昏迷患者的促醒作用研究
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摘要
目的观察电针联合西医常规疗法对弥漫性轴索损伤昏迷患者的促苏醒作用。方法将145例弥漫性轴索损伤(Ⅲ型)昏迷患者分为治疗组(71例)和对照组(74例),对照组采用西医常规治疗,治疗组在常规治疗基础上加用电针治疗。观察治疗前及治疗后10、20、30天格拉斯哥昏迷量表(GCS)评分、促醒率,采用ELISA技术测定两组血清乙酰胆碱酯酶(AchE)浓度,应用速率法测定其活性;多元逐步回归法分析治疗组GCS评分与AchE浓度及活性的相关性。结果与本组治疗前比较,治疗组治疗10、20、30天后GCS评分均明显升高(P<0.01,P<0.05),对照组治疗20、30天GCS评分升高(P<0.01)。治疗组GCS评分及苏醒率较对照组同期升高(P<0.01,P<0.05)。AchE浓度与GCS评分呈负相关性,其浓度对CCS评分影响大于活性(P<0.05)。结论电针联合西医常规疗法对弥漫性轴索损伤有促苏醒作用,可缩短患者昏迷时间,其促醒机制与AchE浓度有关。
Objective To observe the wake-promoting effects of electroacupuncture combined with routine therapy on comatose patients with diffuse axonal injury.Methods Totally 145 patients with diffuse axonal injury(typeⅢ)were assigned to the treatment group(71 cases)and the control group(74 cases).The control group was treated with conventional Western medicine therapy,and the treatment group with conventional Western medicine therapy combined with electroacupuncture.The GCS score and wake-promoting rates were observed at baseline and10,20,30 days after treatment.The AchE concentration was measured by ELISA,and the AchE activity was measured by kinetic rate method.The correlation between GCS score and AchE concentration and AchE activity were analyzed by the method of multiple stepwise regression analysis.Results All the GCS score of the patients in the treatment group increased after 10,20,and 30 days of treatment(P<0.05).GCS score increased after 20 and 30 days of treatment in the control group(P<0.05).The GCS score and consciousness-promoting rates of the treatment group were higher than the control group at the same time point(P<0.05).It was found that there was a negative correlation between the AchE concentration and GCS score,The influence of AchE concentration on CCS score was greater than AchE activity(P<0.05).Conclusions It was suggested that conventional Western medicine therapy combined with electroacupuncture can promote the recovery of diffuse axonal injury,shorten the time of coma.The neurotransmitter AchE may play a role in the pathological and physiological mechanism of wake-promoting.
Objective To observe the wake-promoting effects of electroacupuncture combined with routine therapy on comatose patients with diffuse axonal injury.Methods Totally 145 patients with diffuse axonal injury(typeⅢ)were assigned to the treatment group(71 cases)and the control group(74 cases).The control group was treated with conventional Western medicine therapy,and the treatment group with conventional Western medicine therapy combined with electroacupuncture.The GCS score and wake-promoting rates were observed at baseline and10,20,30 days after treatment.The AchE concentration was measured by ELISA,and the AchE activity was measured by kinetic rate method.The correlation between GCS score and AchE concentration and AchE activity were analyzed by the method of multiple stepwise regression analysis.Results All the GCS score of the patients in the treatment group increased after 10,20,and 30 days of treatment(P<0.05).GCS score increased after 20 and 30 days of treatment in the control group(P<0.05).The GCS score and consciousness-promoting rates of the treatment group were higher than the control group at the same time point(P<0.05).It was found that there was a negative correlation between the AchE concentration and GCS score,The influence of AchE concentration on CCS score was greater than AchE activity(P<0.05).Conclusions It was suggested that conventional Western medicine therapy combined with electroacupuncture can promote the recovery of diffuse axonal injury,shorten the time of coma.The neurotransmitter AchE may play a role in the pathological and physiological mechanism of wake-promoting.
引文
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[21]张鹏,赵敏珠,朱士胜,等.微管相关蛋白-1B在弥漫性轴索损伤中的表达变化与意义[J].重庆医科大学学报,2016,41(1):34-37.
[2]Levi L,Guiburd JN,Lemberger A,et al.Diffuse axonal injury:analysis of 100 patients with radiological signs[J].Neurosurgery,1990,27(3):429-432.
[3]Levi L,Guilburd JN,Bar-Yosef G,et al.Severe head injury in children-analyzing the better outcome over adecade and the role of major improvements in intensive care[J].Childs Nerv Syst,1998,14(4-5):195-202.
[4]吴在德,吴肇汉主编.外科学[M].第7版.北京:人民卫生出版社,2008:252-259.
[5]沈菁,雷晓明,宋洋,等.电针内关、百会穴对脑缺血/再灌注大鼠GRP78和Caspase-12基因表达的影响[J].湖南中医药大学学报,2016,36(2):57-60.
[6]尹正录,孟兆祥,林舜艳,等.针刺对老年大鼠术后认知功能障碍的影响及机制研究[J].针灸临床杂志,2015,31(12):70-73.
[7]江钢辉,陈振虎,赖新生.针刺智三针和四神聪穴治疗血管性痴呆的临床研究[J].广州中医药大学学报,2003,20(4):271-273.
[8]许凯声,宋建华,黄迢华,等.针刺素髎为主对重型颅脑损伤昏迷促苏醒的临床疗效观察[J].中国针灸,2014,34(6):532-533.
[9]陈文君,寿依群,李建华,等.应用功能性磁共振成像技术探讨针刺三阴交穴对脑功能的调节作用[J].中华物理医学与康复杂志,2007,29(11):777-778.
[10]魏艳霞,张保朝,周静,等.针灸百会、涌泉穴治疗老年性痴呆的临床效果[J].中国老年学杂志,2016,6(36):2916-1917.
[11]李洪新,张笑吟,牛巧云,等.“醒脑开窍”针刺法结合康复训练治疗脑卒中偏瘫疗效观[J].中华全科医学,2013,11(1):97-98.
[12]李杨,温伟波.针灸治疗早期2型糖尿病神经病变的临床观[J].云南中医中药杂志,2015,36(12):42-44.
[13]冯华,李瑶.针灸治疗改善老年轻度认知功能障碍患者认知功能及生活质量的临床研究[J].神经损伤与功能重建,2016,11(1):89-92.
[14]Lafrenaye AD,Todani M,Walker SA,et al.Microglia processes associate with diffusely injured axons following mild traumatic brain injury in the micro pig[J].J Neuroinflammation,2015,10(12):186.
[15]Sussman JL,Harel M,Frolow F,et al.Atomic structure of acetylchol-inesterase from Torpedo californica:aprototypic acetylcholine-binding protein[J].Science,1991,253(5022):872-879.
[16]Helmhout PH,Staal JB,Heymans MW,et al.Prognostic factors for perceived recovery or functional improvement in non-specific low back pain:secondary analyses of three randomized clinical trials[J].Eur Spine J,2010,19(4):650-659.
[17]Torrent J,Vilchez-Acosta A,Mu1oz-Torrero D,et al.Interaction of prion protein with acetylcholinesterase:potential pathobiological implications in prion diseases[J].Acta Neuropathol Commun,2015,3(3):18.
[18]Madhavan R,Gong ZL,Ma JJ,et al.The function of cortactin in the clustering of acetylcholine receptors at the vertebrate neuromuscular junction[J].PLoS One,2010,5(2):1371.
[19]Zimmermann M.Neuronal AChE splice variants and their non-hydrolytic functions:redefining a target of AChE inhibitors?[J].Br J Pharmacol,2013,170(5):953-967.
[20]Guzik TJ,Marvar P J,Czesnikiewicz-Guzik M,et al.Perivascular adipose tissue as a messenger of the brainvessel axis:role in vascular-inflammation and dysfunction[J].J Physiol Pharmacol,2007,58(4):591-610.
[21]张鹏,赵敏珠,朱士胜,等.微管相关蛋白-1B在弥漫性轴索损伤中的表达变化与意义[J].重庆医科大学学报,2016,41(1):34-37.