醒脑开窍针刺法治疗脑梗死恢复期的临床效果及机制研究
|
摘要
目的观察醒脑开窍针刺法治疗脑梗死恢复期的临床疗效,并探讨其机制。方法将78例中风恢复期患者随机分为针刺对照组和醒脑开窍组,在给予脑梗死恢复期基础治疗的同时分别接受传统针刺和醒脑开窍针刺治疗,疗程4周。采用中医症状积分和美国国立卫生研究院卒中量表(NIHSS)评分分别评价2组治疗前后中医症候和神经功能缺损情况,采用Barthel指数(BI)评定2组治疗前后生活自理能力;经颞窗观察2组治疗前后患侧大脑中动脉、颈内动脉终末段和基底动脉的收缩期血流速度(Vs)、舒张期血流速度(Vd)、平均血流速度(Vm)、脉冲指数(PI)及阻力指数(RI)。结果治疗后2组中医症状积分和NIHSS评分均明显降低而BI均明显升高(P均<0.05),且醒脑开窍组治疗2周、4周后的中医症状积分和治疗4周后的BI改善情况均明显优于针刺对照组(P均<0.05)。醒脑开窍组患者治疗后大脑中动脉Vd、Vs、Vm均比治疗前明显加快而PI和RI显著降低(P均<0.05),颈内动脉颅内段RI比治疗前显著降低(P<0.05),且各指标改善情况均明显优于针刺对照组(P均<0.05);2组治疗前后基底动脉参数无太大变化(P均>0.05)。结论醒脑开窍针刺法可明显缓解脑梗死恢复期患者中医症状和神经功能缺损情况,提高生活自理能力,改善梗死侧脑缺血及颈内动脉参数,增加缺血区血供。
Objective It is to observe the clinical efficacy of Xingnao Kaiqiao acupuncture in the recovery of cerebral infarction and to explore its mechanism. Methods Seventy-eight patients with stroke at recovery stage were randomly divided into acupuncture control group and Xingnao Kaiqiao group which were treated with traditional acupuncture and Xingnao Kaiqiao acupuncture at the same time as the basic treatment of cerebral infarction. The course of treatment was 4 weeks. The TCM symptom scores and the National Institutes of Health Stroke Scale(NIHSS) scores were used to evaluate the symptoms of TCM and neurological deficits before and after treatment. The Barthel index(BI) was used to assess the self-care ability of the two groups before and after treatment. The systolic blood flow velocity(Vs), diastolic blood flow velocity(Vd), mean blood flow velocity(Vm), pulse index(PI) and resistance index(RI) of the middle cerebral artery(MCA), internal carotid artery(ICA) terminal segment and basilar artery before and after treatment in the 2 groups were observed. Results After treatment, the TCM symptom scores and NIHSS scores of the two groups were significantly decreased, and the BI were significantly increased(P<0.05), the improvements of TCM symptom scores after 2 and 4 weeks of treatment, and the BI after 4 weeks of treatment in Xingnao Kaiqiao gorup were significantly better than those in the acupuncture control group(P<0.05). The Vd, Vs, and Vm of the middle cerebral artery were significantly accelerated while PI and RI were significantly decreased after treatment compared with that before treatment in Xingnao Kaiqiao group(P<0.05), and the intracranial RI of the internal carotid artery was significantly lower than that before treatment(P<0.05), and the improvement of each index in the Xingnao Kaiqiao group was significantly better than that in the acupuncture control group(P<0.05). There was no significant change in the basilar artery parameters before and after treatment(P>0.05). Conclusion Xingnao Kaiqiao acupuncture can significantly alleviate TCM symptoms and neurological deficits, improve self-care ability, improve infarct lateral cerebral ischemia and internal carotid artery parameters, and increase blood supply in ischemic area in patients with cerebral infarction at recovery stage.
Objective It is to observe the clinical efficacy of Xingnao Kaiqiao acupuncture in the recovery of cerebral infarction and to explore its mechanism. Methods Seventy-eight patients with stroke at recovery stage were randomly divided into acupuncture control group and Xingnao Kaiqiao group which were treated with traditional acupuncture and Xingnao Kaiqiao acupuncture at the same time as the basic treatment of cerebral infarction. The course of treatment was 4 weeks. The TCM symptom scores and the National Institutes of Health Stroke Scale(NIHSS) scores were used to evaluate the symptoms of TCM and neurological deficits before and after treatment. The Barthel index(BI) was used to assess the self-care ability of the two groups before and after treatment. The systolic blood flow velocity(Vs), diastolic blood flow velocity(Vd), mean blood flow velocity(Vm), pulse index(PI) and resistance index(RI) of the middle cerebral artery(MCA), internal carotid artery(ICA) terminal segment and basilar artery before and after treatment in the 2 groups were observed. Results After treatment, the TCM symptom scores and NIHSS scores of the two groups were significantly decreased, and the BI were significantly increased(P<0.05), the improvements of TCM symptom scores after 2 and 4 weeks of treatment, and the BI after 4 weeks of treatment in Xingnao Kaiqiao gorup were significantly better than those in the acupuncture control group(P<0.05). The Vd, Vs, and Vm of the middle cerebral artery were significantly accelerated while PI and RI were significantly decreased after treatment compared with that before treatment in Xingnao Kaiqiao group(P<0.05), and the intracranial RI of the internal carotid artery was significantly lower than that before treatment(P<0.05), and the improvement of each index in the Xingnao Kaiqiao group was significantly better than that in the acupuncture control group(P<0.05). There was no significant change in the basilar artery parameters before and after treatment(P>0.05). Conclusion Xingnao Kaiqiao acupuncture can significantly alleviate TCM symptoms and neurological deficits, improve self-care ability, improve infarct lateral cerebral ischemia and internal carotid artery parameters, and increase blood supply in ischemic area in patients with cerebral infarction at recovery stage.
引文
[1] 王雪茵,胡永华.脑卒中病因流行病学的家系研究[J].中华流行病学杂志,2013,34(6):647-649
[2] 上官守琴,杨志宏,陈光辉,等.综合康复治疗对脑卒中偏瘫患者日常生活能力的疗效观察[J].卒中与神经疾病,2013,20(5):285-287
[3] 胡智伟.中国脑血管病防治指南[S].杭州:浙江省中西医结合学会急救医学专业委员会第三次学术年会暨省级继续教育学习班,2007
[4] 梁繁荣.针灸学[M].北京:中国中医药出版社,2005:309-310
[5] 中风病诊断与疗效评定标准(试行)[J].北京中医药大学学报,1996,19(1):55-56
[6] Jeyaseelan RD,Vargo MM.National institutes of health stroke scale(NIHSS) as an early predictor of post stroke dysphagia[J].PMR,2015,7(6):593-598
[7] 卫生部疾病控制司、中华医学会神经病学分会.日常生活能力量表- 巴氏指数[S].中国脑血管病防治指南(试行版),2004:81
[8] 王秀菊.急性脑梗死治疗进展[J].齐齐哈尔医学院学报,2014,35(8):1200-1207
[9] 黄玲.脑梗死治疗进展[J].内科,2009,4(4):619-621
[10] 卞金玲,张春红.石学敏院士针刺手法量学的概念及核心[J].中国针灸,2003,23(5):287-289
[11] 赵凯.中医药不同时机介入治疗脑梗死急性期[J].吉林中医药,2014,34(6):585-587
[2] 上官守琴,杨志宏,陈光辉,等.综合康复治疗对脑卒中偏瘫患者日常生活能力的疗效观察[J].卒中与神经疾病,2013,20(5):285-287
[3] 胡智伟.中国脑血管病防治指南[S].杭州:浙江省中西医结合学会急救医学专业委员会第三次学术年会暨省级继续教育学习班,2007
[4] 梁繁荣.针灸学[M].北京:中国中医药出版社,2005:309-310
[5] 中风病诊断与疗效评定标准(试行)[J].北京中医药大学学报,1996,19(1):55-56
[6] Jeyaseelan RD,Vargo MM.National institutes of health stroke scale(NIHSS) as an early predictor of post stroke dysphagia[J].PMR,2015,7(6):593-598
[7] 卫生部疾病控制司、中华医学会神经病学分会.日常生活能力量表- 巴氏指数[S].中国脑血管病防治指南(试行版),2004:81
[8] 王秀菊.急性脑梗死治疗进展[J].齐齐哈尔医学院学报,2014,35(8):1200-1207
[9] 黄玲.脑梗死治疗进展[J].内科,2009,4(4):619-621
[10] 卞金玲,张春红.石学敏院士针刺手法量学的概念及核心[J].中国针灸,2003,23(5):287-289
[11] 赵凯.中医药不同时机介入治疗脑梗死急性期[J].吉林中医药,2014,34(6):585-587