头部水针疗法联合常规康复改善小儿脑性瘫痪智力障碍的临床研究
|
摘要
目的:评价头部水针穴位注射疗法对小儿脑性瘫痪(以下简称脑瘫)智力障碍的临床疗效并探讨其作用机制。方法:将90例脑瘫患儿按照随机数字表法平均分为水针疗法组、肌肉注射组和常规康复组,每组30例,收集同龄健康儿童30例为健康对照组;对常规康复组进行常规康复训练疗法,水针疗法组和肌肉注射组在此基础上分别进行头部穴位注射GM1和肌肉药物注射GM1治疗。分别于治疗前和每个疗程结束后测定每位患儿智力发育指数(MDI)和心理发育指数(PDI),并检测大脑动脉血流动力学参数:收缩期峰值速度(Vs)、舒张末期速度(Vd)、平均血流速度(Vm)及血管阻力指数(RI),同期检测血清NSE和T-SOD的水平。结果:3疗程结束后,三组脑瘫患儿MDI和PDI均较治疗前提高(P<0.05),水针疗法组相对于其他组效果更为明显(P<0.05);与治疗前相比,水针疗法组血流动力学参数Vs、Vm、Vd明显升高,RI显著降低(P<0.05),肌肉注射组与常规康复组的血流动力学参数变化不明显(P>0.05)。治疗后,水针疗法组NSE降低,T-SOD升高,其余两组无变化。结论:水针疗法结合常规康复治疗可以有效地改善脑瘫患儿的脑部血流动力学状况,提高脑瘫患儿的智力发育。
Objective: To study the clinical effect and preliminary mechanism of acupoint injection therapy on mental retardation for children with cerebral palsy.Method: 90 children with cerebral palsy were randomly and equally divided into three groups: the acupoint injection group, the intramuscular injection group and the conventional rehabilitation group, with 30 even-aged healthy children as the health control. Children in the conventional rehabilitation group only received conventional rehabilitation therapy, while children in the acupoint injection group or intramuscular injection group received conventional rehabilitation therapy combined with GM1 acupoint injection therapy or GM1 intramuscular injection therapy respectively. MDI, PDI and the hemodynamic parameters, Vs, Vm, Vd and RI in cerebral arteries of all groups were measured before and after every treatment and the level of NSE and T-SOD were detected at the same time.Result: After 3 courses of treatment, MDI and PDI of 3 groups increased, especially significant effects in acupoint injection group(P<0.05). Vs, Vm, Vd elevated and RI decreased after 3 courses of treatment in acupoint injection group, with statistical significance(P<0.05).However,there were no significant changes in the intramuscular injection group and the control group(P>0.05). The levels of NSE decreased and T-SOD increased in acupoint injection group after the treatments and there was no difference in other groups before and after treatment(P>0.05).Conclusion: Acupoint injection therapy combined with conventional rehabilitation therapy effectively improved the cerebral hemodynamic conditions and improved the mental development of children with cerebral palsy.
Objective: To study the clinical effect and preliminary mechanism of acupoint injection therapy on mental retardation for children with cerebral palsy.Method: 90 children with cerebral palsy were randomly and equally divided into three groups: the acupoint injection group, the intramuscular injection group and the conventional rehabilitation group, with 30 even-aged healthy children as the health control. Children in the conventional rehabilitation group only received conventional rehabilitation therapy, while children in the acupoint injection group or intramuscular injection group received conventional rehabilitation therapy combined with GM1 acupoint injection therapy or GM1 intramuscular injection therapy respectively. MDI, PDI and the hemodynamic parameters, Vs, Vm, Vd and RI in cerebral arteries of all groups were measured before and after every treatment and the level of NSE and T-SOD were detected at the same time.Result: After 3 courses of treatment, MDI and PDI of 3 groups increased, especially significant effects in acupoint injection group(P<0.05). Vs, Vm, Vd elevated and RI decreased after 3 courses of treatment in acupoint injection group, with statistical significance(P<0.05).However,there were no significant changes in the intramuscular injection group and the control group(P>0.05). The levels of NSE decreased and T-SOD increased in acupoint injection group after the treatments and there was no difference in other groups before and after treatment(P>0.05).Conclusion: Acupoint injection therapy combined with conventional rehabilitation therapy effectively improved the cerebral hemodynamic conditions and improved the mental development of children with cerebral palsy.
引文
[1]周宪君,邱洪斌,徐辉,等.145例痉挛型小儿脑性瘫痪危险因素研究[J].中华流行病学杂志,2013,34(4):389-392.
[2]Sherwell S,Reid SM,Reddihougu DS,et al.Measuring intellectual ability in children with cerebral palsy:can we do better?[J].Res Dev Disabil,2014,35(10):2558-2567.
[3]Gabis LV,Tsubary NM,Leon O,et al.Assessment of abilities and comorbidities in children with cerebral palsy[J].JChild Neurol,2015,30(12):1640-1645.
[4]Park EY.Effect of physical therapy frequency on gross motor function in children with cerebral palsy[J].J Phys Ther Sci,2016,28(6):1888-1891.
[5]Yoo JE,Yun YJ,Shin YB,et al.Protocol for a prospective observational study of conventional treatment and traditional Korean medicine combination treatment for children with cerebral palsy[J].BMC Complement Altern Med,2016,16:172.
[6]Sha T,Gao LL,Zhang CH,et al.An update on acupuncture point injection[J].QJM,2016,109(10):639-641.
[7]许晓康,贾春生,王建岭,等.基于数据挖掘技术的穴位注射疗法效应特点研究[J].针刺研究,2012,37(2):155-160.
[8]周开斌,吴小平.穴位注射鼠神经生长因子结合前庭训练对脑瘫患儿平衡功能的作用[J].中国康复医学杂志,2012,27(6):568-569.
[9]刘晓莉,李亚蕊,宋丽娟,等.不同治疗方法对脑性瘫痪并语言发育迟缓儿童的疗效[J].中华实用儿科临床杂志,2017,32(11):867-869.
[10]袁青,刘龙琳,沈秀进,等.论“靳三针”学术内涵[J].中国针灸,2014,34(7):701-704.
[11]高琦,薛小虎.颞三针在小儿脑瘫患儿头针中的重要地位[J].江西中医药,2015,01:61.
[12]张娜,唐巧萍,熊友红.靳三针结合MOTOmed智能运动训练对痉挛型脑瘫患儿下肢功能的影响[J].中国针灸,2014,7:657-660.
[13]中国康复医学会儿童康复专业委员会.小儿脑性瘫痪的定义、分型和诊断条件[J].中华物理医学与康复杂志,2007,29(5):309-309.
[14]颜虹.医学统计学[M].北京:人民卫生出版社,2015:266-267.
[15]Muriel V,Garcia-Molina A,Aparicio-Lopez C,et al.Cognitive stimulation in children with cerebral palsy[J].Rev Neurol,2014,59(10):443-448.
[16]靳瑞,赖新生,王少白.以四神针、智三针为主治疗弱智儿童558例临床疗效观察[J].中国针灸,1992,(2):3-5.
[17]Schnaar RL.Gangliosides of the vertebrate nervous system[J].J Mol Biol,2016,428(16):3325-3336.
[18]杨杰,张燕君.神经节苷脂穴位注射对小儿脑瘫综合能力恢复的对照研究[J].中医儿科杂志,2012,8(5):51-54.
[19]张国平.穴位注射神经节苷脂结合神经促进康复技术治疗小儿脑瘫效果观察[J].中国实用神经疾病杂志,2014,(19):110-111.
[20]Abrahamson EE,Foley LM,Dekosky ST,et al.Cerebral blood flow changes after brain injury in human amyloid-beta knock-in mice[J].J Cereb Blood Flow Metab,2013,33(6):826-833.
[21]Takeuchi H,Taki Y,Hashizume H,et al.Cerebral blood flow during rest associates with general intelligence and creativity[J].PLoS One,2011,6(9):e25532.
[22]刘振寰.脑性瘫痪患儿的脑微循环障碍的临床研究[A].中国康复医学会儿童康复专业委员会、中国残疾人康复协会小儿脑瘫康复专业委员会.第五届全国儿童康复、第十二届全国小儿脑瘫康复学术会议暨国际学术交流会议论文汇编[C].中国康复医学会儿童康复专业委员会、中国残疾人康复协会小儿脑瘫康复专业委员会:,2012:2.
[23]Zhu CJ,Dong JX,Li J,et al.Preliminary study on the mechanism of acupoint injection of bone marrow mesenchymal stem cells in improving blood flow in the rat of hind limb ischemia[J].J Tradit Chin Med,2011,31(3):241-245.
[24]Ratmansky M,Levy A,Messinger A,et al.The effects of acupuncture on cerebral blood flow in post-stroke patients:a randomized controlled trial[J].J Altern Complement Med,2016,22(1):33-37.
[25]苏秀贞,赵永刚.头穴穴位注射改善早期脑瘫患儿大脑微循环作用观察[J].中国针灸,2009,(10):795-798.
[26]Costantine MM,Weiner SJ,Rouse DJ,et al.Umbilical cord blood biomarkers of neurologic injury and the risk of cerebral palsy or infant death[J].Int J Dev Neurosci,2011,29(8):917-922.
[27]Wei LF,Zhang HM,Wang SS,et al.Changes of MDA and SOD in brain tissue after secondary brain injury with seawater immersion in rats[J].Turk Neurosurg,2016,26(3):384-288.
[2]Sherwell S,Reid SM,Reddihougu DS,et al.Measuring intellectual ability in children with cerebral palsy:can we do better?[J].Res Dev Disabil,2014,35(10):2558-2567.
[3]Gabis LV,Tsubary NM,Leon O,et al.Assessment of abilities and comorbidities in children with cerebral palsy[J].JChild Neurol,2015,30(12):1640-1645.
[4]Park EY.Effect of physical therapy frequency on gross motor function in children with cerebral palsy[J].J Phys Ther Sci,2016,28(6):1888-1891.
[5]Yoo JE,Yun YJ,Shin YB,et al.Protocol for a prospective observational study of conventional treatment and traditional Korean medicine combination treatment for children with cerebral palsy[J].BMC Complement Altern Med,2016,16:172.
[6]Sha T,Gao LL,Zhang CH,et al.An update on acupuncture point injection[J].QJM,2016,109(10):639-641.
[7]许晓康,贾春生,王建岭,等.基于数据挖掘技术的穴位注射疗法效应特点研究[J].针刺研究,2012,37(2):155-160.
[8]周开斌,吴小平.穴位注射鼠神经生长因子结合前庭训练对脑瘫患儿平衡功能的作用[J].中国康复医学杂志,2012,27(6):568-569.
[9]刘晓莉,李亚蕊,宋丽娟,等.不同治疗方法对脑性瘫痪并语言发育迟缓儿童的疗效[J].中华实用儿科临床杂志,2017,32(11):867-869.
[10]袁青,刘龙琳,沈秀进,等.论“靳三针”学术内涵[J].中国针灸,2014,34(7):701-704.
[11]高琦,薛小虎.颞三针在小儿脑瘫患儿头针中的重要地位[J].江西中医药,2015,01:61.
[12]张娜,唐巧萍,熊友红.靳三针结合MOTOmed智能运动训练对痉挛型脑瘫患儿下肢功能的影响[J].中国针灸,2014,7:657-660.
[13]中国康复医学会儿童康复专业委员会.小儿脑性瘫痪的定义、分型和诊断条件[J].中华物理医学与康复杂志,2007,29(5):309-309.
[14]颜虹.医学统计学[M].北京:人民卫生出版社,2015:266-267.
[15]Muriel V,Garcia-Molina A,Aparicio-Lopez C,et al.Cognitive stimulation in children with cerebral palsy[J].Rev Neurol,2014,59(10):443-448.
[16]靳瑞,赖新生,王少白.以四神针、智三针为主治疗弱智儿童558例临床疗效观察[J].中国针灸,1992,(2):3-5.
[17]Schnaar RL.Gangliosides of the vertebrate nervous system[J].J Mol Biol,2016,428(16):3325-3336.
[18]杨杰,张燕君.神经节苷脂穴位注射对小儿脑瘫综合能力恢复的对照研究[J].中医儿科杂志,2012,8(5):51-54.
[19]张国平.穴位注射神经节苷脂结合神经促进康复技术治疗小儿脑瘫效果观察[J].中国实用神经疾病杂志,2014,(19):110-111.
[20]Abrahamson EE,Foley LM,Dekosky ST,et al.Cerebral blood flow changes after brain injury in human amyloid-beta knock-in mice[J].J Cereb Blood Flow Metab,2013,33(6):826-833.
[21]Takeuchi H,Taki Y,Hashizume H,et al.Cerebral blood flow during rest associates with general intelligence and creativity[J].PLoS One,2011,6(9):e25532.
[22]刘振寰.脑性瘫痪患儿的脑微循环障碍的临床研究[A].中国康复医学会儿童康复专业委员会、中国残疾人康复协会小儿脑瘫康复专业委员会.第五届全国儿童康复、第十二届全国小儿脑瘫康复学术会议暨国际学术交流会议论文汇编[C].中国康复医学会儿童康复专业委员会、中国残疾人康复协会小儿脑瘫康复专业委员会:,2012:2.
[23]Zhu CJ,Dong JX,Li J,et al.Preliminary study on the mechanism of acupoint injection of bone marrow mesenchymal stem cells in improving blood flow in the rat of hind limb ischemia[J].J Tradit Chin Med,2011,31(3):241-245.
[24]Ratmansky M,Levy A,Messinger A,et al.The effects of acupuncture on cerebral blood flow in post-stroke patients:a randomized controlled trial[J].J Altern Complement Med,2016,22(1):33-37.
[25]苏秀贞,赵永刚.头穴穴位注射改善早期脑瘫患儿大脑微循环作用观察[J].中国针灸,2009,(10):795-798.
[26]Costantine MM,Weiner SJ,Rouse DJ,et al.Umbilical cord blood biomarkers of neurologic injury and the risk of cerebral palsy or infant death[J].Int J Dev Neurosci,2011,29(8):917-922.
[27]Wei LF,Zhang HM,Wang SS,et al.Changes of MDA and SOD in brain tissue after secondary brain injury with seawater immersion in rats[J].Turk Neurosurg,2016,26(3):384-288.