CT定位围针法治疗脑出血的临床研究
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摘要
背景
中风,又称脑卒中,包括缺血性中风和出血性中风。其中出血性中风,又称脑出血,是指原发性脑实质内出血,是临床常见的危急重症,其发病急,病死率与致残率均高,后遗症又缠绵难愈。随着社会人口的老龄化,脑出血的发病率呈上升趋势,脑出血患者数量也日益增多,严重影响患者的日常生活能力,降低生活质量,高昂的康复费用给家庭、社会和个人带来沉重的负担。因此,脑出血及其康复治疗越来越受到人们的重视,这一难题已经成为当今医学界的艰巨任务和攻关热点。针对脑出血的这一难题,对最大限度地减轻肢体功能障碍及降低病死率开展研究,具有深远的社会意义。
目的
本课题针对目前治疗脑出血发病率高、致残率高、治疗难度大这一特点,采用中风病疗效评定量表、神经功能缺损评分量表、日常生活能力评分量表、血肿及水肿体积、CT值、肿瘤坏死因子a、白介素6及主要症状量表来研究CT定位围针法(即以头颅CT成像所示病灶在同侧头皮的最近距离投射区围针)治疗脑出血的临床疗效,观察每个检测指标治疗前后的变化并进行比较,探索防治本病的新疗法,为临床提供一种简便易行、疗效确切的方法。
方法
82例符合条件的脑出血患者,均来自于广州中医药大学第一、第三附属医院,采用随机数字分组法分为CT定位围针组(围针组)和传统头针组(头针组),每组41人。两组均在基础对症治疗的基础上实施。围针组采用CT所示病灶在同侧头皮的投射区周边为针刺部位；头针组采用针刺顶颞前斜线上(运动区),顶颞后斜线(感觉区)。两组均在得气后以行180-200次/min频率捻转2min,留针30min,中间行针1次约1分钟,1次/日,每周连续治疗5天,休息2天,每两周为一个疗程,共2个疗程。治疗前后分别进行血肿及水肿体积、CT值、TNF-a、IL-6、神经功能缺损量表评定、日常生活能力评分量表(ADL)、中风病疗效评定标准量表及主要症状观察表检测评定。所有结果均用SPSS 13.0分析。
结果
1.在总体疗效方面：围针组40例中基本痊愈7例(17.5%),显效24例(60%),有效8例(20%),无效1例(2.5%),总有效率为97.5%；头针组40例中,基本痊愈3例(7.5%),显效20例(50%),有效9例(22.5%),无效8例(20%),总有效率为80%。两组疗效经检验,有统计学差异性(P<0.05)；总有效率围针组明显高于头针组,说明前者疗效优于后者。
2.在血肿及水肿吸收、CT值方面：治疗后组间比较,有统计学差异性(P<0.05)；每组治疗前后自身比较,同样有统计学差异性(P<0.05)；说明两种方法都能促进血肿及水肿吸收、降低CT值,且围针组疗效明显优于头针组。
3.在神经功能缺损评分、日常生活能力评分、中风病的临床疗效标准评分方面：治疗后组间比较,有统计学差异(P<0.05)；每组治疗前后自身比较,有统计学差异性(P<0.05)。说明两种治疗方法都能促进患者神经功能的恢复、改善患者日常生活能力及中风病的临床疗效标准评分,且围针组疗效明显优于头针组。
4.在TNF-a、IL-6方面：治疗后组间比较,有统计学差异(P<0.05)；每组治疗前后自身比较,有统计学差异性(P<0.05)。说明两种治疗方法都能降低患者血清中TNF-a、IL-6的含量,且围针组疗效明显优于头针组。
5.在主要症状方面：治疗后组间比较,疗效相当(除个别症状外),无统计学差异性(P>0.05)；两组患者治疗前后自身比较,有统计学差异性(P<0.05)。说明两种治疗方法都可以改善患者的主要症状,但治疗后组间比较疗效相当,无明显差异性,这可能与样本量小或症状分级没有数值那么精确有关。
结论
1.CT定位围针法和传统头针法治疗脑出血均可以加快血肿及水肿的吸收、降低CT值、降低神经功能缺损及中风疗效标准量表评分、提高日常生活能力量表评分、降低血清中TNF-a和IL-6的含量、改善主要症状,两种治疗方法均有临床疗效。
2.CT定位围针法对脑出血的治疗效果优于传统头针法。
3.CT定位围针法操作简单方便,疗效确切,能实行规范化操作,易于推广应用,具有较广阔的应用前景。
Background
Stroke, also known as apoplexy, including ischemic stroke and hemorrhagic stroke Hemorrhagic stroke, also called cerebral hemorrhage (cerebralhem orhage CH), refers to the parenchymal hemorrhage of primary. It is the clinical common for emergency and severe cases, which acute onset, mortality and disability are high, Sequelae hard to be cured. In the future as the aging of our population, the incidence of intracerebral hemorrhage shows ascendant trend, cerebral hemorrhage patients are increasing number, which have seriously affected the patients' activities of daily living, reduced quality of life and high rehabilitation cost brought a heavy burden to families and society and individual. Therefore, more and more attention has been paied to the treatment of cerebral hemorrhage and subsequent rehabilitation. This problem has become the arduous task of the medical profession and research hot spots. This problem for cerebral hemorrhage, the research on the limbs of patients to minimize dysfunction and decrease mortality, that has far-reaching social significance.
Objective
The topic for the current treatment of cerebral hemorrhage with high incidence, high morbidity, high disability, treatment of this characteristic is difficult adopt Treatment of Stroke Evaluation Standards, Neurological Deficit Score(NDS), Activities of Daily Living rating scale(ADL), Hematoma and edema volume, CT Value, Tumor Necrosis Factor(TNF-a) and Interleukin-6(IL-6) and the Main Symptom scale to study the changes for scores and values about different sclales and values before and after treament, To study the clinical effect of the Surrounding Needling based on CT location (ie, cranial CT imaging shows lesions in the ipsilateral projection area from the nearest area), adopted arrounding needling(CT positioning around needle)for the treatment of cerebral hemorrhage.Explore new treatment prevention and treatment of the disease. Providing clinical with a simple and effective therapy.
Method
82 patients of cerebral hemorrhage, came from the clinic of first and third affiliated hospital of Guangzhou University of Traditional Chinese Medicine, were randomly divided into Surrounding Needling based on CT location group (Surrounding Needling group, n=41) and Traditional Scalp Acupuncture group (Scalp Acupuncture group, n=41), Both groups were in the implementation that based on the basis of symptomatic treatment. The areas of surrounding needling group for acupuncture were selected according to the localization by CT and needles were inserted in the scalp around the selected areas, the areas of scalp acupuncture group were selected according to the front slash of top (motor area) and the rear slash of top(sensory area) needles were inserted in the scalp along the slash. Both groups have 180-200 times frequency of twisting per minute, twisting for 2 minutes after had the sense of needle, needles retained for 30 minetes,there was a twisting during needles retention for about 1 minute. Per day for a time of treatment,5 days was a course of treatment. Between courses of treatment for 2 days off.2 courses were over.Compared two groups pre-treatment and post-treatment, Self-comparisons with the various indexes including:Treatment of Stroke Evaluation Standards, Neurological Deficit Score(NDS), Activities of Daily Living rating scale(ADL), Hematoma and Edema volume, CT Value, Tumor Necrosis Factor a(TNF-a) and Interleukin-6(IL-6) and the Main Symptom Scale. All results were analyzed by SPSS 13.0.
Results
1. The total efficacy:In 40 cases of Surrounding Needling group 7 cases(17.5%) were cured,24 cases(60%) were well effective,8 cases (20%) were effective,1 case (2.5%) was no effective, the total effective rate was 97.5%; in 40 cases of Scalp Acupuncture group,3 cases (7.5%) were cured,20 cases(50%) well effective,9 cases (22.5%) effective,8 cases(20%) were no effective,total effective rate was 80%. The effect of them were tested,there are significant differences(P<0.05);The total effective rates of them, there is a significant difference(P<0.05).The rusult showed that Surrounding Needling group has better effect than Scalp Acupuncture group.
2. Absorption of the hematoma and edema, CT value:Compared the two groups with the various indexes of after treatment, there are significant differences (P<0.05);Self-comparisons with the various indexes of the two groups pre-treatment and post-treatment, there are significant differences (P<0.05). Statistically showed that both of groups can increase the absorption of hematoma and edema volume and decrease CT Value, and Surrounding Needling group has better effect than Scalp Acupuncture group.
3. Neurological Deficit Score(NDS), Activities of Daily Living scale(ADL), the Clinical Efficacy of standard stroke score:Compared the two groups with the various indexes of after treatment, there are significant differences(P<0.05);Self-comparisons with the various indexes of the two groups pre-treatment and post-treatment, there are significant differences (P<0.05). Statistically showed that both of groups can increase the scores of ADL, decrease scores of the NDS and the Clinical Efficacy of standard stroke score, and Surrounding Needling group has better effect than Scalp Acupuncture group.
4. Tumor Necrosis Factor a(TNF-a) and Interleukin-6(IL-6):Compared the two groups with the various indexes of after treatment, there are significant differences(P<0.05),Self-comparisons with the various indexes of the two groups pre-treatment and post-treatment, there are significant differences (P<0.05). Statistically showed that both of groups can decrease scores of TNF-a and IL-6, and Surrounding Needling group has better effect than Scalp Acupuncture group.
5. Main Symptoms:Compared the two groups with the various values of the Main Symptom Scale after treatment,there are not significant differences (except for individual symptoms) (P>0.05);Self-comparisons with the various indexes of the two groups pre-treatment and post-treatment, there are significant differences (P<0.05).Statistically significant showed that both of groups can promotion and improvement the Scores of the Main Symptoms, there are not significant differences between them after treatment. It may be related to the small sample size or symptom rating is not precise classification as numerical grade.
Conclusion
1. Surrounding Needling based on CT location group and Traditional Scalp Acupuncture group can all speed up the absorption of hematoma and edema volume, decrease CT Value and Neurological Deficit Score and the Clinical Efficacy of standard stroke score and TNF-a and IL-6 levels, improve the Activities of Daily Living score, promotion and improvement the Scores of the Main Symptoms.Both of the two methods of treatment for cerebral hemorrhage have clinical effect.
2. Surrounding Needling group has better effect than Traditional Scalp Acupuncture group.
3. Surrounding Needling based on CT location is easy and convenient and effective, easy implemented, with clinical feasibility and broad prospect for clinical application.
中风,又称脑卒中,包括缺血性中风和出血性中风。其中出血性中风,又称脑出血,是指原发性脑实质内出血,是临床常见的危急重症,其发病急,病死率与致残率均高,后遗症又缠绵难愈。随着社会人口的老龄化,脑出血的发病率呈上升趋势,脑出血患者数量也日益增多,严重影响患者的日常生活能力,降低生活质量,高昂的康复费用给家庭、社会和个人带来沉重的负担。因此,脑出血及其康复治疗越来越受到人们的重视,这一难题已经成为当今医学界的艰巨任务和攻关热点。针对脑出血的这一难题,对最大限度地减轻肢体功能障碍及降低病死率开展研究,具有深远的社会意义。
目的
本课题针对目前治疗脑出血发病率高、致残率高、治疗难度大这一特点,采用中风病疗效评定量表、神经功能缺损评分量表、日常生活能力评分量表、血肿及水肿体积、CT值、肿瘤坏死因子a、白介素6及主要症状量表来研究CT定位围针法(即以头颅CT成像所示病灶在同侧头皮的最近距离投射区围针)治疗脑出血的临床疗效,观察每个检测指标治疗前后的变化并进行比较,探索防治本病的新疗法,为临床提供一种简便易行、疗效确切的方法。
方法
82例符合条件的脑出血患者,均来自于广州中医药大学第一、第三附属医院,采用随机数字分组法分为CT定位围针组(围针组)和传统头针组(头针组),每组41人。两组均在基础对症治疗的基础上实施。围针组采用CT所示病灶在同侧头皮的投射区周边为针刺部位；头针组采用针刺顶颞前斜线上(运动区),顶颞后斜线(感觉区)。两组均在得气后以行180-200次/min频率捻转2min,留针30min,中间行针1次约1分钟,1次/日,每周连续治疗5天,休息2天,每两周为一个疗程,共2个疗程。治疗前后分别进行血肿及水肿体积、CT值、TNF-a、IL-6、神经功能缺损量表评定、日常生活能力评分量表(ADL)、中风病疗效评定标准量表及主要症状观察表检测评定。所有结果均用SPSS 13.0分析。
结果
1.在总体疗效方面：围针组40例中基本痊愈7例(17.5%),显效24例(60%),有效8例(20%),无效1例(2.5%),总有效率为97.5%；头针组40例中,基本痊愈3例(7.5%),显效20例(50%),有效9例(22.5%),无效8例(20%),总有效率为80%。两组疗效经检验,有统计学差异性(P<0.05)；总有效率围针组明显高于头针组,说明前者疗效优于后者。
2.在血肿及水肿吸收、CT值方面：治疗后组间比较,有统计学差异性(P<0.05)；每组治疗前后自身比较,同样有统计学差异性(P<0.05)；说明两种方法都能促进血肿及水肿吸收、降低CT值,且围针组疗效明显优于头针组。
3.在神经功能缺损评分、日常生活能力评分、中风病的临床疗效标准评分方面：治疗后组间比较,有统计学差异(P<0.05)；每组治疗前后自身比较,有统计学差异性(P<0.05)。说明两种治疗方法都能促进患者神经功能的恢复、改善患者日常生活能力及中风病的临床疗效标准评分,且围针组疗效明显优于头针组。
4.在TNF-a、IL-6方面：治疗后组间比较,有统计学差异(P<0.05)；每组治疗前后自身比较,有统计学差异性(P<0.05)。说明两种治疗方法都能降低患者血清中TNF-a、IL-6的含量,且围针组疗效明显优于头针组。
5.在主要症状方面：治疗后组间比较,疗效相当(除个别症状外),无统计学差异性(P>0.05)；两组患者治疗前后自身比较,有统计学差异性(P<0.05)。说明两种治疗方法都可以改善患者的主要症状,但治疗后组间比较疗效相当,无明显差异性,这可能与样本量小或症状分级没有数值那么精确有关。
结论
1.CT定位围针法和传统头针法治疗脑出血均可以加快血肿及水肿的吸收、降低CT值、降低神经功能缺损及中风疗效标准量表评分、提高日常生活能力量表评分、降低血清中TNF-a和IL-6的含量、改善主要症状,两种治疗方法均有临床疗效。
2.CT定位围针法对脑出血的治疗效果优于传统头针法。
3.CT定位围针法操作简单方便,疗效确切,能实行规范化操作,易于推广应用,具有较广阔的应用前景。
Background
Stroke, also known as apoplexy, including ischemic stroke and hemorrhagic stroke Hemorrhagic stroke, also called cerebral hemorrhage (cerebralhem orhage CH), refers to the parenchymal hemorrhage of primary. It is the clinical common for emergency and severe cases, which acute onset, mortality and disability are high, Sequelae hard to be cured. In the future as the aging of our population, the incidence of intracerebral hemorrhage shows ascendant trend, cerebral hemorrhage patients are increasing number, which have seriously affected the patients' activities of daily living, reduced quality of life and high rehabilitation cost brought a heavy burden to families and society and individual. Therefore, more and more attention has been paied to the treatment of cerebral hemorrhage and subsequent rehabilitation. This problem has become the arduous task of the medical profession and research hot spots. This problem for cerebral hemorrhage, the research on the limbs of patients to minimize dysfunction and decrease mortality, that has far-reaching social significance.
Objective
The topic for the current treatment of cerebral hemorrhage with high incidence, high morbidity, high disability, treatment of this characteristic is difficult adopt Treatment of Stroke Evaluation Standards, Neurological Deficit Score(NDS), Activities of Daily Living rating scale(ADL), Hematoma and edema volume, CT Value, Tumor Necrosis Factor(TNF-a) and Interleukin-6(IL-6) and the Main Symptom scale to study the changes for scores and values about different sclales and values before and after treament, To study the clinical effect of the Surrounding Needling based on CT location (ie, cranial CT imaging shows lesions in the ipsilateral projection area from the nearest area), adopted arrounding needling(CT positioning around needle)for the treatment of cerebral hemorrhage.Explore new treatment prevention and treatment of the disease. Providing clinical with a simple and effective therapy.
Method
82 patients of cerebral hemorrhage, came from the clinic of first and third affiliated hospital of Guangzhou University of Traditional Chinese Medicine, were randomly divided into Surrounding Needling based on CT location group (Surrounding Needling group, n=41) and Traditional Scalp Acupuncture group (Scalp Acupuncture group, n=41), Both groups were in the implementation that based on the basis of symptomatic treatment. The areas of surrounding needling group for acupuncture were selected according to the localization by CT and needles were inserted in the scalp around the selected areas, the areas of scalp acupuncture group were selected according to the front slash of top (motor area) and the rear slash of top(sensory area) needles were inserted in the scalp along the slash. Both groups have 180-200 times frequency of twisting per minute, twisting for 2 minutes after had the sense of needle, needles retained for 30 minetes,there was a twisting during needles retention for about 1 minute. Per day for a time of treatment,5 days was a course of treatment. Between courses of treatment for 2 days off.2 courses were over.Compared two groups pre-treatment and post-treatment, Self-comparisons with the various indexes including:Treatment of Stroke Evaluation Standards, Neurological Deficit Score(NDS), Activities of Daily Living rating scale(ADL), Hematoma and Edema volume, CT Value, Tumor Necrosis Factor a(TNF-a) and Interleukin-6(IL-6) and the Main Symptom Scale. All results were analyzed by SPSS 13.0.
Results
1. The total efficacy:In 40 cases of Surrounding Needling group 7 cases(17.5%) were cured,24 cases(60%) were well effective,8 cases (20%) were effective,1 case (2.5%) was no effective, the total effective rate was 97.5%; in 40 cases of Scalp Acupuncture group,3 cases (7.5%) were cured,20 cases(50%) well effective,9 cases (22.5%) effective,8 cases(20%) were no effective,total effective rate was 80%. The effect of them were tested,there are significant differences(P<0.05);The total effective rates of them, there is a significant difference(P<0.05).The rusult showed that Surrounding Needling group has better effect than Scalp Acupuncture group.
2. Absorption of the hematoma and edema, CT value:Compared the two groups with the various indexes of after treatment, there are significant differences (P<0.05);Self-comparisons with the various indexes of the two groups pre-treatment and post-treatment, there are significant differences (P<0.05). Statistically showed that both of groups can increase the absorption of hematoma and edema volume and decrease CT Value, and Surrounding Needling group has better effect than Scalp Acupuncture group.
3. Neurological Deficit Score(NDS), Activities of Daily Living scale(ADL), the Clinical Efficacy of standard stroke score:Compared the two groups with the various indexes of after treatment, there are significant differences(P<0.05);Self-comparisons with the various indexes of the two groups pre-treatment and post-treatment, there are significant differences (P<0.05). Statistically showed that both of groups can increase the scores of ADL, decrease scores of the NDS and the Clinical Efficacy of standard stroke score, and Surrounding Needling group has better effect than Scalp Acupuncture group.
4. Tumor Necrosis Factor a(TNF-a) and Interleukin-6(IL-6):Compared the two groups with the various indexes of after treatment, there are significant differences(P<0.05),Self-comparisons with the various indexes of the two groups pre-treatment and post-treatment, there are significant differences (P<0.05). Statistically showed that both of groups can decrease scores of TNF-a and IL-6, and Surrounding Needling group has better effect than Scalp Acupuncture group.
5. Main Symptoms:Compared the two groups with the various values of the Main Symptom Scale after treatment,there are not significant differences (except for individual symptoms) (P>0.05);Self-comparisons with the various indexes of the two groups pre-treatment and post-treatment, there are significant differences (P<0.05).Statistically significant showed that both of groups can promotion and improvement the Scores of the Main Symptoms, there are not significant differences between them after treatment. It may be related to the small sample size or symptom rating is not precise classification as numerical grade.
Conclusion
1. Surrounding Needling based on CT location group and Traditional Scalp Acupuncture group can all speed up the absorption of hematoma and edema volume, decrease CT Value and Neurological Deficit Score and the Clinical Efficacy of standard stroke score and TNF-a and IL-6 levels, improve the Activities of Daily Living score, promotion and improvement the Scores of the Main Symptoms.Both of the two methods of treatment for cerebral hemorrhage have clinical effect.
2. Surrounding Needling group has better effect than Traditional Scalp Acupuncture group.
3. Surrounding Needling based on CT location is easy and convenient and effective, easy implemented, with clinical feasibility and broad prospect for clinical application.
引文
[1]唐宇红,郭文莉,饶萍,等.活血化瘀中药制剂血栓通注射液对原发性脑出血急性亚急性期的临床研究[J].现代中西医结合杂志,2007；16(29)：4285-4286.
[2]周自祥.加服自拟化瘀汤治疗急性脑出血疗效观察[J].广西中医药,2008；31(2)：19-20.
[3]孟祥庚.加味复元活血汤治疗急性期脑出血疗效观察[J].中医中药,2008；5(9)：16.
[4]张震中,张宾辉,陈眉.丹参注射液防治脑出血急性期脑水肿的实验研究[J].浙江中西医结合杂志,2003；13(6)：355-357.
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