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中华针灸电子杂志 ›› 2016, Vol. 05 ›› Issue (02) : 51 -56. doi: 10.3877/cma.j.issn.2095-3240.2016.02.003

论著

醒脑开窍针刺法调节脑梗死患者血流动力学的临床研究
李晶1,()   
  1. 1.300193 天津中医药大学第一附属医院针灸研究所
  • 收稿日期:2015-08-03 出版日期:2016-05-15
  • 通信作者: 李晶
  • 基金资助:
    国家自然科学基金项目(81001550)天津市应用基础及前沿技术研究计划项目(11JCYBJC13100)

Experimental study of cerebral hemodynamics in patients with adjustment with consciousness-restoring resuscitation acupuncture

Jing Li1,()   

  1. 1.Institute of Acupuncture, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin 300193, China
  • Received:2015-08-03 Published:2016-05-15
  • Corresponding author: Jing Li
引用本文:

李晶. 醒脑开窍针刺法调节脑梗死患者血流动力学的临床研究[J/OL]. 中华针灸电子杂志, 2016, 05(02): 51-56.

Jing Li. Experimental study of cerebral hemodynamics in patients with adjustment with consciousness-restoring resuscitation acupuncture[J/OL]. Chinese Journal of Acupuncture and Moxibustion(Electronic Edition), 2016, 05(02): 51-56.

目的

观察醒脑开窍针刺法调节脑梗死患者血流动力学参数的干预效应及规律。

方法

选择2015 年1 至10 月天津中医大学第一附属医院住院患者30 例接受醒脑开窍针刺法治疗4 周。采用随机区组设计双因素方差分析治疗前、治疗2 周后和治疗4 周后3 个时间点中医证候疗效评价、美国国立卫生研究院卒中量表(NIHSS)及巴氏指数(BI)的差异;采用配对t 检验比较针刺治疗前、治疗4 周后脑梗死患者患侧大脑中动脉(MCA)、颈内动脉(ICA)终末段和基底动脉(BA)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)的差异。

结果

(1)醒脑开窍针刺法治疗脑梗死恢复期患者,治疗2 周后在中医症状积分为(9.67±3.76)分,优于治疗前(15.10±4.98)分,且差异有统计学意义(q= 16.61,P<0.01);治疗2 周后NIHSS 评分和BI 分别为[(6.50±2.40)、(50.00±17.61)分,较治疗前[(7.53±2.43)、(48.13±14.26)分]有改善,并且差异均有统计学意义(q= 16.97、18.49,P 均<0.01)。治疗4 周后,中医症状积分、NIHSS 评分和BI 分别为(6.77±3.05)、(5.50±1.74)、(69.13±14.26)分,均优于治疗前和治疗后2 周,且差异均有统计学意义(q= 14.07、14.81、15.55,P 均<0.01;q= 12.16、17.34、26.56,P 均<0.01)。(2)大脑主要动脉的Vs 和RI 在治疗前和治疗4 周后差异均无统计学意义;与治疗前相比[(36.41±3.92)、(25.28±5.35)、(57.7±7.94)、(35.87±8.36)cm/s],针刺治疗后MCA 和BA 的Vd 和Vm 均加快[(44.07±2.92,28.12±2.92,63.17±4.51,40.37±4.54)cm/s],且差异均有统计学意义(t=-10.043,P<0.01;t=-3.271,P<0.05;t=-4.097,P<0.01;t=-3.807,P<0.01),而ICA 的Vd 和Vm 治疗前和治疗4 周后差异无统计学意义(P>0.05)。MCA 的PI 治疗后(0.80±0.02)较治疗前(0.96±0.13)下降,且差异有统计学意义(t=6.95,P<0.01)。BA 和ICA 的PI 治疗前后差异无统计学意义。

结论

醒脑开窍针刺法对中风恢复期患者具有良好的治疗作用,可以有效改善患者颅内主要动脉血流动力学参数,加快Vd 和Vm,降低PI,有效缓解血管痉挛状态,提升血液流速,增加缺血区血压供应量,改善梗死侧脑缺血状况。

Objective

To observe the intervention effects and changes on hemodynamic parameters in cerebral infarction patients treated with (consciousness-restoring resuscitation) acupuncture.

Methods

Thirty patients selected in the First Teaching Hospital of Tianjin University of Traditional Chinese Medicine (TCM)from January 2015 to October were treated with consciousness-restoring resuscitation acupuncture for four weeks. The efficacy was observed before and after treatment. The two-way analysis of variance of randomized block design was used to compare changes of the U.S. National Institutes of Health Stroke Scale (NIHSS)and Barthel index (BI) were evaluated in patients before and after treatment. The paired t-test was used to compare changes of hemodynamic parameters middle cerebral artery (MCA), the internal segment of carotid artery (ICA) and the terminal segment of the basilar artery, systolic flow velocity (Vs), diastolic flow velocity(Vd), mean velocity (Vm), pulse index (PI) and resistance index (RI).

Results

(1) The Chinese medicine symptom score was significantly changed from (15.10 ± 4.98) points to (9.67 ± 3.76) points in cerebral infarction patients after treatment with consciousness-restoring resuscitation acupuncture for two weeks(q=16.61,P<0.05). The NIHSS scores and BI were significantly changed from[(7.53±2.43),(48.13±14.26)]points to[(6.50±2.40),(50.00±17.61)] points in cerebral infarction patients after treatment with consciousness-restoring resuscitation acupuncture for two weeks (q=16.97 and 18.49,P<0.05).After 4-week treatment, The Chinese medicine symptom score ,NIHSS score and BI were[(6.77±3.05),(5.50±1.74) and(69.13±14.26) ]points, which were much better than those before treatment and two weeks after treatment,the difference was statistically significant (q=14.07、14.81、15.55,P<0.01;q= 12.16、17.34、26.56,P<0.01). The results showed that consciousness-restoring resuscitation acupuncture had good therapeutic effect on stroke recovery patients. (2) The VS and RI of Main cerebral artery were no significant differences before and after 4-week consciousness-restoring resuscitation acupuncture treatment.The Vd and Vm of MCA and BA was accelerated form[ (36.41±3.92),(25.28±5.35),(57.7±7.94),(35.87±8.36)]cm/s to[(44.07±2.92),(28.12±2.92),(63.17±4.51),(40.37±4.54)]cm/s after consciousness-restoring resuscitation acupuncture treatment, the difference was statistically significant (t=-10.043,P<0.01;t=-3.271,P<0.05;t=-4.097,P<0.01;t=-3.807,P<0.01). But the Vd and Vm had no significant differences in hemodynamic parameters except RI before and after ICA treatment (P>0.05).The PI of MCA was declined form (0.96±0.13) to (0.80±0.02) after consciousness-restoring resuscitation acupuncture treatment, the difference was statistically significant (t=6.95,P<0.05),and there were no significant differences in PI before and after BA and ICA treatment (P>0.05) .

Conclusions

Consciousness-restoring resuscitation acupuncture has a good therapeutic effect on stroke recovery patients, which can effectively improve major intracranial arterial hemodynamics, accelerate diastolic flow velocity, reduce blood flow resistance index and index pulse,effectively alleviate vascular spasticity, improve blood flow, increase blood pressure and the supply of the ischemic area, and improve cerebral ischemic infarction status.

表1 脑梗死患者针刺治疗前后疗效比较(分,±s
表2 大脑主要动脉针刺治疗前、治疗4 周后血流动力学参数变化(cm/s,±s
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