针刺治疗急性脑梗死产生缺血预适应效应的机制  

Mechanism of ischemic preconditioning effect of acupuncture in treating acute cerebral infarction

作　　者：谷巍[1] 刘碌[1] 高轶[1] 项曜祖[1] 庞莹[1] 李琛[1] 励志英[1] 王战国[1] 

机构地区：[1]天津中医学院第一附属医院针灸部,天津市300193

出　　处：《中国临床康复》2005年第41期88-89,共2页Chinese Journal of Clinical Rehabilitation

摘　　要：目的:引用缺血预适应这一学说,探讨针刺风池、完骨、天柱在治疗急性脑梗死过程中的作用机制。方法:①选择2004-02／2005-06天津中医学院第一附属医院针灸部住院急性脑梗死患者80例,年龄35-70岁。均签署知情同意书。随机将患者分为2组,每组40例,针刺组(男28例,女12例)和对照组(男24例,女 16例)。②两组患者均接受脑梗死常规治疗。针刺组在此基础上加针刺双侧风池、完骨、天柱,两风池穴加电针30min。2次／d,间隔6 h,2周为1 个疗程。③采用神经功能缺损程度评分评估神经功能(总分0-45分,0 -15分为轻度功能缺损,31-45分为重度神经功能缺损)。神经功能缺损程度评分减少50％-100％为显效,神经功能缺损程度评分减少20％- 49％为有效,神经功能缺损程度评分减少小于20％为无效。④采用 Barthel指数(共10项,每项0-15分不等,<60分为不能自理)和Rankin 量表(0表示完全恢复,6表示死亡)辅助评估患者治疗前后日常生活能力和功能残疾水平。⑤分别于针刺组针刺前、针刺中20 min、针刺后 30 min采用经颅多普勒检测仪检测右椎动脉、左椎动脉、基底动脉平均血流速度和血管阻力指数的变化。⑥计量和计数资料差异性比较分别采用方差分析和x2检验。结果:急性脑梗死患者80例均进入结果分析。①神经功能缺损评分、 Rankin评分:两组治疗后明显低于治疗前(P<0．05-0．01),针刺组治疗后明显低于对照组治疗后(P<0．01,0.05);Barthel指数:两组治疗后明显高于治疗前(P<0．01,0.05),针刺组治疗后明显高于对照组治疗后(P<0．01)。②总有效率:针刺组治疗后明显高于对照组(P<0．05)。③左右椎动脉、基底动脉平均血流速度:针刺组针刺中20min明显低于针刺前(P<0．01), 针刺后30 min明显高于针刺前(P<0．05-0．01)。④左右椎动脉、基底动脉血管阻力指数:针刺组针刺中20 min明显高于针刺前(P<0．05-0．01), �AIM：To explore the mechanism of acupuncture at the acupoints of Fengchi （GB20）, Wangu （GB12） and Tianzha （BL10） in treating acute cerebral infarction with quoting the theory of ischemic preconditioning. METHODS：① Eighty inpatients with acute cerebral infarction aged 35-70 years were selected from the Department of Acupuncture in the First Affiliated Hospital of Tianjin University of Traditional Chinese Medicine from February 2004 to June 2005, All the patients had signed the informed consent, The 80 patients were randomized into acupuncture group （n=40, 28 males and 12 females） and control group （n=40, 24 males and 16 females）, ② All the patients received routine treatment for cerebral infarction. Besides, those in the acupuncture group were treated with acupuncture at acupoints of Fengchi （GB20）, Wangu （GB12） and Tianzhu （BL10）, as well as electroaeupuncture at bilateral Fengchi for 30 minutes, twice a day with an interval of 6 hours, two weeks as a course. ③ The neurological function was assessed with neurologic deficit score （NDS, the total score was 0-45 points, 0-15 points was taken as mild neurological impairment, 31-45 as severe neurological impairment）. The score of NDS decreased by 50%-100% was taken as significant effect, 20%-49% as effective, 〈 20% as invalid. ④ The activities of daily life （ADL） and level of functional disability were evaluated assisted by Barthel index （10 items, 0-15 points for each item, 〈 60 points as disorder of self-care） and Rankin scale （0 as fully recovered, 6 as dead）.⑤ The changes of mean blood flow rate and vascular resistant index of left and right vertebral arteries and basilar artery were detected with American transcranial Doppler detector before acupuncture, 20 minutes during acupuncture and 30 minutes after acupuncture respectively. ⑥ The differences of measurement data and enumeration data were compared with analysis of variance and X^2 test. RESULTS： All the 80 cases of acute cerebral infarction

关 键 词：脑梗塞/针灸疗法 针刺 缺血预处理 心肌 侧支循环 

分 类 号：R743.33[医药卫生—神经病学与精神病学]