合募配穴针刺治疗颅脑创伤后应激性胃黏膜损伤的疗效观察  

Observation on therapeutic effect of combined acupuncture for stress gastric mucosal injury after traumaticbrain injury

作　　者：孙艳[1] 马铁柱[1] 陈翀[1] 张赛[1] Sun Yan;Ma Tiezhu;Chen Chong;Zhang Sai(Department of Neurology,Affiliated Hospital of Logistics University of PAP,Key Laboratory of Nerve Trauma Repair in Tianjin,Tianjin 300162,China)

机构地区：[1]武警后勤学院附属医院脑科中心,天津市神经创伤修复重点实验室,天津300162

出　　处：《中华危重病急救医学》2018年第6期564-568,共5页Chinese Critical Care Medicine

基　　金：国家自然科学基金（81671222）

摘　　要：目的观察合募配穴针刺疗法联合奥美拉唑对颅脑创伤并发应激性胃黏膜损伤患者的治疗效果。方法选择2016年6月至2017年7月武警后勤学院附属医院脑科医院神经重症科收治的颅脑创伤后应激性胃黏膜损伤患者〔伤后24 h内入院、格拉斯哥昏迷评分（GCS）≤12分〕，并按照随机数字表法分为奥美拉唑组、针刺组及针刺＋奥美拉唑联合治疗组。3组患者入院后均给予及时对症治疗，于确诊后奥美拉唑组静脉滴注奥美拉唑，每次40 mg，12 h 1次，治疗7 d；针刺组针刺双侧足三里穴及中脘穴，留针20 min，每日1次，治疗7 d；联合治疗组则同时给予针刺和奥美拉唑治疗。于患者入院时及治疗7 d进行GCS评分、胃液潜血试验；于入院时及治疗1、3、5、7 d测定胃液pH值、血清神经降压素（NT）和内皮素-1（ET-1）水平。选取同期10例健康体检者作为对照。结果最终入选90例患者，每组30例。奥美拉唑组、针刺组、联合治疗组患者治疗7 d GCS评分均较入院时明显升高，但各组间差异无统计学意义（分：9.46±2.81、10.26±2.24、10.52±2.50，F=2.010，P=0.141）。治疗7 d，联合治疗组胃液潜血发生率显著低于奥美拉唑组和针刺组（13.3%比36.7%、40.0%，均P〈0.05）。3组患者治疗后胃液pH值逐渐升高，联合治疗组治疗5 d时胃液pH值即显著高于奥美拉唑组和针刺组（4.58±0.53比4.20±0.52、4.28±0.43，均P〈0.05）。3组患者血清NT水平呈双向变化：入院时3组患者NT水平均明显高于健康对照组，随后显著下降，治疗3 d均明显低于健康对照组，之后逐渐升高；联合治疗组治疗5 d NT水平已明显高于奥美拉唑组和针刺组（ng/L：45.88±8.03比36.15±11.54、37.32±7.79，均P〈0.05），并于治疗7 d恢复至正常水平（ng/L：56.88±12.54）。3组患者血清ET-1水平呈双峰变化：入院时3组患者ET-1水平均明显高于健康对照组，治疗1 dObjectiveTo observe the therapeutic effect of combined acupuncture combined with omeprazole on patients with craniocerebral trauma complicated with stress gastric mucosal injury.MethodsPatients with stress gastric mucosal injury after cerebral trauma admitted to neurology of Brain Hospital, Affiliated Hospital of Logistics University from June 2016 to July 2017 were enrolled, with the inclusion criteria within 24 hours after injury at admission, and Glasgow coma scale （GCS） less than 12. Patients were divided into omeprazole group, acupuncture group and acupuncture plus omeprazole combined treatment group according to random number table method. All patients in the three groups were given symptomatic treatment in time after admission. After diagnosis, omeprazole group was injected intravenously omeprazole, 40 mg each time, one dose in 12 hours for 7 days; acupuncture group was acupunctured at bilateral Zusanli point and Zhongwan point, 20 minutes for needle retention, once a day for 7 days; combined treatment group was given acupuncture and omeprazole at the same time. The GCS score and the occult stool test were performed at admission and treatment of 7 days; the pH of gastric juice, the levels of serum neurotensin （NT） and endothelin-1 （ET-1） were measured at admission and treatment 1, 3, 5, 7 days. At the same time, 10 healthy persons were selected as the control.ResultsFinally, 90 patients were selected, 30 in each group. GCS score at 7 days after treatment in omeprazole group, acupuncture group and combined treatment group were significantly higher than those at admission, but there was no statistical difference among the groups （9.46±2.81, 10.26±2.24, 10.52±2.50, F = 2.010, P = 0.141）. For treatment of 7 days, the incidence of occult stool in the combined treatment group was significantly lower than that in the omeprazole group and acupuncture group （13.3% vs. 36.7%, 40.0%, both P 〈 0.05）. The pH value of gastric excretion was increased gradually after treatment in the three groups.

关 键 词：颅脑创伤 应激性胃黏膜损伤 针刺 足三里穴 中脘穴 神经降压素 内皮素-1 

分 类 号：R246[医药卫生—针灸推拿学]