电针联合艾灸治疗蛛网膜下腔出血后脑血管痉挛的临床观察  

Clinical Observation of Electroacupuncture Combined with Moxibustion for Cerebral Vasospasm Following Subarachnoid Hemorrhage

作　　者：张云会[1] 朱文锐[1] 贾文瀚 陈建基 林诗雨 ZHANG Yun-Hui;ZHU Wen-Rui;JIA Wen-Han;CHEN Jian-Ji;LIN Shi-Yu(The First Affiliated Hospital of Guangzhou University of Chinese Medicine,Guangzhou 510405 Guangdong,China;Clinical Medical School of Acupuncture,Moxibustion and Rehabilitation,Guangzhou University of Chinese Medicine,Guangzhou 510006 Guangdong,China)

机构地区：[1]广州中医药大学第一附属医院,广东广州510405 [2]广州中医药大学针灸康复临床医学院,广东广州510006

出　　处：《广州中医药大学学报》2022年第1期99-105,共7页Journal of Guangzhou University of Traditional Chinese Medicine

基　　金：广东省中医药局科研课题资助项目(编号:20132126)。

摘　　要：【目的】观察电针联合艾灸治疗蛛网膜下腔出血后脑血管痉挛的临床疗效,并探讨其对一氧化氮(NO)及内皮素1(ET-1)水平的影响。【方法】将120例蛛网膜下腔出血后脑血管痉挛患者随机分为治疗组和对照组,每组各60例。2组患者均给予吸氧、镇静、脑神经保护等基础常规处理。治疗组在常规处理的基础上,给予电针联合艾灸治疗,对照组在常规处理的基础上,给予模拟电针针刺治疗。每天治疗1次,连续治疗2周。治疗2周后,评价2组患者的临床疗效,观察2组患者治疗前后大脑中动脉平均流速(MCA-Vm)、颈内动脉颅外段平均流速(VICA-Vm)及Lindegaard指数的变化情况,以及血清NO和ET-1水平的情况。比较2组患者治疗后改良Rankin量表评分,并观察2组患者并发症的发生情况。【结果】(1)研究过程中,治疗组中有1例退出,对照组中有3例退出。最终治疗组59例、对照组57例纳入疗效统计。(2)治疗后,2组患者的大脑中动脉平均流速、颈内动脉颅外段平均流速、Lindegaard指数均明显改善(P<0.05),且治疗组在改善大脑中动脉平均流速、颈内动脉颅外段平均流速、Lindegaard指数方面均明显优于对照组,差异均有统计学意义(P<0.05)。(3)治疗后,2组患者的血清NO和ET-1水平均明显改善(P<0.05),且治疗组在改善血清NO和ET-1水平方面均明显优于对照组,差异有统计学意义(P<0.05)。(4)治疗组总有效率为98.31%(58/59),对照组为77.19%(44/57)。治疗组疗效优于对照组,差异有统计学意义(P<0.05)。(5)治疗后,治疗组在改善改良Rankin评分方面明显优于对照组,差异有统计学意义(P<0.05)。(6)治疗2周后,治疗组发生迟发性缺血性神经功能缺损1例,未见其他并发症,并发症发生率为1.69%(1/59);对照组发生迟发性缺血性神经功能缺损7例,血管痉挛相关脑梗塞4例,并发症发生率为19.30%(11/57);与对照组比较,治疗组的并发症发生率明显降低,差异Objective To observe the clinical efficacy of electroacupuncture combined with moxibustion in the treatment of cerebral vasospasm following subarachnoid hemorrhage,and to explore its effects on nitric oxide(NO)and endothelin-1(ET-1)levels. Methods A total of 120 patients with cerebral vasospasm following subarachnoid hemorrhage were randomly divided into the treatment group and the control group with 60 cases in each group. Both groups were given oxygen inhalation, sedation, neuroprotection and other basic routine treatment, and additionally, the treatment group was given electroacupuncture, and the control group was given simulated electroacupuncture treatment. The treatment performed once a day for two consecutive weeks. After two weeks of treatment,the clinical efficacy of the two groups was evaluated,and the changes of mean middle cerebral artery flow rate(MCA-Vm),mean extracranial internal carotid artery flow rate(VICA-Vm)and Lindegaard index,as well as the levels of serum NO and ET-1 were observed before and after treatment. The modified Rankin scale score after treatment was compared between the two groups,and the incidence of complications in the two groups was observed. Results(1)During the study,one case dropped out of the treatment group and 3 cases dropped out of the control group. Finally,59 cases in the treatment group and 57 cases in the control group were included in the curative effect statistics.(2)After treatment,the mean flow velocity of middle cerebral artery,mean flow velocity of extracranial segment of internal carotid artery and Lindegaard index in the two groups were significantly improved(P<0.05),and the treatment group was significantly superior to the control group in improving above indexes,the difference being statistically significant(P<0.05).(3)After treatment,serum NO and ET-1 levels in the two groups were significantly improved(P<0.05),and the improvement of serum NO and ET-1 levels in the treatment group was significantly superior to that in the control group,the difference bein

关 键 词：蛛网膜下腔出血 电针 艾灸 脑血管痉挛 一氧化氮 内皮素-1 临床观察 

分 类 号：R246.9[医药卫生—针灸推拿学]