针灸电刺激联合血管内亚低温治疗对重症颅脑外伤患者血清脑组织损害标志物水平的影响  

Effects of acupuncture electrical stimulation combined with intravascular mild hypothermia on serum brain tissue damage markers levels in patients with severe traumatic brain injury

作　　者：韩近超 孟晨 解强 HAN Jin-chao;MENG Chen;XIE Qiang(Department of Neurosurgery,1.Beijing Royal Integrative Medicine Hospital,Beijing 102209;Shijiazhuang Ping an Hospital,Shijiazhuang 050025,Hebei,China)

机构地区：[1]北京王府中西医结合医院神经外科,北京102209 [2]石家庄平安医院神经外科,河北石家庄050025

出　　处：《川北医学院学报》2022年第6期708-711,737,共5页Journal of North Sichuan Medical College

基　　金：北京市中医药科技项目(JJ2015-0143)。

摘　　要：目的:探讨针灸电刺激联合血管内亚低温治疗对重症颅脑外伤(sTBI)患者血清脑组织损害标志物水平的影响。方法:选取87例sTBI患者为研究对象,根据治疗方法不同分为研究组(n=45)和对照组(n=42)。伤后12 h,对照组患者给予血管内低温治疗,研究组患者给予亚低温治疗+针灸电刺激治疗,疗程均为7 d。比较两组患者在开始低温治疗即刻、72 h、7 d的颅内压、格拉斯哥昏迷量表(GCS)评分、美国国立卫生研究院卒中量表(NIHSS)评分及血清神经元特异性烯醇化酶(NSE)、髓鞘碱性蛋白(MBP)、胰岛素样生长因子-Ⅱ(IGF-Ⅱ)水平、治疗期间床边寒战评估量表(BSAS)分级、寒战发生率及平均每日应用抗寒战药物剂量。结果:在低温治疗72 h及7 d,研究组患者颅内压、NIHSS评分和血清NSE、MBP水平低于对照组(P<0.05),GCS评分和血清IGF-Ⅱ水平高于对照组(P<0.05)。在低温治疗期间,研究组患者BSAS分级分布、寒战发生率及平均每日应用丁螺环酮、哌替啶等抗寒战药物的剂量低于对照组(P<0.05)。结论:在sTBI早期血管内亚低温治疗过程中,联合应用针灸电刺激治疗,能够提高治疗效果,缓解治疗中的寒战程度,降低血清脑损伤标志物水平,有一定的辅助治疗作用。Objective:To analyze the effects of acupuncture electrical stimulation combined with intravascular mild hypothermia on the levels of serum brain tissue damage markers in patients with severe traumatic brain injury(sTBI).Methods:87 patients with sTBI were selected as the research subjects and divided into the study group(n=45)and the control group(n=42)according to the therapy methods.Both groups were treated with intravascular hypothermia within 12 hours after injury,and rewarming after 7 days of continuous treatment.The patients in the study group were treated with combined acupuncture electrical stimulation at the beginning of mild hypothermia for 7 days.The intracranial pressure,Glasgow Coma Scale(GCS)score,the National Institute of Health Stroke Scale(NIHSS)score and the serum neuron specific enolase(NSE),myelin basic protein(MBP)and insulin-like growth factor-Ⅱ(IGF-Ⅱ)levels,classification of Bedside Shivering Assessment Scale(BSAS),the incidence of shivering and the average daily dose of anti shivering drugs immediately after hypothermia treatment,72 h and 7 days after hypothermia treatment were compared between the two groups.Results:At 72 hours and 7 days of hypothermia treatment,the intracranial pressure,NIHSS score and the serum NSE,MBP levels of the patients in the study group were lower than those in the control group.GCS score and the serum IGF-Ⅱlevel were higher than those in the control group(P<0.05).During the hypothermia treatment,the grade distribution of BSAS,the incidence of shivering and the average daily dose of anti shivering drugs such as buspirone,pethidine were lower than those in the control group(P<0.05).Conclusion:During the early intravascular mild hypothermia treatment of sTBI,the combined application of acupuncture electrical stimulation can improve the therapeutic effects,alleviate the degree of shivering in the treatment,and reduce the level of serum brain injury markers,which has a certain adjuvant therapeutic effect.

关 键 词：针灸 电刺激 亚低温治疗 重症颅脑外伤 神经元特异性烯醇化酶 髓鞘碱性蛋白 胰岛素样生长因子-Ⅱ 

分 类 号：R743.34[医药卫生—神经病学与精神病学]