醒脑开窍针刺法对脑梗死患者rt-PA静脉溶栓安全性的影响:随机对照试验  

Effect of Xingnao Kaiqiao acupuncture on safety of rt-PA intravenous thrombolysis in patients with cerebral infarction:a randomized controlled trial

作　　者：宋扬扬 张新昌 张加英 王淑兰 柏亚妹[3] 徐炳国[2] 陆敏[4] 倪光夏 SONG Yang-yang;ZHANG Xin-chang;ZHANG Jia-ying;WANG Shu-lan;BAI Ya-mei;XU Bing-guo;LU Min;NI Guang-xia(Collge of Acupuncture-Moxibustion and Tuina/Cllege of Regimen and Rehabiliation,Nanjing 210023,Jiangsu Province,China;Department of TCM;Collge of Nursing,Nanjing University of Chinese Medicine,Nanjing 210023,Jiangsu Province,China;Department of Neurology,Nanjing First Hospit)

机构地区：[1]南京中医药大学针灸推拿学院·养生康复学院,江苏南京210023 [2]南京市第一医院中医科 [3]南京中医药大学护理学院,江苏南京210023 [4]南京市第一医院神经内科

出　　处：《中国针灸》2022年第9期961-965,共5页Chinese Acupuncture & Moxibustion

基　　金：江苏省中医药科技发展计划项目:YB2020005;江苏高校护理学优势学科建设工程资助项目:2019YSHL055。

摘　　要：目的:观察醒脑开窍针刺法对脑梗死患者重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓疗效及安全性的影响。方法:将142例脑梗死rt-PA静脉溶栓患者随机分为针药组(71例)和西药组(71例,脱落1例)。西药组予rt-PA静脉溶栓治疗,针药组在西药组的基础上予醒脑开窍针刺法治疗,穴取水沟、内关、三阴交、极泉等,每日针刺1次,6 d为一疗程,共治疗1个疗程。比较两组患者治疗前后美国国立卫生研究院卒中量表(NIHSS)评分、症状性颅内出血(s ICH)相关指标[血小板计数(PLT)、D-二聚体、纤维蛋白原]水平及s ICH发生率、不良反应发生率,评定两组患者临床疗效。结果:治疗后,两组患者NIHSS评分、D-二聚体水平均较治疗前降低(P<0.05),且针药组低于西药组(P<0.05);针药组患者纤维蛋白原水平较治疗前升高(P<0.05),且针药组高于西药组(P<0.05)。针药组s ICH发生率为0%(0/71),低于西药组的8.6%(6/70,P<0.05)。针药组有效率为97.2%(69/71),高于西药组的87.1%(61/70,P<0.05)。针药组不良反应发生率为2.8%(2/71),低于西药组的12.9%(9/70,P<0.05)。结论:醒脑开窍针刺法可提高脑梗死患者rt-PA静脉溶栓的疗效,降低s ICH和不良反应发生率,其机制可能与调节纤维蛋白原和D-二聚体水平有关。Objective To assess the effect of Xingnao Kaiqiao(regaining consciousness and opening orifices)acupuncture on the efficacy and safety of intravenous thrombolysis with recombinant tissue plasminogen activator(rt-PA) in patients with cerebral infarction.Methods A total number of 142 patients of cerebral infarction undergoing rt-PA intravenous thrombolysis were randomized into an acupuncture-medication group(71 cases) and a western medication group(71 cases,1 case dropped off).In the western medication group,rt-PA intravenous thrombolysis was given.In the acupuncture-medication group,besides the intervention as the control group,Xingnao Kaiqiao acupuncture was provided at Shuigou(GV 26),Neiguan(PC 6),Sanyinjiao(SP 6),Jiquan(HT 1),etc.once daily.One treatment session contained 6treatments and 1 session was required.Before and after treatment,the score of the National Institute of Health stroke scale(NIHSS),the levels of the relevant indexes of symptomatic intracerebral hemorrhage(sICH)(platelet [PLT],D-dimer and fibrinogen),the incidences of sICH and adverse effect were compared between groups.The efficacy was assessed in two groups.Results After treatment,NIHSS scores and the levels of D-dimer were reduced compared with those before treatment in both groups(P<0.05),and those in the acupuncture-medication group were lower than the western medication group(P<0.05).The level of fibrinogen in the acupuncture-medication group was increased in comparison with that before treatment(P<0.05),and also higher than the western medication group(P<0.05).The incidence of sICH was 0%(0/71) in the acupuncture-medication group,lower than 8.6%(6/70) in the western medication group(P<0.05).The effective rate was 97.2%(69/71) in the acupuncture-medication group,higher than 87.1%(61/70) in the western medication group(P<0.05).The incidence of adverse effect was 2.8%(2/71) in the acupuncture-medication group,lower than 12.9%(9/70) in the western medication group(P<0.05).Conclusion Xingnao Kaiqiao acupuncture may improve the efficacy of rt

关 键 词：脑梗死 静脉溶栓 醒脑开窍法 针刺 症状性颅内出血 随机对照试验 

分 类 号：R246.6[医药卫生—针灸推拿学]