针药结合对急性期缺血性脑卒中患者神经功能的保护作用  

Protective Effect of Combination of Acupuncture and Medicine on Nerve Function in Patients with Acute Ischemic Stroke

作　　者：杨乐乐[1] 储呈海 杨丹 YANG Le-le;CHU Cheng-hai;YANG Dan(Dongtai Hospital of Traditional Chinese Medicine,Dongtai,Jiangsu,China,224200)

机构地区：[1]东台市中医院,江苏东台224200

出　　处：《河南中医》2023年第3期464-467,共4页Henan Traditional Chinese Medicine

基　　金：江苏中医药科技计划项目(LHGJ20190021)。

摘　　要：目的:观察针药结合对急性期缺血性脑卒中患者神经功能的保护作用。方法:选取2019年3月至2021年3月东台市中医院急诊收住入院治疗的急性期缺血性脑卒中气虚血瘀证患者90例,按照随机数字表法分为观察组和对照组,每组45例。两组患者均给予神经内科常规治疗,在病情允许的情况下,让患者行坐位保持,并进行坐位平衡训练,嘱咐患者多活动肩、肘、腕关节,并根据患者能忍受最大限度,进行旋、展、收等运动。对照组另给予补阳还五汤治疗,观察组在对照组治疗的基础上加用针刺疗法治疗。观察两组患者临床疗效及治疗前后神经功能缺损评分(national institute of health stroke scale,NIHSS)、Barthel指数、脑卒中专用生活质量量表(stroke specific quality of life,SS-QOL)、脑灌注指标[大脑后动脉(posterior cerebral artery,PCA)、大脑前动脉(arteriae cerebri anterior,ACA)、大脑中动脉(middle cerebral artery,MCA)的平均血流速度]、脑血流动力学指标[平均血流速度(mean velocity,Vm)、血管阻力指数(resistance index,RI)、搏动指数(pulsatility Index,PI)]变化情况。结果:观察组有效率95.56%,对照组有效率77.78%,观察组有效率高于对照组,差异有统计学意义(P<0.05);观察组治疗后Barthel指数、SS-QOL评分、PCA、ACA、MCA、Vm指标高于对照组,NIHSS评分、PI指标低于对照组,差异有统计学意义(P<0.05),观察组治疗后RI低于对照组,但差异无统计学意义(P>0.05)。结论:针药结合对急性期缺血性脑卒中气虚血瘀证患者神经功能有积极保护作用,提高患者NIHSS评分、Barthel指数,改善患者生活质量、脑组织再灌注指标、脑部血流动力学指标。Objective:To observe the protective effect of combination of acupuncture and medicine on nerve function in patients with acute ischemic stroke.Methods:A total of 90 patients with qi deficiency and blood stasis syndrome of acute ischemic stroke admitted to Dongtai Hospital of TCM for emergency treatment from March 2019 to March 2021 were randomly divided into the observation group and the control group,with 45 cases in each group.Both groups were first given routine treatment in the department of neurology.If the condition allowed,the patients were asked to maintain the sitting position and perform the sitting balance training.They were instructed to move their shoulders,elbows and wrists more,and to perform rotation,extension and retraction movements according to their maximum tolerance.The control group was then treated with Yang-Supplementing and Five-Returning Decoction,while the observation group was additionally treated with acupuncture on the basis of the treatment of the control group.The clinical efficacy,the changes of the national institute of health stroke scale(NIHSS),Barthel index,stroke specific quality of life(SS-QOL) cerebral perfusion indexes [including mean blood flow velocity of posterior cerebral artery(PCA),anterior cerebral artery(ACA),middle cerebral artery(MCA)],cerebral hemodynamic indexes [including mean blood flow velocity(Vm),vascular resistance index(RI),and pulsatility index(PI)] of the two groups before and after treatment were observed.Results:The effective rate of the observation group was 95.56%,which was higher than that of the control group:77.78%,and the difference was statistically significant(P0.05).Conclusion:The combination of acupuncture and moxibustion has a positive protective effect on the neurological function of patients with acute ischemic stroke of qi deficiency and blood stasis syndrome,and can improve the NIHSS score,Barthel index,quality of life,cerebral tissue reperfusion index,and cerebral hemodynamics index.

关 键 词：缺血性脑卒中 急性期 补阳还五汤 针刺疗法 针药结合 

分 类 号：R255.2[医药卫生—中医内科学]