针药并用联合溶栓治疗急性缺血性卒中的疗效观察及对血清炎性因子水平的影响  

Efficacy observation of combined acupuncture and medication plus thrombolysis for acute ischemic stroke and the effects on serum inflammatory factor levels

作　　者：占道伟[1] 顾芳芳[1] 杨帆[1] 钱立锋[1] 钱华 茅利玉[1] 杨喜兵[1] 罗开涛[1] ZHAN Daowei;GU Fangfang;YANG Fan;QIAN Lifeng;QIAN Hua;MAO Liyu;YANG Xibing;LUO Kaitao(Jiaxing Hospital of Traditional Chinese Medicine,Zhejiang Chinese Medical University,Jiaxing 314000,China)

机构地区：[1]浙江中医药大学附属嘉兴市中医医院,嘉兴314000

出　　处：《上海针灸杂志》2023年第7期709-714,共6页Shanghai Journal of Acupuncture and Moxibustion

基　　金：浙江省科技厅科研项目(LGF20H270003);浙江省沈来华名老中医专家传承工作室建设项目(GZS2021036);嘉兴市沈来华名中医传承工作室建设项目[嘉卫办(2021)28号];嘉兴市公益性研究计划项目(2020AD30026);嘉兴市脑血管病中西医结合康复研究重点实验室。

摘　　要：目的在溶栓治疗的基础上,观察针刺联合补阳还五汤治疗急性缺血性卒中(acute ischemic stroke,AIS)的临床疗效及对血清炎性因子水平的影响。方法将108例AIS患者随机分为中药组、针刺组和联合组,每组36例。3组均采用静脉溶栓、内科及康复常规干预,中药组采用补阳还五汤治疗,针刺组在常规针刺基础上联合“气机升降调脾胃”配穴法针刺,联合组采用针刺联合中药治疗。采用美国国立卫生研究院卒中量表(National Institutes of Health stroke scale,NIHSS)、改良Ranking量表(modified Rankin scale,mRS)和改良Barthel指数(modified Barthel index,MBI)评价患者神经功能缺损状况、日常生活能力以及独立预后,比较3组治疗前后血清同型半胱氨酸(homocysteine,Hcy)和超敏C反应蛋白(hypersensitive C-reactive protein,hs-CRP)水平,并比较3组的临床疗效。结果治疗后,3组NIHSS、mRS及MBI评分均有改善(P<0.05);联合组NIHSS与mRS评分低于针刺组和中药组(P<0.05),MBI评分高于针刺组和中药组(P<0.05);针刺组与中药组NIHSS、mRS及MBI评分比较差异无统计学意义(P>0.05)。治疗后,3组血清Hcy和hs-CRP水平均下降(P<0.05),联合组低于针刺组和中药组(P<0.05),针刺组血清Hcy和hs-CRP水平与中药组比较差异无统计学意义(P>0.05)。联合组总有效率高于针刺组和中药组(P<0.05)。结论在溶栓治疗的基础上,针药并用治疗AIS可更好地提升日常生活能力与独立生活水平,机制可能与降低外周血Hcy和hs-CRP水平抑制局部炎症反应有关。Objective To observe the clinical efficacy of combined acupuncture and Bu Yang Huan Wu Tang based on thrombolysis therapy in treating acute ischemic stroke(AIS)and the impact on serum inflammatory factor levels.Method A total of 108 AIS patients were randomly divided into a Chinese medication group,an acupuncture group,and an integrated group,with 36 cases in each group.Intravenous thrombolysis and conventional internal medicine and rehabilitation interventions were offered to all three groups.In addition,the Chinese medication group received Bu Yang Huan Wu Tang,the acupuncture group received the ordinary acupuncture treatment combined with acupuncture point selection based on“regulating the spleen and stomach via ascending and descending Qi movements”,and the integrated group was given the acupuncture and Chinese medication treatments together.The National Institutes of Health stroke scale(NIHSS),modified Rankin scale(mRS),and modified Barthel index(MBI)were adopted to assess the neural deficit,activities of daily living,and independent prognosis in the patients.The levels of serum homocysteine(Hcy)and hypersensitive C-reactive protein(hs-CRP)were compared before and after treatment.The clinical efficacy was also compared among the three groups.Result After treatment,all three groups showed improvements in the NIHSS,mRS,and MBI scores(P<0.05);the NIHSS and mRS scores were lower in the integrated group than in the acupuncture and Chinese medication groups(P<0.05),and the MBI was higher in the integrated group than in the other two groups(P<0.05);there was no statistical significance in comparing the NIHSS,mRS,and MBI scores between the acupuncture and Chinese medication groups(P>0.05).The serum Hcy and hs-CRP levels went down after intervention in all three groups(P<0.05)and were lower in the integrated group than in the acupuncture and Chinese medication groups(P<0.05);there were no significant differences in the serum Hcy and hs-CRP levels between the acupuncture and Chinese medication groups(P>0.05).The i

关 键 词：针刺疗法 针药并用 缺血性中风 溶栓 同型半胱氨酸 超敏C反应蛋白 

分 类 号：R246.6[医药卫生—针灸推拿学]