针刺联合截喘汤加减治疗急性缺血性脑卒中相关性肺炎(痰热壅肺证)临床观察  

Clinical Observation of Acupuncture Combined with Modified Jiechuan Decoction in Treating Acute Ischemic Stroke-associated Pneumonia(Syndrome of Phlegm-heat Obstructing Lung)

作　　者：欧阳媛 楼衷晗 洪珍梅[1] 叶卫江 Ouyang Yuan;Lou Zhonghan;Hong Zhenmei;Ye Weijiang(The Third Affiliated Hospital of Zhejiang Chinese Medical University,Zhejiang,Hangzhou 310000,China)

机构地区：[1]浙江中医药大学附属第三医院,浙江杭州310000 [2]浙江中医药大学附属杭州市西溪医院,浙江杭州310000

出　　处：《中国中医急症》2024年第10期1788-1792,共5页Journal of Emergency in Traditional Chinese Medicine

基　　金：浙江省基础公益研究计划项目(LQ23H270008);2022年度浙江中医药大学附属第三医院院级课题项目(ZS22YA04)。

摘　　要：目的 观察针刺联合截喘汤加减治疗急性缺血性脑卒中(AIS)相关性肺炎(痰热壅肺证)的临床疗效。方法 采用随机信封法将112例患者随机分为常规组(常规西药治疗)、针刺组(在常规组的基础上进行针刺治疗)、中药组(在常规组的基础上给予截喘汤加减治疗)和联用组(在常规组基础上进行针刺和截喘汤加减治疗)各28例。治疗4周后,比较两组疗效、中医证候积分、炎症因子水平、免疫功能、致病菌清除率和不良反应情况。结果 联用组治疗总有效率为96.43%,高于常规组的67.86%、中药组的78.57%和针刺组的78.57%(P <0.05),常规组、中药组和针刺组组间总有效率比较,差异均无统计学意义(P> 0.05);治疗后,针刺组、中药组和联用组患者的中医证候积分、白细胞计数(WBC)、C反应蛋白(CRP)、白细胞介素-6(IL-6)水平均低于常规组,免疫球蛋白M(IgM)、免疫球蛋白G(IgG)水平均高于常规组(P <0.05);治疗后,联合组患者的中医证候积分、WBC、CRP、IL-6水平均低于针刺组和中药组,IgM、IgG水平均高于针刺组和中药组(P <0.05),而针刺组和中药组间的中医证候积分、WBC、CRP、IL-6、IgM、IgG水平差异无统计学意义(P> 0.05);联用组致病菌清除率为46.43%,高于常规组的10.71%、中药组的21.43%和针刺组的21.43%(P <0.05),常规组、中药组和针刺组组间致病菌清除率比较,差异均无统计学意义(P> 0.05);各组间不良反应发生率差异均无统计学意义(P>0.05)。结论 针刺联合截喘汤加减在AIS相关性肺炎(痰热壅肺证)患者中的治疗效果显著,可以有效改善患者的临床症状,致病菌清除率高,改善炎症因子水平和免疫功能,且不会加重不良反应,安全性高。Objective:To observe the application value of acupuncture combined with modified Jiechuan Decoc-tion in treating acute ischemic stroke(AIS)-associated pneumonia(syndrome of phlegm-heat obstructing lung).Methods:A total of 112 patients were randomly divided into four groups of 28 patients each using the random en-velope method:a conventional group(routine western medicine treatment),an acupuncture group(acupuncture treatment in addition to the conventional group′s treatment),a TCM group(modified Jiechuan Decoction treatment in addition to the conventional group′s treatment),and a combined group(acupuncture and modified Jiechuan De-coction treatment in addition to the conventional group′s treatment).After four weeks of treatment,the efficacy,TCM syndrome scores,inflammatory factor levels,immune function,pathogen clearance rates,and adverse reaction incidences were compared among the groups.Results:The overall effective rate of the combined group(96.43%)was higher than that of the conventional group(67.86%),the TCM group(78.57%),and the acupuncture group(78.57%)(P<0.05).There were no significant differences in the overall effective rates among the conventional,TCM,and acupuncture groups(P>0.05).After treatment,the TCM syndrome scores,white blood cell counts(WBC),C-reactive protein(CRP),and interleukin-6(IL-6)levels were lower in the acupuncture,TCM,and com-bined groups than in the conventional group,while immunoglobulin M(IgM)and immunoglobulin G(IgG)levels were higher(P<0.05).After treatment,the TCM syndrome scores,WBC,CRP,and IL-6 levels were lower in the combined group than in the acupuncture and TCM groups,while IgM and IgG levels were higher(P<0.05).There were no significant differences in the TCM syndrome scores,WBC,CRP,IL-6,IgM,and IgG levels between the acupuncture and TCM groups(P>0.05).The pathogen clearance rate in the combined group(46.43%)was higher than that in the conventional group(10.71%),the TCM group(21.43%),and the acupuncture group(21.43%)(P<0.05).There were no significant differences in t

关 键 词：急性缺血性脑卒中 肺炎 针刺 截喘汤加减 痰热壅肺证 炎症因子 

分 类 号：R743.9[医药卫生—神经病学与精神病学]