醒脑开窍针刺对急性脑梗死患者神经功能缺损及脑氧代谢指标的影响

许卓 刘洋

【摘要】 目的：觀察醒脑开窍针刺对急性脑梗死患者神经功能缺损及脑氧代谢指标的影响。方法：选取2014年1月-2019年1月本院的192例急性脑梗死患者，采用随机数字表法将其分为观察组和对照组，各96例。对照组患者在常规治疗的基础上予以依达拉奉治疗，观察组在对照组的基础上联合应用醒脑开窍针刺。比较两组治疗2周后临床疗效、神经功能mRS评分，治疗前、治疗2周后的动脉血氧含量（CaO2）、脑氧摄取率（ERO2）、动静脉血氧含量差[D（a-jvO）2]及神经元特异性烯醇化酶（NSE）、神经生长因子（NGF）、神经营养因子（NTF）。结果：治疗2周后，两组mRS评分均较治疗前均降低，且观察组显著低于对照组，差异均有统计学意义（P<0.05）。治疗2周后，两组CaO2较治疗前升高，两组ERO2、D（a-jvO）2均较治疗前降低，且观察组均低于对照组，差异均有统计学意义（P<0.05）。两组外周血NSE水平较治疗前明显下降，且观察组低于对照组，NGF、NTF水平较治疗前均明显升高，且观察组均高于对照组，差异均有统计学意义（P<0.05）。结论：醒脑开窍针刺治疗急性脑梗死疗效确切，可促进神经功能恢复，改善脑部血供，于患者预后有利。

【关键词】 醒脑开窍针刺 急性脑梗死 神经功能 脑氧代谢

Effect of Xingnao Kaiqiao Acupuncture on Neurological Defects and Cerebral Oxygen Metabolism Indexes in patients with Acute Cerebral Infarction/XU Zhuo， LIU Yang. //Medical Innovation of China， 2021， 18（07）： 0-094

[Abstract] Objective： To observe the effect of Xingnao Kaiqiao Acupuncture on neurological deficits and cerebral oxygen metabolism indexes in patients with acute cerebral infarction. Method： A total of 192 patients with acute cerebral infarction in our hospital from January 2014 to January 2019 were selected， they were divided into observation group and control group by random number table method， 96 cases in each group. Patients in control group were treated with Edaravone on the basis of conventional treatment， patients in observation group were combined with Xingnao Kaiqiao Acupuncture on the basis of control group. The clinical efficacy and modified Rankin Scale （mRS） score after 2 weeks of treatment， arterial blood oxygen content （CaO2）， cerebral oxygen extraction rate （ERO2）， arterial venous oxygen content difference [D（a-jvO）2] and neuron-specific enolase （NSE）， nerve growth factor （NGF）， neurotrophic factor （NTF） before treatment and after 2 weeks of treatment were compared between the two groups. Result： After 2 weeks of treatment， the mRS scores in both groups were lower than before treatment， the observation group was significantly lower than the control group， the difference was statistical significance （P<0.05）. After 2 weeks of treatment， CaO2 in both groups increased compared with before treatment， ERO2 and D（a-jvO）2 in both groups decreased compared with before treatment， the observation group were lower than the control group， the differences were statistical significance （P<0.05）. The levels of NSE in peripheral blood of the two groups were significantly decreased compared with before treatment， the observation group was lower than the control group; the levels of NGF and NTF were significantly increased compared with before treatment， the observation group were higher than those in the control group， the differences were statistical significance （P<0.05）. Conclusion： Xingnao Kaiqiao acupuncture has a definite efficacy on acute cerebral infarction， it can promote the recovery of neurological function and improve the blood supply to the brain， it is beneficial to the prognosis of patients.

[Key words] Xingnao Kaiqiao acupuncture Acute cerebral infarction Neurological function Cerebral oxygen metabolism

First-authors address： The Fourth Affiliated Hospital of Liaoning University of Traditional Chinese Medicine， Shenyang 110100， China

doi：10.3969/j.issn.1674-4985.2021.07.022

急性脑梗死是由于脑血管狭窄等原因造成的脑供血骤然中断，脑组织局部缺氧缺血性坏死，是临床常见的脑血管危重病，随着我国人口老龄化趋势增加，发病率呈现逐年升高趋势[1]。其起病急骤，常在睡眠状态下发生，常见临床表现包括恶心、呕吐、头晕等症状，可并发认知功能障碍、运动功能障碍等后遗症，严重影响生活质量[2]。目前针对急性脑梗死尚无有效治疗方法，西医治疗以溶栓、降脂、降压为主，但对预后改善不理想[3]。醒脑开窍针刺法为针灸手法量学标准化之代表，根据“窍闭神匿”的根本病机，治疗原则为以醒脑开窍，补益肝肾为主，疏通经络为辅[4]。本研究对急性脑梗死患者采用醒脑开窍针刺治疗，并观察其对神经功能缺损及脑氧代谢指标的影响的影响，现报道如下。……