目的 探讨对急性脑梗死(acute cerebral infarction,ACI)患者采用丁苯酞注射液的基础上给予针刺治疗的临床疗效。方法 收集联勤保障部队第九六〇医院急诊收治的ACI患者92例,按照入组标准随机分为对照组与观察组,每组46例。对照组在抗血小板、抗凝等常规治疗的基础上给予丁苯酞(dl-3n-butylphthalide,NBP)25 mg/次静脉滴注,2次/d。观察组在对照组治疗的基础上给予针刺治疗,两组治疗时间均为2周。最终完成临床研究且实验结果可靠的有75例,其中对照组40例,观察组35例,记录并比较两组治疗后的临床疗效,采用美国国立卫生院脑卒中量表(NIHSS)评估治疗前后神经功能,采用Barthel指数评定量表评估患者生活自理能力,测定治疗前后神经功能指标[(神经元特异性烯醇化酶(NSE)、血管内皮生长因子(VEGF)、S100B蛋白]、血流变学指标(全血黏度、低切黏度、中切黏度、高切黏度、红细胞聚集指数、红细胞刚性指数、纤维蛋白原)及其凝血状态指标[血小板分子标志物1(PAC-1)和D-二聚体(D-Dimer)]的变化,记录治疗过程中出现的不良反应。结果 观察组的临床疗效高于对照组,但差异无统计学意义。治疗后两组神经功能(NIHSS)评分较治疗前降低(P＜0.05),且观察组低于对照组(P＜0.05);治疗后两组生活自理能力评分(Barthel)较治疗前升高(P＜0.05),且观察组高于对照组(P＜0.05);治疗后两组血流变学指标(全血黏度、低切黏度、中切黏度、高切黏度、红细胞聚集指数、红细胞刚性指数、纤维蛋白原)、NSE、S100B蛋白、PAC-1、D-Dimer较治疗前降低,差异有统计学意义(P＜0.05),且观察组低于对照组(P＜0.05);治疗后两组VEGF均较治疗前升高(P＜0.05),且观察组高于对照组(P＜0.05);治疗中对照组不良反应发生率为17.50%,低于与观察组的42.86%,差异有统计学意义(P＜0.05)。结论 丁苯酞联合针刺治疗能很好地改善ACI患者的神经功能及其血凝状态,进而提高临床疗效,且安全可靠。
Abstract
Objective To observe the clinical efficacy of butylphthalide injection combined with acupuncture-moxibustion in patients with acute cerebral infarction. Methods Ninety-two patients with acute cerebral infarction were selected and divided into the control group (n=46) and observation group (n=46). The patients in the control group were given intravenous injection of butylphthalide as well as antiplatelet and anticoagulant drugs, while those in the observation group received acupuncture treatment besides the medication mentioned above. The course of treatment was two weeks. The clinical effects were recorded and compared between the two groups. The National Institutes of Health Stroke Scale (NIHSS) was used to assess the neurological function before and after treatment, and the self-care ability of patients was assessed by the Barthel scale. The neurological function index (neuron specific enolase (NSE), vascular endothelial growth factor (VEGF), and S100B protein were measured before and after treatment, so were the hemorheological index and coagulation index (PAC-1, D-Dimer). Adverse reactions were recorded during treatment. Results After treatment, the total effective rate in the observation group was better than in the control group (P＜0.05). The NIHSS scores of the two groups were lower (P＜0.05), especially in the observation group (P＜0.05), but Barthel scores of self-care ability of the two groups were higher (P＜0.05), especially in the observation group (P＜0.05). Hemorheological indexes of the two groups were lower (P＜0.05), especially in the observation group (P＜0.05). Levels of NSE and S100B protein of the two groups were lower (P＜0.05), especially in the observation group (P＜0.05), but levels of VEGF of the two groups were higher (P＜0.05), especially in the observation group (P＜0.05). PAC-1 and D-Dimer of the two groups were lower (P＜0.05), especially in the observation group (P＜0.05). Adverse reactions occurred in the control group (17.50%) and in the observation group (42.86%). Conclusions Butylphthalide combined with acupuncture can improve the neurological function and blood coagulation of patients with acute cerebral infarction, with better clinical efficacy, safety and reliability.
关键词
急性脑梗死 /
丁苯酞 /
针刺治疗 /
临床疗效
Key words
acute cerebral infarction /
butylphthalide /
acupuncture-moxibustion /
clinical efficacy
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基金
北京新兴卫生产业发展基金会科研项目(XXCY2018-011)
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