目的 研究针灸和药物治疗对急性缺血性脑卒中患者大脑中动脉血流量的即刻效应及神经损害程度的影响.方法 选取福建医科大学附属泉州第一医院2021年6月至2023年6月收治入院的100例急性缺血性脑卒中患者,采用随机数字表法分为针刺治疗组(35例)、非穴针刺组(32例)、常规药物治疗组(33例).所有缺血性脑卒中患者入院后均予西医常规治疗,在此基础上,针刺治疗组与非穴针刺组均在入组的第1天未使用药物改善循环的情况下进行首次针灸治疗.三组患者连续治疗14d,观察患者治疗前后的大脑血流动力学指标:大脑中动脉的收缩期峰速(systolic peak velocity,Vs)、舒张期峰速(diastolic peak velocity,Vd)、搏动指数(pulsatility index,PI)、阻力指数(resistance index,RI)及平均血流速度(mean blood flow velocity,MFV);检测患者治疗前后的脑神经损伤标志物水平,并通过美国国立卫生研究院卒中量表(National Institute of Health stroke scale,NIHSS)评估患者的神经功能损伤程度.结果 与治疗前比较,治疗后常规药物治疗组和非穴针刺组患者的Vs、MFV水平提高(P＜0.05),PI较治疗前显降低(P＜0.05);针刺治疗组患者的Vs、Vd、MFV水平均提高(P＜0.05);PI、RI较治疗前降低(P＜0.05).三组治疗后比较,针刺治疗组患者的Vs、Vd、PI、RI、MFV改善情况优于非穴针刺组与常规药物治疗组(P＜0.05).针刺治疗组患者首次针刺后的Vs、Vd、PI、RI、MFV均有改善,其改善程度优于非穴针刺组(P＜0.05).三组治疗后,患者的血清S-100β蛋白、心型脂肪酸结合蛋白(heart-type fatty acid binding protein,H-FABP)、神经元特异性烯醇化酶(neuron specific enolase,NSE)水平显著降低(P＜0.05),其中针刺治疗组指标低于非穴针刺组和常规药物治疗组(P＜0.05).与非穴针刺组和常规药物治疗组比较,针刺治疗组在治疗2周后、随访30d后,患者的NIHSS评分更低,差异有统计学意义(P＜0.05).结论 早期针刺治疗可改善急性缺血性脑卒中患者的大脑中动脉的血流情况,减轻患者神经损伤的程度.
Effect of early acupuncture and drug treatment on blood flow and nerve injury in patients with ischemic stroke
Objective To investigate the immediate effect of early acupuncture and drug treatment on cerebral arterial blood flow and the degree of nerve damage in patients with acute ischemic stroke.Methods A total of 100 cases acute ischemic stroke patients treated in Quanzhou First Hospital Affiliated to Fujian Medical University were selected from June 2021 to June 2023,using clinical random number table method,the patients were divided into acupuncture treatment group(35 cases),non acupoint acupuncture group(32 cases),and conventional drug treatment group(33 cases).After admission to the hospital,all stroke patients were treated with conventional western medicine treatment,Both acupuncture treatment group and non acupoint acupuncture group received initial acupuncture treatment on the first day of enrollment without using drugs to improve circulation.Three groups of patients were treated continuously for 14 days,and their cerebral hemodynamic indicators before and after treatment were observed,including systolic peak velocity(Vs),diastolic peak velocity(Vd),pulsatile index(PI),resistance index(RI),and mean blood flow velocity(MFV).The levels of brain nerve injury markers in patients before and after treatment were measured,and the degree of neurological impairment were evaluated using National Institute of Health stroke scale(NIHSS).Results Compared with before treatment,the Vs and MFV levels of patients in conventional drug treatment group and non acupoint acupuncture group increased after treatment(P＜0.05),and PI decreased significantly compared with before treatment(P＜0.05);The levels of Vs,Vd,and MFV in acupuncture treatment group were all increased(P＜0.05);PI and RI decreased compared to before treatment(P＜0.05);After comparing the three treatment groups,the improvement of Vs,Vd,PI,RI,and MFV in acupuncture treatment group were better than those in non acupoint acupuncture group and conventional drug treatment group(P＜0.05).The Vs,Vd,PI,RI,and MFV of patients in the acupuncture treatment group improved after the first acupuncture,and the degree of improvement was better than that of the non acupoint acupuncture group(P＜0.05).After treatment in the three groups,the levels of serum S-100 β protein,heart-type fatty acid binding protein(H-FABP),and neuron specific enolase(NSE)were significantly reduced(P＜0.05),among which the index levels in acupuncture group were lower than those in the other two groups(P＜0.05),and the NIHSS score was lower in acupuncture group after 2 weeks of treatment and 30 days of follow-up compared with non acupoint acupuncture group and conventional drug treatment group(P＜0.05).Conclusion Early acupuncture treatment can improve the blood flow of the middle cerebral artery in patients with acute ischemic stroke and reduce the degree of nerve damage.
万方数据
维普
