麦粒灸法与疏血通注射液联合常规疗法治疗急性脑梗死后手功能障碍临床研究
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R246.6

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河南省中医药科学研究专项课题(TCM2019016);河南省中医药传承与创新人才工程(仲景工程) 中医药拔尖人才培养项目(豫卫 中医函〔2021〕15号)


Clinical Study on Moxibustion with Seed-Sized Moxa Cone and Shuxuetong Injection Combined with Routine Therapy for Hand Dysfunction After Acute Cerebral Infarction
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    摘要:

    目的:观察麦粒灸法与疏血通注射液联合常规疗法治疗急性脑梗死后手功能障碍的临床疗效。方 法:将180 例急性脑梗死后手功能障碍气虚血瘀证患者按照随机数字表法分为观察组和对照组各90 例。对照 组采用常规疗法和疏血通注射液治疗,观察组在对照组基础上加用麦粒灸法治疗,2 组均以2 周为1 个疗程, 连续治疗2 个疗程。治疗前后应用Fugl-meyer 运动功能评分量表(FMA) 评定患手的运动功能,应用偏瘫手 功能评分表评定患手综合功能,应用神经功能缺损程度评定量表(NDS) 评定患手的神经功能缺损程度,使用 肌电图设备检测患手手腕肌群的积分肌电值(iEMG);检测血清神经元特异性烯醇化酶(NSE)、S100B 蛋白及 血管内皮生长因子(VEGF)、白细胞介素(IL) -18、IL-6、血小板分子标志物1(PAC-1)、D-二聚体(D-D) 水平。比较2 组临床疗效。结果:治疗后,观察组总有效率98.89%,对照组总有效率85.56%,2 组比较, 差异有统计学意义(P<0.05)。2 组FMA 评分、偏瘫手功能评分均较治疗前升高(P<0.05),观察组FMA 评 分、偏瘫手功能评分均高于对照组(P<0.05)。2 组NDS 评分均较治疗前降低(P<0.05),观察组NDS 评分 低于对照组(P<0.05)。2 组腕背伸肌群、腕掌屈肌群iEMG 均较治疗前升高(P<0.05),观察组腕背伸肌 群、腕掌屈肌群iEMG 均高于对照组(P<0.05)。2 组血清NSE、S100B 蛋白、IL-18、IL-6、PAC-1、D-D 水 平均较治疗前降低(P<0.05),血清VEGF 水平均较治疗前升高(P<0.05);观察组血清NSE、S100B 蛋白、 IL-18、IL-6、PAC-1、D-D 水平均低于对照组(P<0.05),血清VEGF 水平高于对照组(P<0.05)。结论: 在常规脑梗死基础疗法和常规康复疗法基础上加用麦粒灸法联合疏血通注射液治疗气虚血瘀型急性脑梗死后手 功能障碍效果确切,可有效减轻患手的神经功能缺损程度和脑梗死局部的炎症程度,改善脑部血液循环和患手 的腕背伸肌群、腕掌屈肌群力量,提高患手的综合功能。

    Abstract:

    Abstract: Objective: To observe the clinical effect of moxibustion with seed- sized moxa cone and Shuxuetong Injection combined with routine therapy for hand dysfunction after cerebral infarction. Methods:A total of 180 cases of patients with hand dysfunction after cerebral infarction with qi deficiency and blood stasis syndrome were divided into the observation group and the control group according to the random number table method, with 90 cases in each group. The control group was treated with routine therapy and Shuxuetong Injection, and the observation group was additionally treated with moxibustion with seed-sized moxa cone based on the treatment of the control group. Both groups were treated for 2 courses,with 2 weeks being 1 course. Before and after treatment,motor function of the affected hand was evaluated by Fugl-Meyer Assessment Scale (FMA),comprehensive function of the affected hand was evaluated by hemiplegic hand function rating scale,degree of neurological deficit of the affected hand was evaluated by Neurological Disability Score (NDS), and integrated electromyography (iEMG) of muscles in wrist the affected hand was detected by EMG equipment; the levels of neuron- specific enolase (NSE), S100B protein,vascular endothelial growth factor (VEGF),interleukin- 18 (IL- 18),interleukin- 6 (IL- 6), platelet molecular marker 1 (PAC- 1),and D- dimer (D- D) in serum were detected. The clinical effects in the two groups were compared. Results:After treatment,the total clinical effective rate was 98.89% in the observation group and 85.56% in the control group, the difference being significant (P<0.05). The scores of FMA and hemiplegic hand function rating scale in the two groups were increased when compared with those before treatment, differences being significant (P<0.05), and the scores of FMA and hemiplegic hand function rating scale in the observation group were higher than those in the control group (P<0.05). The NDS scores in the two groups were decreased when compared with those before treatment (P<0.05),and the NDS score in the observation group was lower than that in the control group (P<0.05). The iEMG values in muscles of wrist dorsiflexion and wrist palmar flexion in the two groups were increased when compared with those before treatment (P<0.05), and the iEMG values in muscles of wrist dorsiflexion and wrist palmar flexion in the observation group were higher than those in the control group (P<0.05). The levels of NSE,S100B protein,IL-18,IL-6,PAC-1,and D-D in serum in the two groups were decreased when compared with those before treatment (P<0.05),and VEGF levels in serum were increased when compared with those before treatment (P<0.05); the levels of NSE, S100B protein, IL- 18,IL- 6,PAC- 1,and D- D in serum in the observation group were lower than those in the control group (P<0.05), and the VEGF level in serum was higher than that in the control group (P<0.05). Conclusion:On the basis of routine treatment for cerebral infarction and routine rehabilitation therapy,the additional treatment of moxibustion with seed-sized moxa cone combined with Shuxuetong Injection has a definite effect in treating hand dysfunction after cerebral infarction of qi deficiency and blood stasis type, which can effectively reduce the degree of neurological deficit of the affected hand and local inflammation of cerebral infarction,improve blood circulation of the brain and the strength of muscles of wrist dorsiflexion and wrist palmar flexion of the affected hand,and enhance the comprehensive hand function.

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邢若星,秦合伟,刘建东.麦粒灸法与疏血通注射液联合常规疗法治疗急性脑梗死后手功能障碍临床研究[J].新中医,2023,55(12):130-135

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  • 在线发布日期: 2023-06-27
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