世界中医药

目的：探究醒脑开窍针对急性脑梗死临床效果，并对其作用机制进行分析，以期提高治疗水平。方法：选取2014年6月至2017年2月秦皇岛市中医医院收治的急性脑梗死患者108例作为研究对象，按照入组先后顺序分为对照组和观察组，每组54例。对照组营养神经等对症治疗，观察组加用醒脑开窍针治疗，均治疗2周。观察治疗前、完成治疗后炎性反应因子、血液流变学、神经元、超声等变化并比较，总结疗效。结果：1）完成治疗后2组神经功能缺损评分（NIHSS评分）、症状积分较治疗前均显著下降，Barthel指数则显著升高，差异有统计学意义（P<0.05），完成治疗后观察组Barthel指数显著高于对照组，余显著低于对照组，差异有统计学意义（P<0.05）。2）完成治疗后2组C反应蛋白（CRP）、一氧化氮（NO）、白细胞介素-6（IL-6）、肿瘤坏死因子-α（TNF-α）、IL-12、干扰素-γ（INF-γ）较治疗前均显著下降，差异有统计学意义（P<0.05），完成治疗后观察组以上指标均显著低于对照组，差异有统计学意义（P<0.05）。3）完成治疗后2组收缩峰值血流速度（Vs）、舒张末期血流速度（Vd）、血流评价速度（Vm）较治疗前显著升高，PI（搏动指数）较治疗前显著下降，差异有统计学意义（P<0.05），完成治疗后观察组PI显著低于对照组，余显著高于对照组，差异有统计学意义（P<0.05）。4）完成治疗后2组全血黏度、血浆黏度、纤维蛋白原、血小板聚集率、红细胞压积、S100B、基质金属蛋白酶-9（MMP-9）较治疗前均显著下降，差异有统计学意义（P<0.05），金属蛋白酶-1（TIMP-1）显著升高，差异有统计学意义（P<0.05），完成治疗后观察组TIMP-1显著高于对照组，余指标均显著低于对照组，差异有统计学意义（P<0.05）。5）观察组基本痊愈率、总有效率显著高于对照组，差异有统计学意义（P<0.05）。结论：醒脑开窍针能促进急性脑梗死侧支血液循环，抑制炎症应激反应，改善神经元，从而提高疗效。

English Summary:

To explore the clinical effect of Xingnao Kaiqiao Acupuncture on acute cerebral infarction and analyze its mechanism in order to improve the treatment level.Methods:A total of 108 patients with acute cerebral infarction from June 2014 to February 2017 in Qinhuangdao Chinese Medicine Hospital were selected as the study subjects, and divided into a control group and an observation group according to the order of enrollment, with 54 cases in each group.The control group received symptomatic treatment such as nutritional nerve, and the observation group received Xingnao Kaiqiao acupuncture for 2 weeks.The changes of inflammatory factors, hemorheology, neurons and ultrasonography before and after treatment were observed and compared, and the curative effect was summarized.Results:1)After treatment, the scores of neurological deficit(NIHSS)and symptoms in both groups decreased significantly, while the Barthel index increased significantly(P<0.05).After treatment, the Barthel index in the observation group was significantly higher than that in the control group, and the rest was significantly lower than that in the control group(P<0.05).2)After treatment, the levels of CRP, NO, IL-6, TNF-α, IL-12 and INF-γ in the 2 groups were significantly decreased than those before treatment(P<0.05), and the above indexes in the observation group were significantly lower than those in the control group(P<0.05).3)After treatment, Vs(peak systolic blood flow velocity), Vd(end diastolic blood flow velocity)and Vm(blood flow evaluation velocity)in the 2 groups increased significantly, and PI(pulsation index)decreased significantly(P<0.05).PI in the observation group was significantly lower than that in the control group, and the rest was significantly higher than that in the control group(P<0.05).4)After treatment, the whole blood viscosity, plasma viscosity, fibrinogen, platelet aggregation rate, hematocrit, S100B, matrix metalloproteinase-9(MMP-9)of the 2 groups decreased significantly(P<0.05), and the level of metalloproteinase-1(TIMP-1)increased significantly(P<0.05).After treatment, TIMP-1 in the observation group was significantly higher than that in the control group, and the remaining indicators were significantly lower than those in the control group(P<0.05).5)The basic recovery rate and total effective rate in the observation group were significantly higher than those in the control group(P<0.05).Conclusion:Xingnao Kaiqiao Acupuncture can promote collateral blood circulation, inhibit inflammatory stress response and improve neurons in patients with acute cerebral infarction, so as to improve the curative effect.

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