电针早期干预高龄高血压壳核脑出血疗效分析

Analysis of Effect of early intervention with electro-acupuncture in the elderly with hypertensive putaminal hematoma

目的:评估电针早期干预对高血压脑出血病人康复的疗效并分析电针作用的可能机制。方法:患者随机分为西药组和针药结合组,每组各32例患者;针药结合组于卒中后72 h内增加电针治疗,其余治疗方法两组相同;电针治疗1次/d,共治疗28 d,主要腧穴为百会、风池、曲池、合谷、足三里和太冲穴等;评价疗效采用格拉斯哥昏迷评分(GCS)、格拉斯哥预后评分(GOS)及脑水肿指数(BEI),同时检测血中炎性细胞因子如C反应蛋白(CRP)、白介素-6(IL-6)及同型半胱氨酸(Hcy)含量。结果:(1)两组患者的治疗均有效,GCS评分两组间比较,差异无统计学意义(P>0.05);GOS评分提示,不利结局者比率针药组为21.9%,低于西药组的40.6%(P<0.05),而有利结局者率针药组为78.1%,高于西药组的59.4%(P<0.05);BEI显示针药组较西药组有差异(P<0.05);(2)血CRP及IL-6含量针药组较西药组下降更明显(P<0.05);针药组血Hcy水平较低,但与西药组比较,差异无统计意义(P>0.05)。结论:高龄高血压性壳核脑出血患者进行电针早期治疗,可改善病情,加速脑水肿吸收,有利于患者康复;电针的作用机制可能与降低血炎性细胞因子如CRP及IL-6的表达有关。

Objective:To evaluate the effect of early intervention of electro-acupuncture(EA)on the rehabilitation of patients with hypertensive putaminal hematoma and to analyze the possible mechanism of electro-acupuncture.Methods:The patients included in the study were divided into a western medication group and an acupuncture combined with medicine group by stratified block randomization,with 32 patients in each group.In the acupuncture and medicine combination group,EA was added within 72 h after stroke,and the other treatment methods were the same in the two groups.EA was performed once a day for 28 days,and the main acupoints were Baihui,Fengchi,Quchi,Hegu,Zusanli and Taichong points.Glasgow Coma score(GCS),Glasgow prognostic score(GOS)and brain edema index(BEI)were used to evaluate the efficacy,and the levels of inflammatory cytokines such as C-reactive protein(CRP),interleukin-6(IL-6)and homocysteine(Hcy)in blood were measured.Results:(1)The treatment was effective in both groups,and there was no statistical significance in GCS score between the two groups(P>0.05);GOS scores showed that the ratio of adverse outcomes in the acupuncture combined with medicine group was 21.9%,lower than that in the western medicine group(40.6%)(P<0.05),while the ratio of favorable outcomes in the acupuncture combined with medicine group was 78.1%,higher than that in the western medicine group(59.4%,P<0.05).BEI showed that there was a difference between the acupuncture combined with medicine group and western medicine group(P<0.05).(2)The levels of CRP and IL-6 in the acupuncture combined with medicine group were significantly lower than those in the western medicine group(P<0.05).The blood Hcy level in the acupuncture combined with medicine group was lower than that in western medicine group,but there was no statistical significance(P>0.05).Conclusion:Early treatment of EA in elderly patients with hypertensive putaminal hematoma can improve the condition,accelerate the absorption of cerebral edema,and facilitate the rehabilitation of patients.The mechanism of EA may be related to the reduction of the expression of inflammatory cytokines such as CRP and IL-6.