针刺治疗破裂动脉瘤栓塞术后脑血管痉挛临床观察

Observation of clinical efficacy of acupuncture for cerebral vasospasm after embolization of ruptured aneurysms

目的:观察针刺对破裂动脉瘤栓塞术后脑血管痉挛(CVS)的改善作用。方法:将60例CVS患者随机分为针药组和常规治疗组,每组30例。常规治疗组使用尼莫地平治疗脑血管痉挛,针药组在常规治疗组基础上加用针刺百会、风池穴为主治疗脑血管痉挛,共治疗3周。采用Hunt-Hess分级标准评定两组治疗前后病情的严重程度并进行疗效比较。术后第1、4、7、10、14、21天分别行经颅超声多普勒检查(TCD),并记录大脑前动脉(ACA)、大脑中动脉(MCA)和大脑后动脉(PCA)的平均血流速度(Vm);术后第1、7、14、21天分别行CT灌注成像(CTP)检查脑血流量(CBF)、脑血容量(CBV)和造影剂平均通过时间(MTT)等指标。结果:针药组对病情的Hunt-Hess分级改善程度优于常规治疗组(P<0.05)。对两组患者的ACA、MCA、PCA和CBF、CBV、MTT等指标分别进行方差分析比较,显示两组方法对CVS均有治疗效果(均P<0.05),但针药组对以上指标的改善优于常规治疗组(均P<0.05)。结论:针刺百会、风池穴能使TCD和CTP各指标变化曲线的波峰压低或者波谷抬高,有效缓解脑血管痉挛的高峰,显著改善临床预后,对动脉瘤性蛛网膜下腔出血后血管痉挛有较好的治疗作用。

ABSTRACT Objective To observe the improvement of acupuncture in cerebral vasospasm （CVS） after emboliza- tion of ruptured aneurysms. Methods Sixty czases were randomly divided into two groups, an acupuncture-medica- tion group and a conventional treatment group, 30 cases in each one. The cases of CVS in conventional treatmentgroup were treated with Nimodipine. In actlpuncture-medication group, on the basis of the treatment as conven- tional treatment group, Bail^ui （GV 20） and Fengch{ （GB 20/ were selected as the main aeupoints in the treatment of CVS. The treatment lasted for 3 weeks. Hunt Hess scale for the standard assessment was adopted to determine the severity of disease before and after treatment and compare the efficacy between two groups. The transcranial Doppler （TCD） was conducted on tile 1st, 4th, 7th, the average flow velocity of 3 pairs of vessels （ACA, 10th, 14th and 21st days successively after operation, and MCA, and PCA） was recorded. CT perfusion （CTP） wastaken to test cerebral blood flow （CBF）, cerebral blood volume （CBV） and mean transit time （MTT） on the 1st, 7th, 14th and 2]st days successively. Results The improvement of Hunt-Hess scale in acupuncture-medication group was superior to that in conventional treatment group （P（0.05）. The analysis of variance （ANOVA） was adopted in the comparison of ACA, MCA, /）CA, CBF, CBV and MTT between two groups. The results showed that the therapy in either group achieved the effect on CVS （all P〈0.05）. But, the improvements in the above mentioned indices in acupuncture-medication group were superior to those in conventional treatment group （all P〈 0.05）. Conclusion Acupuncture at Baihui （GV 20） and Fengchi （GB 20） down-regulates the peak values or up- regulates the valley wtlues. It releases the peak of CVS effectively, improves the clinical prognosis significantly and is the effective therapy for CVS after subarachnoid hemorrhage.