针刺辅助治疗蛛网膜下腔出血继发脑血管痉挛的临床研究

Clinical Observation on the Effect of Acupuncture Auxiliary Therapy in the Cerebral Vasospasm after Subarachnoid Hemorrhage

目的观察针刺辅助治疗SAH继发脑血管痉挛的作用。方法 40例SAH继发脑血管痉挛的患者随机分为对照组和治疗组,对照组(20例)应用常规西医治疗,治疗组(20例)在常规西医治疗基础上于入院后第1天起针刺水沟、百会、内关、合谷、四神聪、阴陵泉、阳陵泉(时间为30min,1次/天,共14天),观察两组病人的格拉斯哥昏迷计分(Glasgow coma score,GCS)、大脑中动脉血流速度(采用TCD检测)、六点行为评分(采用Budzyuki的六点行为评分法)及于治疗后1个月及3个月格拉斯哥预后计分(Glasgow outcome scale,GOS)。结果①对照组、治疗组中GCS、GOS治疗后均明显回升,大脑中动脉血流速度及六点行为评分治疗后均明显下降,与治疗前比较均有统计学意义(P<0.05);②治疗组治疗后3、7、14天的大脑中动脉血流速度均低于同期对照组,其中14天显著低于对照组(P<0.05),但3、7天差异均无显著性(P>0.05);③治疗组治疗后7、14天的GCS均高于同期对照组;治疗后3、7、14天的六点行为评分低于同期对照组;治疗后1、3个月的GOS均高于同期对照组,但均无统计学意义。结论针刺治疗组在提高临床疗效方面优于常规对照组,通过扩张脑血管降低大脑中动脉血流速度是针刺治疗SAH继发脑血管痉挛的机制之一。

Objective To observe the effect of acupuncture auxiliary therapy in the cerebral vasospasm after subarachniod hemorrhage.Methods Forty cases with cerebral vasospasm after subarachniod hemorrhage were randomly divided into the contrast（20 cases） and treatment group（20 cases）.Patents in the contrast group were treated with the conventional therapy and those in treatment group were treated with the conventional therapy besides acupuncture therapy from the first day after their admissions by pinpricking the acupoint of Shuigou,Baihui,Neiguan,Hegu,Sishencong,Yinlingquan、Yanglingquan half an hour once everyday for 14 days.The change of GCS,the blood flow rate of the middle cerebral artery were measured by TCD.The 6 points behavioral rating scale and the GOS 1month,3months after treated were observed.Results ①The GCS and GOS were obviously increased after being treated in the treatment and contrast group.The blood flow rate of the middle cerebral artery and the 6 point behavioral rating scale were decreased after being treated in two groups.②The blood flow rate of the middle cerebral artery in the treatment group was lower than that of control group after being treated 3,7,14 days,and it was obviously low at 14 days（P0.05）,but the difference at 3,7 days had no statistical significance（P0.05）.③The GCS of the treatment group was higher than that of the contrast group after being treated.The 6 points behavioral rating scale of the treatment group was higher than that of the contrast group after being treated 3,7,14 days.The GOS of the treatment group was higher than that of the contrast group after being treated 1,3 months,which had no statistical significance.Conclusion The treatment group evaluating the curative effect was superior to the contrast group.One of the Acupuncture therapy for the CVS after SAH pathogenesis is expanding the cerebral vas to low the blood flow rate of the middle cerebral artery.