早期应用醒脑开窍针刺法改善急性硬膜下血肿术后患者神经和运动功能障碍的临床研究

A clinical study of early application of Xingnao Kaiqiao acupuncture to improve acute subdural hematomapatients with postoperative nerve and motor dysfunction

目的探讨早期应用醒脑开窍针刺法对急性硬膜下血肿（ASH）术后患者神经和运动功能障碍的影响。方法采用前瞻性研究方法，将120例符合入选标准的ASH术后患者按随机数字表法分为对照组、治疗I组、治疗Ⅱ组，每组40例。对照组给予神经外科常规治疗；治疗I组在常规治疗基础上于伤后1d加用醒脑开窍针刺法，治疗Ⅱ组于伤后7d加用醒脑开窍针刺法，均每日1次，15d为1个疗程，共2个疗程。于治疗前后采用神经功能缺损程度评分（NDS）、简式Fugl-Meyer运动功能评分法（FMA），改良Barthel指数（MBI）分别评定患者神经功能、肢体运动功能、日常生活活动能力（ADL）的恢复情况。结果与本组治疗前比较，治疗I组和治疗Ⅱ组治疗后NDS评分均明显降低，FMA、MBI明显升高，而对照组治疗后FMA明显升高（P〈0．05或P〈0．01）。与对照组比较，治疗I组和治疗Ⅱ组NDS评分（分）明显降低（30．12±7．95、32．32±7．97比37．03±9．97，均P〈0．01），FMA（分）、MBI明显升高（FMA：57．29±9．31、46．45±9．82比23．87±8．89，MBI：60．01±9．55、50．55±9．62比14．87±9．89，P〈0．05或P〈O．01），且治疗I组较治疗Ⅱ组FMA、MBI改善更显著（均P〈0．01）。结论早期采用醒脑开窍针刺法对改善ASH术后患者神经和运动功能障碍确有疗效，可提高患者的生活质量。

Objective To study the effect of early application of Xingnao Kaiqiao acupuncture on patients with acute subdural hematoma （ASH） and postoperative nerve and motor dysfunction. Methods A prospective study was counducted, 120 postoperative patients with ASH were randomly divided into three groups ： control, treatment I and Ⅱ groups （each,40 cases）. Conventional neurosurgical treatment was given to the control group. On the basis of routine treatment, after surgery for 1 day and 7 days, Xingnao Kaiqiao acupuncture was added respectively in I group and Ⅱ group, once every day, 15 days constituting 1 therapeutic course, and 2 courses were applied. Before treatment and after treatment, stroke clinical neurologic function deficits score （NDS）, a simple type of Fugl-Meyer motor function assessment （FMA） method, and modified Barthel index （MBI） were used to assess the neurologie function, extremity movement function, activities of daily living （ADL）. Results Compared with those before treatment, NDS in I and Ⅱ treatment groups was significantly decreased after treatment, and FMA and MBI were obviously increased, while in the control group FMA was markedly increased after treatment （P〈0.05 or P〈0.01）, Compared with the same time control group, NDS （score） was decreased obviously in treatment I and Ⅱ groups （30.12±7.95, 32.32±7.97 vs. 37.03±9.97, both P〈0.01）, FMA （score）and MBI were increased markedly （FMA ： 57.29±9.31,46.45±9.82 vs. 23.87±8.89, MBI ：60.01±9.55,50.55±9.62 vs.14.87±9.89, P〈0.05 or P〈0.01）, and the improvement in FMA and MBI was more significant in treatment I group than those in treatment Ⅱgroup （both P〈0.01 ）. Conclusion The early application of Xingnao Kaiqiao acupuncture has certain therapeutic effect to improve the nerve and motor functions in postoperative ASH patients with nerve and motor dysfunction, thus it can elevate the patients＇ quality of life.