醒神开窍针刺法结合丹参川芎嗪注射液治疗急性脑梗死临床研究

Clinical study on the Xingshen-Kaiqiao acupuncture combined with salviae miltiorrhizae and ligustrazine hydrochloride injection for acute cerebral infarction

目的 评价醒脑开窍针法结合丹参川芎嗪注射液治疗急性脑梗死（acute cerebral infarct，ACI）的疗效。方法将符合入选标准的142例ACI患者采用随机数字表法分为2组，每组71例。对照组在常规治疗基础上静脉注射丹参川芎嗪注射液，观察组在对照组的基础上结合醒脑开窍针法。2组均治疗14d。采用ELISA法检测血清中枢神经特异蛋白（s100 beta protein，SI11βl3），采用循环酶法检测同型半胱氨酸（homocysteine，Hcy），采用免疫散射比浊法检测超敏C反应蛋白（hypersensitive C-reactiveprotein，hs．CRP），采用全自动血凝仪检测D-二聚体（D-Dimer,D-D）、抗凝血酶Ⅲ（antithrombinⅢ，ATⅢ）；采用美国国立卫生研究院卒中量表（National Institute of Health Stroke Scale，NIHSS）评价神经功能缺损程度，采用改良Barthel指数（Modified Barthel Index，MBI）评价日常生活能力，观察临床疗效。结果观察组总有效率为97．2％（69／71）、对照组为88．7％（63／71），2组比较差异有统计学意义（χ^2=3．873，P=0．049）。观察组NIHSS评分治疗后7d[（6．1±1．9）分比（8．2±2．1）分，f=2．520]、14d[（3．8±1．1）分比（6．2±1．8）分，t=2．712]低于对照组（P〈0．05）；MBI评分治疗后7d[（77．7±8．1）分比（64．1±7．1）分，t=2．803]、14d[（83．2±9．1）分比（76．5±7．8）分，t=4．014]高于对照组（P〈0．05）。治疗后，观察组D．D[（0．79±0．33）g／ml比（1．22±0．37）g／ml，t=4．221]、Hcy[（13．46±2．89）μmol／L比（18．33±3．09）μmol／L，t=5．692]、hs-CRP[（12．85±3．23）mg／L比（18．65±4．13）megL，t=5．279]、S10013[（0．22±0．11）“g／L比（0．42±0．09）lag／L，t=3．891]水平均低于对照组（P〈0．05），ATIII[（91．63±5．06）％比（83．05±4．87）％，t=6．086]水平高于对照组（P〈O．05）。结论醒脑开窍针法联合丹参川芎嗪注射液可提高ACI患者的抗凝血因子水平，降低梗死区域炎症反应，促进神经功能恢复。

Objective To evaluate the efficacy of Xingshen-Kaiqiao combined with salviae miltiorrhizae and ligustrazine hydrochloride injection in the treatment of acute cerebral infarct （ACI）. Methods A total of 142 patients with ACI meeting the inclusion criteria were randomly divided into 2 groups, with 71 cases in each group. The control group received intravenous injection of salviae miltiorrhizae and ligustrazine hydrochloride injection on the basis of routine treatment, and the observation group was given Xingshen-Kaiqiao acupuncture method on the basis of the control group. After treatment of ed with 14 days, the enzyme linked immunosorbent assay was used to detect the central nervous specific protein （S10013） was detected by the enzyme linked immunosorbent assay, the level of homocysteine （Hcy） was detected by circulating enzyme method. T, the level of hypersensitive C-reactive protein （hs-CRP） was detected by immunization turbidimetry, and the automatic coagulant was used to detecded the D-Dimer （D-D） and antithrombin III （AT III） levels by the automatic coagulant. The degree of nerve function defect in patients were evaluated using the National Institute of Health Stroke Scale （NIHSS）, and the daily living ability of the patients by the improved barthel index （MBI） were evaluated, and the clinical efficacy was also observed. Results The total effective rate of the observation group was 97.2% （69/71）, and the total effective rate of thecontrol group was 88.7% （63/71）, with the difference showing statistically significant （χ^2=3.873, t=-0.049）. The score of 7 d （6.1±1.9 vs. 8.2±2.1, t=2.520）, 14 d （3.8±1.1 vs. 6.2±1.8, t=2.712） of the observation group were significantly lower than that those of the control group （P〈0.05）;）. The MBI scores after 7 d and 14 d were respectively （77.7 ± 8.1 vs. 64.1 ± 7.1, t=2.803） and 14 d and （83.2±9.1 vs. 76.5 ± 7.8, t=4.014） of the observation group were significantly higher than those of the control group （P〈0.05）;）. After the treatment, the D-D （0.79 ±0.33 g/ml vs. 1.22±0.37 g/ml, t=4.221）, Hcy （13.46 ± 2.89 μmol/L vs. 18.33± 3.09μmol/L, t=5.692）, hs-CRP （12.85±3.23 mg/L vs. 18.65 ±4.13 mg/L t=5.279）, the S10013 （91.63% ±5.06% vs. 83.05%±4.87%, t=6.086） of the observation group were significantly higher than those of the control group （P〈0.01）. Conclusions The combination of Xingshen-Kaiqiao acupuncture method and salviae miltiorrhizae and ligustrazine hydrochloride injection can improve the level of anticoagulant factor in the patients, and reduce the inflammatory response in the infarct area and promote the recovery of nerve.