摘要
Objective To observe the efficacy of acupuncture combined with naloxone hydrochloride in the treatment of coma after surgery for cerebral hemorrhage and to explore its possible mechanism of action.Methods Seventy-two patients were divided into a control group and an observation group according to the random number table method,with 36 cases in each group.The control group was treated with intravenous naloxone hydrochloride,and the observation group received additional acupuncture treatment.After 1 month of treatment,the awakening rate,Glasgow coma scale(GCS)score,cerebral edema volume,mean velocity(Vm)of the middle cerebral artery,and cerebrospinal fluid Caspase-3,and macrophage migration inhibitory factor(MIF)levels were compared between the two groups.Results During the study,there were 2 cases of shedding in the control group and 34 remaining valid cases;1 case of shedding in the observation group and 35 remaining valid cases.After treatment,the awakening rate was higher in the observation group than in the control group(P<0.05);the GCS score increased in both groups compared with that before treatment(P<0.05),and was higher in the observation group than in the control group(P<0.05);the volume of cerebral edema decreased in both groups(P<0.05),and was smaller in the observation group than in the control group(P<0.05);the middle cerebral artery Vm increased in both groups(P<0.05),and was higher in the observation group than in the control group(P<0.05);the cerebrospinal fluid Caspase-3 and MIF levels decreased significantly in both groups(P<0.05)and were lower in the observation group than in the control group(P<0.05).Conclusion Acupuncture combined with naloxone hydrochloride for the treatment of coma after surgery for cerebral hemorrhage can promote patients’awakening,improve the degree of coma,reduce the volume of cerebral edema,and enhance cerebral blood flow velocity,producing a better effect than naloxone hydrochloride used alone;it may be related to its reduction of cerebrospinal fluid Caspase-3 and MIF levels.
目的观察针刺联合盐酸纳洛酮治疗脑出血术后昏迷的疗效并探讨其可能机制。方法将72例患者按随机数字表法分为对照组和观察组,每组36例。对照组予静脉滴注盐酸纳洛酮治疗,观察组在此基础上加用针刺治疗。治疗1个月后比较两组苏醒率、格拉斯哥昏迷量表(GCS)评分、脑水肿体积、大脑中动脉平均血流速度(Vm)、脑脊液Caspase-3、巨噬细胞移动抑制因子(MIF)水平。结果研究过程中对照组脱落2例,剩余有效样本34例;观察组脱落1例,剩余有效样本35例。治疗后观察组苏醒率高于对照组(P<0.05);两组GCS评分均较治疗前增加(P<0.05),观察组高于对照组(P<0.05);两组脑水肿体积均减小(P<0.05),观察组小于对照组(P<0.05);两组大脑中动脉Vm均增加(P<0.05),观察组高于对照组(P<0.05);两组脑脊液Caspase-3和MIF水平明显降低(P<0.05),且观察组低于对照组(P<0.05)。结论针刺联合盐酸纳洛酮治疗脑出血术后昏迷可促进患者苏醒,改善昏迷程度,减少脑水肿体积,提升脑血流速度,疗效优于盐酸纳洛酮单独使用,可能与其降低脑脊液Caspase-3和MIF水平有关。
