开窍通络针刺法联合治疗对颅脑损伤大骨瓣减压术后患者神经损伤因子、意识状况的影响

Effect of Combined Kaiqiao Tongluo Acupuncture Therapy on Nerve Injury Factors and Consciousness of Patients with Craniocerebral Injury after Large Bone Flap Decompression

目的探讨开窍通络针刺法联合治疗对颅脑损伤大骨瓣减压术后患者神经损伤因子、意识状况的影响。方法选取2019年4月—2022年3月收治的100例颅脑损伤,根据治疗方法不同均分为联合组和对照组。2组均予大骨瓣减压术等常规综合治疗,在此基础上联合组加用开窍通络针刺法治疗。比较2组意识状况[清醒时间及治疗前、治疗3 d后、治疗5 d后、治疗12 d后格拉斯哥昏迷评分法(GCS)评分],治疗前及治疗3、5、12 d后神经损伤因子[神经元特异性烯醇化酶(NSE)、S-100B]水平、氧化应激指标[血清丙二醛(MDA)、超氧化物歧化酶(SOD)、谷胱甘肽过氧化物酶(GSH-Px)、晚期蛋白氧化产物(AOPPs)]水平和颅内压、脑灌注压。结果联合组清醒时间早于对照组,治疗3、5、12 d后GCS评分高于对照组(P<0.01)。2组治疗3、5、12 d后NSE、S-100B、MDA、AOPPs水平及颅内压均低于治疗前(P<0.05),并随时间推移呈降低趋势(P<0.01);联合组治疗3、5、12 d后NSE、S-100B、MDA、AOPPs水平及颅内压低于对照组(P<0.05)。2组治疗3、5、12 d后SOD、GSH-Px水平及脑灌注压均高于治疗前(P<0.05),并随时间推移呈增高趋势(P<0.01);联合组治疗3、5、12 d后SOD、GSH-Px水平及脑灌注压高于对照组(P<0.05)。结论开窍通络针刺法联合治疗可改善颅脑损伤大骨瓣减压术后患者神经损伤和氧化应激情况,降低颅内压,增加脑灌注压,促进患者苏醒,改善患者意识状态。

Objective To investigate the effect of combined Kaiqiao Tongluo acupuncture therapy on nerve injury factors and consciousness of patients with craniocerebral injury after large bone flap decompression.Methods In total,100 patients with craniocerebral injury admitted from April 2019 to March 2022 were selected and divided into the combination group and the control group according to different treatment methods.Both groups were treated with large bone flap decompression and other conventional comprehensive treatment.On this basis,the combination group was supplemented with Kaiqiao Tongluo acupuncture.The consciousness status of the two groups[time of regaining consciousness,and Glasgow Coma Scale(GCS)scores before and after treatment,at 3,5 and 12 d after treatment],the levels of nerve injury factors[neuron specific enolase(NSE),S-100B]before and at 3,5,and 12 d after treatment,oxidative stress indexes[serum malondialdehyde(MDA),superoxide dismutase(SOD),glutathione peroxidase(GSH-Px),advanced oxidation protein products(AOPPs)]levels,intracranial pressure and cerebral perfusion pressure were compared between the two groups.Results The time of regaining consciousness in the combination group was earlier than that of the control group,and the GCS score of the combination group was higher than that of the control group at 3,5 and 12 d after treatment(P<0.01).The levels of NSE,S-100B,MDA,AOPPs and intracranial pressure in both groups were lower than those before treatment at 3,5 and 12 d after treatment(P<0.05),which showed a decreasing trend with time(P<0.01).The levels of NSE,S-100B,MDA,AOPPs and intracranial pressure in the combination group were lower than those in the control group at 3,5 and 12 d after treatment(P<0.05).The levels of SOD,GSH-Px and cerebral perfusion pressure in both groups were higher than those before treatment at 3,5 and 12 d after treatment(P<0.05),showing an increasing trend with time(P<0.01).The levels of SOD,GSH-Px and cerebral perfusion pressure in the combination group were higher than those in the control group at 3,5 and 12 d after treatment(P<0.05).Conclusion The combined treatment with Kaiqiao Tongluo acupuncture can improve the condition of nerve injury and oxidative stress,reduce intracranial pressure,increase cerebral perfusion pressure,promote the recovery of patients and improve the consciousness of patients with brain injury after large bone flap decompression.