针刺联合冰麝人中穴中药敷贴治疗高血压脑出血后昏迷的临床研究

Clinical study of acupuncture combined with Bingshe traditional Chinese medicine application at Renzhong acupoint in treating coma after hypertensive intracerebral hemorrhage

目的探讨针刺联合冰麝人中穴中药敷贴治疗高血压脑出血(hypertensive cerebral hemorrhage,HICH)昏迷的效果。方法选取上海中医药大学附属岳阳中西医结合医院2019年11月-2021年11月收治的95例术后昏迷的HICH患者,随机分为两组,对照组(47例)给予盐酸纳洛酮治疗,观察组在此基础上给予针刺治疗,同时以冰麝散敷于人中穴,比较两组苏醒率、苏醒时间以及治疗前后GCS评分、脑电图分级、脑血流速度、脑脊液以及血清生化指标。结果观察组苏醒率(58.33%)高于对照组(31.91%),苏醒时间(9.24±3.18)d短于对照组(13.97±3.45)d(P<0.05);治疗后观察组GCS评分(9.84±1.92)高于对照组(8.24±1.49)(P<0.05);治疗后观察组脑电图分级(I级29例,II级9例,III级6例,IV级2例,V级2例)优于对照组(I级15例,II级13例,III级9例,IV级6例,V级4例)(P<0.05);治疗后观察组基底动脉Vm(39.78±4.35)cm/s、大脑中动脉Vm(93.27±5.88)cm/s高于对照组[(31.48±3.47)cm/s、(86.57±5.32)cm/s)](P<0.05);治疗后观察组IL-1β(2.16±0.24)pg/mL、LA(1.72±0.34)ng/mL、NT-proBNP(184.72±19.87)pg/mL、HMGB-1(7.13±2.93)ng/mL及GM-CSF(3.53±1.15)pg/mL低于对照组[(2.89±0.28)pg/mL、(4.10±0.46)ng/mL、(219.93±25.25)pg/mL、(13.76±3.14)ng/mL、(4.24±2.07)pg/mL](P<0.05)。结论针刺联合冰麝人中穴中药敷贴有助于提高HICH昏迷患者苏醒率,其机制可能与改善脑血流循环、抑制炎症有关。

Objective To investigate the effect of acupuncture combined with Bingshe traditional Chinese medicine application at Renzhong acupoint on coma caused by hypertensive cerebral hemorrhage(HICH).Methods From Nov.2019 to Nov.2021,totally 95 patients with postoperative coma of HICH were selected and randomly divided into two groups.The control group(47 cases)was treated with naloxone hydrochloride,and the observation group was treated with acupuncture on the basis of naloxone hydrochloride,at the same time,Bingshesan was attached to the Renzhong acupoint.The recovery rate,recovery time,GCS score,EEG grade,cerebral blood flow velocity,cerebrospinal fluid and serum biochemical indexes before and after treatment were compared between the two groups.Results The resuscitation rate of observation group(58.33%)was higher than that of control group(31.91%),and the resuscitation time of observation group(9.24±3.18)d was shorter than that of control group(13.97±3.45)d(P<0.05).After treatment,the GCS score of observation group was(9.84±1.92)higher than that of control group(8.24±1.49)(P<0.05).After treatment,the EEG grading of the observation group(29 cases of grade I,9 cases of grade II,6 cases of grade III,2 cases of grade IV,2 cases of grade V)was better than that of the control group(15 cases of grade I,13 cases of grade II,9 cases of grade III,6 cases of grade IV,4 cases of grade V)(P<0.05).After treatment,the Vm of basilar artery(39.78±4.35)cm/s and middle cerebral artery(93.27±5.88)cm/s in observation group were higher than those in control group(31.48±3.47)cm/s,(86.57±5.32)cm/s(P<0.05).After treatment,IL-1β(2.16±0.24)pg/mL and LA(1.72±0.34)ng/mL,NT-probNP(184.72±19.87)pg/mL,HMGB-1(7.13±2.93)ng/mL and GM-CSF(3.53±1.15)pg/mL in observation group were lower than those in control group[(2.89±0.28)pg/mL,(4.10±0.46)ng/mL,(219.93±25.25)pg/mL,(13.76±3.14)ng/mL,(4.24±2.07)pg/mL](P<0.05).Conclusion Acupuncture combined with Bingshe traditional Chinese medicine application at Renzhong acupoint can improve the resuscitation rate of coma patients with HICH,and its mechanism may be related to improving cerebral blood circulation and inhibiting inflammation.