针刺联合康复训练治疗气虚血瘀型高血压脑出血恢复期患者的临床观察

Clinical Observation on Acupuncture Combined with Rehabilitation Trainingin Treating Patients with Qi Deficiency and Blood Stasis Type ofHypertensive Cerebral Hemorrhage in the Recovery Period

【目的】观察针刺联合康复训练治疗气虚血瘀型高血压脑出血恢复期的临床疗效。【方法】将132例气虚血瘀型高血压脑出血恢复期患者随机分为观察组和对照组,每组各66例,对照组给予西医常规治疗联合康复训练,观察组在对照组治疗的基础上联合针刺治疗。2组患者均连续治疗12周。治疗12周后,评价2组临床疗效。观察2组患者治疗前后简化Fugl-Meyer运动功能评定量表(FMA)、美国国立卫生院神经功能缺损量表(NIHSS)评分和中医证候积分的变化情况,以及血清白细胞介素6(IL-6)、同型半胱氨酸(Hcy)、内皮素1(ET-1)、血清基质金属蛋白酶9(MMP-9)、脑源性神经营养因子(BDNF)水平的情况。比较2组患者治疗前后血清丝氨酸-苏氨酸蛋白激酶(AKT)、磷脂酰肌醇-3激酶(PI3K)、Bcl-2相关X蛋白(bax)水平的变化情况。【结果】(1)治疗后,2组患者血清IL-6、Hcy、ET-1水平均明显改善(P<0.05),且观察组在改善血清IL-6、Hcy、ET-1水平方面明显优于对照组,差异有统计学意义(P<0.05)。(2)治疗后,2组患者血清MMP-9、BDNF水平均明显改善(P<0.05),且观察组在改善血清MMP-9、BDNF水平方面明显优于对照组,差异有统计学意义(P<0.05)。(3)治疗后,2组患者血清AKT、PI3K、bax水平明显改善(P<0.05),且观察组在改善血清AKT、PI3K、bax水平方面明显优于对照组,差异有统计学意义(P<0.05)。(4)治疗后,2组患者的FMA评分、中医证候积分、NIHSS评分均明显改善(P<0.05),且观察组在改善FMA评分、中医证候积分、NIHSS评分方面明显优于对照组,差异均有统计学意义(P<0.05)。(5)观察组总有效率为93.34%(62/66),对照组为81.82%(54/66)。观察组疗效优于对照组,差异有统计学意义(P<0.05)。【结论】针刺联合康复训练治疗气虚血瘀型高血压脑出血恢复期患者,能明显减轻患者的炎症反应,调节神经因子水平,抑制神经细胞凋亡,促进神经功能恢复,临床疗效显著。

Objective To observe the clinical efficacy of acupuncture combined with rehabilitation training in treating qi deficiency and blood stasis type of hypertensive cerebral hemorrhage in the recovery stage.Methods A total of 132 patients with qi deficiency and blood stasis type of hypertensive cerebral hemorrhage in the recovery period were randomly divided into observation group and control group,with 66 cases in each group,the control group was given western medicine conventional treatment combined with rehabilitation training,and the observation group was treated with acupuncture on the basis of the control group.Both groups of patients were treated for 12 consecutive weeks.After 12 weeks of treatment,the clinical efficacy of the two groups was evaluated.The changes of simplified Fugl-Meyer Assessment(FMA),National Institutes of Health Neurological Impairment Scale(NIHSS),and traditional Chinese medicine(TCM)syndrome scores,as well as the changes of serum interleukin 6(IL-6),homocysteine(Hcy),and endothelin 1(ET-1),serum matrix metalloproteinase 9(MMP-9),and brain-derived neurotrophic factor(BDNF)levels were observed before and after the treatment of the patients in the two groups.The changes of serum serine-threonine protein kinase(AKT),phosphatidylinositol-3 kinase(PI3K),and Bcl-2-related X protein(bax)levels were compared between the two groups before and after treatment.Results(1)After treatment,the serum IL-6,Hcy,ET-1 levels of patients in the two groups were significantly improved(P<0.05),and the observation group was significantly superior to the control group in improving the serum IL-6,Hcy,ET-1 levels,and the difference was statistically significant(P<0.05).(2)After treatment,the serum MMP-9 and BDNF levels of patients in the two groups were significantly improved(P<0.05),and the observation group was significantly superior to the control group in improving serum MMP-9 and BDNF levels,with statistically significant differences(P<0.05).(3)After treatment,the serum AKT,PI3K,bax levels of patients in the two groups were significantly improved(P<0.05),and the observation group was significantly superior to the control group in improving serum AKT,PI3K,bax levels,and the difference was statistically significant(P<0.05).(4)After treatment,the FMA score,TCM syndrome scores,and NIHSS score of patients in the two groups were significantly improved(P<0.05),and the observation group was significantly superior to the control group in improving the FMA score,TCM syndrome scores,and NIHSS score,and the differences were statistically significant(P<0.05).(5)The total effective rate was 93.34%(62/66)in the observation group and 81.82%(54/66)in the control group.The efficacy of the observation group was superior to that of the control group,and the difference was statistically significant(P<0.05).Conclusion Acupuncture combined with rehabilitation training for the treatment of patients recovering from hypertensive cerebral hemorrhage of qi deficiency and blood stasis type can significantly reduce the patient’s inflammatory response,regulate the level of neurofactors,inhibit neuronal apoptosis,and promote the recovery of neurological function,and the clinical efficacy is remarkable.