针刺联合循经按摩治疗新生儿缺氧缺血性脑病恢复期临床研究

Clincial Study on Acupuncture Combined with Meridian Massage in the Treatment of Neonatal Hypoxic-Ischemic Encephalopathy at Recovery Stage

目的:观察针刺联合循经按摩治疗新生儿缺氧缺血性脑病(NHIE)恢复期的疗效。方法:选取102例NHIE恢复期患儿作为研究对象,按照治疗方案不同分为针刺组、抚触按摩组、联合组,各34例。3组均给予常规康复治疗,在此基础上,针刺组给予针刺治疗,抚触按摩组给予循经按摩,联合组给予针刺联合循经按摩治疗。比较3组临床疗效及预后情况,比较3组治疗前后血液流变学指标[全血高切黏度、全血低切黏度、血浆黏度]、血清炎性因子[白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、可溶性细胞间黏附分子-1(sICAM-1)]、神经相关因子[Tau蛋白、生长激素(GH)、胰岛素生长因子-1 (IGF-1)、金属蛋白酶-9 (MMP-9)]、生长发育指标[智能发育(MDI)、运动发育(PDI)]值的变化。结果:联合组总有效率为94.12%,针刺组、抚触按摩组分别为76.47%、70.59%,针刺组、抚触按摩组与联合组比较,差异有统计学意义(P<0.05)。治疗4周、8周后,3组血浆全血高切黏度、全血低切黏度、血浆黏度均较治疗前下降(P<0.05);治疗4周、8周后,联合组血浆全血高切黏度、全血低切黏度、血浆黏度均低于同一时间段的针刺组、抚触按摩组(P<0.05)。治疗4周、8周后,3组血清IL-6、TNF-α、sICAM-1水平均较治疗前下降(P<0.05);治疗4周、8周后,联合组血清IL-6、TNF-α、sICAM-1水平均低于同一时间段的针刺组、抚触按摩组(P<0.05)。治疗4周、8周后,3组血清Tau蛋白、MMP-9水平均较治疗前下降,血清GH、IGF-1水平均较治疗前上升(P<0.05);治疗4周、8周后,联合组血清Tau蛋白、MMP-9水平低于同一时间段的针刺组、抚触按摩组,血清GH、IGF-1水平高于同一时间段的针刺组、抚触按摩组(P<0.05)。治疗4周、8周后,3组MDI、PDI评分均较治疗前升高(P<0.05);治疗4周、8周后,联合组MDI、PDI评分均大于同一时间段的针刺组、抚触按摩组。随访6个月,Ridit检验显示,联合组预后情况优于针刺组、抚触按摩组(P<0.05);针刺组与抚触按摩组预后情况比较,差异无统计学意义(P>0.05)。结论:针刺联合循经按摩疗效确切,可调节NHIE患儿血液流变情况,抑制炎症因子分泌,调节神经相关因子水平,有助于患儿智力及运动发育,预后良好。

Objective:To observe the curative effect of acupuncture combined with meridian massage in the treatment of neonatal hypoxic-ischemic encephalopathy(NHIE) at the recovery stage.Methods:A total of 102 cases of NHIE children in recovery period were selected as the research objects,and were divided into acupuncture group,the massage group and the combination group according to different treatment schemes,with 34 cases in each group.All the three groups were given routine rehabilitation treatment.On this basis,the acupuncture group was given acupuncture treatment,the massage group was given meridian massage,and the combination group was given acupuncture combined with meridian massage.The clinical effects and prognosis were compared among the three groups.The changes in hemorheological indexes(whole blood high shear viscosity,whole blood low shear viscosity,and plasma viscosity),serum inflammatory factors [interleukin-6(IL-6),tumor necrosis factor-α(TNF-α),and soluble intercellular adhesion molecule-1(sICAM-1)],neuro-related factors [Tau protein,growth hormone(GH),insulin growth factor-1(IGF-1),and metalloproteinase-9(MMP-9)],and growth and development indexes [mental developmental index(MDI) and psychomotor developmental index(PDI)] were compared among the three groups.Results:The total effective rate was 94.12% in the combination group,76.47% in the acupuncture group and 70.59% in the massage group respectively,the difference being significant(P<0.05).After 4 and 8 weeks of treatment,the whole blood high shear viscosity,whole blood low shear viscosity and plasma viscosity in the three groups were decreased when compared with those before treatment(P<0.05).After 4 and 8 weeks of treatment,whole blood high shear viscosity,whole blood low shear viscosity and plasma viscosity in the combination group were lower than those in the acupuncture group and the massage group at the same time(P<0.05).After 4 and 8 weeks of treatment,the levels of IL-6 and TNF-α and sICAM-1 in three groups were decreased when compared with those before treatment(P<0.05).After 4 and 8 weeks of treatment,the levels of IL-6 and TNF-α and sICAM-1in serum in the combination group were lower than those in the acupuncture group and the massage group at the same time(P<0.05).After 4 and 8 weeks of treatment,the levels of Tau protein and MMP-9 in serum in the three groups were decreased when compared with those before treatment,and the levels of GH and IGF-1 in serum were increased when compared with those before treatment(P<0.05);after 4 and 8 weeks of treatment,the levels of Tau protein and MMP-9 in serum in the combination group were lower than those in the acupuncture group and the massage group at the same time,and the levels of GH and IGF-1 in serum were higher than those in the acupuncture group and the massage group at the same time(P<0.05).After 4 and 8 weeks of treatment,the MDI and PDI scores in the three groups were increased when compared with those before treatment(P < 0.05);after 4 and 8 weeks of treatment,the MDI and PDI scores in the combination group were higher than those in the acupuncture group and the massage group at the same time.After 6 months of follow-up,Ridit test showed that the prognosis of the combination group was better than that in the acupuncture group and the massage group(P<0.05);there was no significant difference in the prognosis between the acupuncture group and the massage group(P>0.05).Conclusion:Acupuncture combined with meridian massage has a definite curative effect,which can regulate the hemorheology of NHIE children,inhibit the secretion of inflammatory factors,and regulate the levels of nerve-related factors,which is helpful to children's intellectual and motor development,with a good prognosis.