“醒脑开窍”针法治疗中风适宜技术在灵武地区推广应用的评价

目的 "醒脑开窍"针法治疗中风的适宜技术(简称技术)在宁夏灵武的推广与应用进行分析和评价研究,以明确其推广应用效果。方法抽取宁夏地区灵武市1个县、8个乡、51个村的医疗卫生机构,选取中期调查数据库农村卫生适宜技术服务使用登记表,计算技术知晓率、技术应用率,统计医务人员培训人次和临床有效率;设计调查问卷,对技术的科学性、实效性、成熟程度、可推广性、安全性、可接受性、易操作性、通过培训对技术的掌握程度进行评价。结果研究登记观察病例243例。灵武市县、乡、村医疗机构的技术知晓率为70%、50%、30%,应用率为89%、81%、64%,临床医务人员培训率96%、84%、76%,技术治疗有效率为87.34%、88.54%、89.71%。技术综合评价,"高"和"较高"的比率分别为:科学性73%%和23%、实效性59%和30%、成熟度59%和32%、可推广性52%和27%、安全性52%和45%、可接受性48%和32%、易操作性34%和45%、中医特色明显75%和23%;一次培训掌握16%和45%。结论 "醒脑开窍"针法治疗中风的适宜技术在宁夏推广、培训和应用状况理想;技术疗效好,安全性和成熟度高,操作规范,稳定性好,难易度适中,层次卫生技术人员可以掌握,适宜推广应用。

醒脑开窍针法对非痴呆性血管认知障碍的影响

目的观察醒脑开窍针法治疗非痴呆性血管认知障碍(VCIND)的疗效并探讨其可能的作用机制。方法82例VCIND患者基于Zelen’s设计分为针刺组46例和西药组36例,两组患者均给予口服拜阿司匹林肠溶片、阿托伐他汀钙片作为基础治疗;西药组加用口服盐酸多奈哌齐片5 mg,每日1次;针刺组加用醒脑开窍针法治疗,每日2次,每周6天,两组均治疗8周。治疗前及治疗4、8周后评价两组患者蒙特利尔认知评估量表(MoCA)、日常生活能力量表(ADL)评分结果,并观察血清降钙素基因相关肽(CGRP)、淀粉蛋白前β位分解酶1(BACE1)及其mRNA水平。治疗4、8周后评价临床疗效。结果针刺组治疗4、8周后总有效率分别为64.86%(24/37)、89.19%(33/37),均高于西药组的54.84%(17/31)、80.65%(25/31)(P<0.05)。两组患者治疗4、8周后MoCA、ADL评分均较治疗前显著改善,且针刺组优于西药组(P<0.05)。两组患者治疗4、8周后血清CGRP及其mRNA均升高,BACE1及其mRNA均降低,且针刺组治疗4、8周改善均优于西药组(P<0.05)。结论醒脑开窍针法可显著改善VCIND患者临床症状,其机制可能涉及调节神经中枢血管舒张因子CGRP和神经元损害蛋白标志物BACE1表达。

Study of remote efficacy and safety of acupuncture on cerebral infarction at recovery phase:multi-central randomized comparison trial

Objective To explore the remote efficacy and safety of consciousness-restoring resuscitation （Xingnao Kaiqiao, short for XNKQ） acupuncture on cerebral infarction at recovery phase. Methods Two hundred and thirty-four cases of cerebral infarction at recovery phase were randomized into XNKQ group and routine acupuncture group （routine group） in light of SAS code. One hundred and sixteen cases in the XNKQ group were treated with XNKQ acupuncture （once a day, totally 4 weeks） and routine treatment with western medicine. One hundred and eighteen cases in the routine group received routine acupuncture and routine treatment with western medicine. Follow-up lasted 6 months. Primary indexes： the situations of survival, treatment and recurrence at the end of follow-up. Secondary indexes： assessment of nerve functions at the end of follow-up and rate of adverse events during acupunc- ture. Results In 6 months follow-up, the mortality was 0.86% and rate of continuous treatment was 36.21% in the XNKQ group and they were 1.69% and 36.44% respectively in the routine group. The differences did not present statistical significance between the two groups （X^2 = 0.29, P=0.59; X^2 = 0.32, P = 0.57）. Concerning to the decrease of recurrence rate and improvement of nerve functions, the out-comes in the XNKQ group were superior to those in the routine group （P〈0.01）. Severe adverse events did not happen in the two groups. Conclusion XNKQ acupuncture is safe therapy and its remote efficacy is superior to that of routine acupuncture in the decrease of recurrence rate and improvement of nerve functions.