溫針灸對ICU急性腦梗死患者腦血流動力學的影響

楊丹丹 陳洪英 劉瑩瑩

[摘要] 目的 探討溫針灸對ICU急性腦梗死患者腦血流動力學的影響。 方法 選擇2018年7～12月在醫院診斷治療的急性腦卒中患者60例為研究對象，隨機分為觀察組與對照組，每組30例。對照組采用常規治療，觀察組在常規治療基礎上給予溫針灸治療。比較兩組治療前后腦血流動力學指標，NIHSS評分，Fugl-Meyer運動評分。 結果 （1）治療后，兩組腦血流動力學Vs、Vm水平均較治療前顯著提高，差異有統計學意義（P<0.05）;治療后，觀察組腦血流動力學Vs、Vm水平顯著高于對照組，差異有統計學意義（P<0.05）。（2）治療后，兩組NIHSS評分均較入組時顯著下降，差異有統計學意義（P<0.05）;治療后，觀察組NIHSS評分均顯著低于對照組，差異有統計學意義（P<0.05）。（3）兩組治療后Fugl-Meyer運動評分均較入組時顯著提高，差異有統計學意義（P<0.05）;治療后，觀察組Fugl-Meyer運動評分顯著高于對照組，差異有統計學意義（P<0.05）。 結論 溫針灸能夠顯著改善急性腦梗死患者腦血流動力學指標，改善NIHSS評分及Fugl-Meyer運動評分。

[關鍵詞] 溫針灸;ICU;急性腦梗死;腦血流動力學;NIHSS;Fugl-Meyer運動功能評分

[中圖分類號] R246.6? ? ? ? ? [文獻標識碼] B? ? ? ? ? [文章編號] 1673-9701（2020）19-0143-04

Effect of warm acupuncture on cerebral hemodynamics in patients with acute cerebral infarction in ICU

YANG Dandan? ?CHEN Hongying? ?LIU Yingying

Department of Critical Care Medicine， Taizhou Hospital in Zhejiang Province， Linhai? ?317000， China

[Abstract] Objective To investigate the effect of warm acupuncture on cerebral hemodynamics in patients with acute cerebral infarction in ICU. Methods Sixty patients with acute stroke diagnosed and treated in the hospital from July to December 2018 were enrolled in the study. They were randomly divided into observation group and control group， with 30 cases in each group. The control group received conventional treatment， and the observation group received warm acupuncture treatment on the basis of conventional treatment. The cerebral hemodynamic parameters， NIHSS score and Fugl-Meyer exercise score between two groups before and after treatment were compared. Results （1）After treatment， the cerebral hemodynamics Vs and Vm levels in the two groups were significantly higher than those before treatment（P<0.05）. After treatment， the cerebral hemodynamics Vs and Vm levels in the observation group were significantly higher than those of the control group， and the difference was statistically significant（P<0.05）. （2） After treatment， the NIHSS scores of the two groups were significantly lower than those at enrollment（P<0.05）. After treatment， the NIHSS scores of the observation group were significantly lower than those of the control group， and the difference was statistically significant（P<0.05）. （3） The Fugl-Meyer exercise scores of the two groups after treatment were significantly higher than those at enrollment（P<0.05）. And the Fugl-Meyer exercise score of the observation group was significantly higher than that of the control group， with significant difference（P<0.05）. Conclusion Warm acupuncture can significantly improve cerebral hemodynamics in patients with acute cerebral infarction， improve NIHSS score and Fugl-Meyer exercise score.

[Key words] Warm acupuncture; ICU; Acute cerebral infarction; Cerebral hemodynamics; NIHSS; Fugl-Meyer motor function score

腦梗死為缺血性腦卒中，是各種原因所導致腦部血液供應障礙，導致腦組織缺血、缺氧性壞死，出現相應的神經功能缺損。腦梗死占全部腦卒中的60%～80%，我國的發病率大約200萬例/年。大動脈閉塞、心源性栓子、小血管病變是常見的原因。改善腦組織血液供應對減少腦細胞損傷有重要的意義。溫針灸是用艾絨等方法加熱刺入體內的針柄，將針刺與艾灸相結合治療疾病的方法。首次見于《傷寒論》，適用于既需要留針而又適宜用艾灸的病癥，具有溫通經脈、宣行氣血的作用[1-3]。本文將溫針灸用于急性腦梗死患者的治療，分析其對患者腦血流動力學的影響，以期為臨床治療提供參考，現報道如下。

1 資料與方法

1.1 一般資料

選擇2018年7～12月在醫院ICU診斷治療的急性腦卒中患者60例為研究對象。納入標準：符合急性腦梗死的診斷標準，意識清醒，病情穩定，對本次研究知情同意者。排除標準：新發腦梗死，合并腦出血、蛛網膜下腔出血、腦血管畸形、腦腫瘤、嚴重感染，其他系統器質性疾病，血液系統疾病，對針灸治療不能耐受或者有禁忌證，血管炎、凝血機制障礙導致的腦梗死，TIA發作者。……