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银杏达莫联合针灸康复治疗外伤性脑出血后神经功能恢复的研究
作者:田守森1  田雯艳2  陆强3  刘珍1  刘倩倩1  潘亮4 
单位:1. 河北省沧州中西医结合医院 急诊科, 河北 沧州 061000;
2. 河北省沧州中西医结合医院 脑病三科, 河北 沧州 061000;
3. 河北省沧州中西医结合医院 心内二科, 河北 沧州 061000;
4. 河北省沧州中西医结合医院 脑外一科, 河北 沧州 061000
关键词:银杏达莫 针灸 外伤性脑出血 神经功能 炎症反应 
分类号:R743.34
出版年·卷·期(页码):2019·47·第二期(131-136)
摘要:

目的:探讨银杏达莫联合针灸康复治疗外伤性脑出血(TBI)对神经功能恢复的影响。方法:80例TBI患者采用随机数字表法分为对照组和治疗组,各40例。两组均给予西医常规治疗,在此基础上对照组给予针灸康复治疗(1次·d-1),治疗组给予银杏达莫注射液(40 ml·d-1)联合针灸康复(1次·d-1)治疗,两组均持续治疗14 d。比较两组患者治疗前和治疗后7 d、14 d血清神经生长因子(NGF)、脑源性神经营养因子(BDNF)、肿瘤坏死因子-α(TNF-α)、白细胞介素-4(IL-4)、白细胞介素-8(IL-8)的水平,和两组患者治疗前和治疗后14 d、20 d的Fugl-Meyer运动功能(FMA)评分、格拉斯昏迷评分量表(GCS)评分、美国国立卫生研究院卒中量表(NIHSS)评分。结果:治疗前两组各项观察指标的数值差异均无统计学意义(P>0.05);两组治疗后7 d、14 d的血清NGF、BDNF水平均高于治疗前(P<0.01),且治疗组血清NGF、BDNF水平显著高于对照组(P<0.01);对照组治疗后7 d、14 d的血清IL-4、IL-8水平均低于治疗前(P<0.05或P<0.01),治疗组治疗后7 d、14 d的血清TNF-α、IL-4、IL-8水平均低于治疗前(P<0.01),治疗后7 d,治疗组血清TNF-α、IL-8水平显著低于对照组(P<0.05或P<0.01),治疗后14 d,治疗组血清TNF-α、IL-4、IL-8水平显著低于对照组(P<0.05或P<0.01);两组治疗后14 d、20 d的FMA评分、GCS评分均高于治疗前(P<0.01),NIHSS评分显著低于治疗前(P<0.01);治疗后14 d、20 d,治疗组的FMA评分、GCS评分显著高于对照组(P<0.01),NIHSS评分显著低于对照组(P<0.01)。结论:银杏达莫联合针灸康复治疗TBI能够促进神经功能的恢复,减少炎症反应,提高患者的综合运动功能,并减轻其昏迷程度,应用效果优于针灸治疗。

Objective:To investigate the effect of ginkgo-dipyridamole combined with acupuncture on the recovery of neural function in patients with traumatic brain injury(TBI).Methods:A total of 80 patients with TBI treated from March 2017 to March 2018 were selected as research objects and were divided into control group and treatment group according to the random number table method(n=44, each). The two groups were given routine treatment of western medicine, the control group was given treatment of acupuncture(1 time a day) on top ofthe routine treatment, and the treatment group was giventreatment of ginkgo-dipyridamole injection combined with acupuncture on top of the routine treatment. The two groups were treated for 14 days continuously.The levels of serum nerve growth factor(NGF), brain-derived neurotrophic factor(BDNF), tumor necrosis factor-α(TNF-α), interleukin-4(IL-4), interleukin-8(IL-8) were compared between the two groups before treatment and 7 days, 14 days after treatment. The scores of Fugl-Meyer assessment(FMA), glasgow coma scale(GCS), and national instiutes of health stroke scale(NIHSS) were compared between two groups before treatment and 14 days, 20 days after the treatment.Results:There were no significant differences in all observation indexes between the two groups before treatment(P>0.05). 7 days and 14 days after treatment, the levels of serum NGF and BDNF in the two groups were higher than those before treatment(P<0.01), and the levels of serum NGF and BDNF in the treatment group were higher than those in the control group significantly(P<0.01). 7 days and 14 days after treatment, the levels of serum IL-4 and IL-8 in the control group were lower than those before treatment(P<0.05 or P<0.01). 7 days and 14 days after treatment, the levels of serum TNF-α, IL-4 and IL-8 in the treatment group were lower than those before treatment(P<0.01). 7 days after treatment, the levels of serum TNF-α and IL-8 in the treatment group were lower than those in the control group(P<0.05 or P<0.01). 14 days after treatment, the levels of serum TNF-α, IL-4 and IL-8 in the treatment group were lower than those in control group(P<0.05 or P<0.01). 14 days and 20 days after treatment, the scores of FMA and GCS in the two groups were higher than those before treatment(P<0.01), while the scores of NIHSS the were lower than those before treatment(P<0.01). 14 days and 20 days after treatment, the scores of FMA and GCS in treatment group were higher than those in the control group(P<0.01), and the scores of NIHSS in treatment group were lower than those in control group(P<0.01).Conclusion:Ginkgo-dipyridamole combined with acupuncture in the treatment of TBI can promote the recovery of nerve function, reduce inflammatory reaction, improve the comprehensive motor function of patients, and reduce the degree of coma, and the application effect is better than that of acupuncture.

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