【作者】 许能贵；

【导师】 勒瑞；

【作者基本信息】 广州中医药大学 ， 针灸学， 2001， 博士

【摘要】 缺血性脑血管疾病，中医学将其归属为“中风”范畴，以其发病、死亡、致残率高而严重危害着人类健康，对该病的防治是重要的医学及社会课题。针灸疗法因其简、便、验、廉在治疗缺血性中风的疾病中占有一定的优势，且疗效也早已被国内外同行及患者首肯。为了更系统更全面地探讨针灸治疗缺血性中风的作用机制，本文从以下几个方面进行了研究。一．文献研究 推本溯源，从我国第一部中医学系统经典著作《黄帝内经》开始，直至唐宋元明清时期，对古文献中有关中风的病名、病因病机及针灸治疗等方面进行了探讨。并就近几年来针刺治疗缺血性中风的临床研究概况和现代医学对缺血性脑损伤的病理、生理学基础及针刺干预作用的研究进展作一系统综述。为进一步研究针刺治疗缺血性中风奠定了理论基础。二．实验研究 本研究选择凝闭大鼠大脑中动脉致局灶性脑缺血为模型，针对缺血性脑损伤的病理生理机制，采用电生理学、形态学、生物化学、细胞化学、放射免疫学等方法，系统全面地研究针刺督脉经穴对脑缺血后继发神经元的损伤的保护作用，其结果如下：1．致大鼠局灶性脑缺血10min、60min和120min后，缺血区局 部脑血流量（rCBF）迅速下降，电针具有改善缺血区脑组织局 部血流量的作用，阻止脑缺血后血流量下降的效应。2．脑缺血后脑内产生大量的自由基，电针可抑制缺血区自由基的 产生，提高缺血区脑组织SOD活性，降低MDA含量，从而 阻止脂质过氧化反应对缺血神经元的损伤。针刺对脑缺血后神经元损伤保护作用的研究 中文摘要3．脑缺血后缺血区脑组织中的NO、NOS及ET－l水平呈增高趋 势，电针可逆转这一趋势，从而改善脑血流量，有利于保护缺 血神经元的进一步损伤。4．脑缺血后神经细胞的机能活动明显受到抑制，电针可显著改善 脑缺血后自发脑电（EEG）和体感诱发电位（SEP）的变化， 从电生理学角度证明电针具有保护缺血性脑神经元的机能活 动。5．脑缺血后兴奋性氨基酸（EAA）过度释放，导致缺血区谷氨酸 （GIS）和天门冬氨酸（ASp）积蓄增多。电针可降低缺血区 脑组织中m 和ASp的含量，从而有效抑制“兴奋毒性”作用， 保护缺血性脑损伤。6．脑缺血后脑内单胺类神经递质代谢紊乱，缺血区脑组织内多巴 胺（DA）、5－羟色胺（5－HT）和去甲肾上腺素（NE）含量明显 降低，电针可纠正这一现象，从而保护脑的缺血性损伤。7．胞内旷”超载是脑缺血后神经细胞损伤和死亡的“最后共同通 路”，脑缺血后大量对”涌入胞内，导致胞内＊”超载，针刺 叮阻止C／”向胞内迁移，调节细胞钙稳态，保护缺血神经元免 受损伤。8．光镜和电镜研究证明，电针可有效保护缺血后神经元的形态结 构，井可减轻缺血区脑组织水肿，从而保护缺血性脑损伤。三．结论 1．通过对古今文献的研究，我们认为针刺治疗缺血性中风具有 科学的理论依据和良好的临床疗效。2．通过实验研究，我们发现针刺可通过全面调整脑缺血后脑功 能的失衡状态，包括脑血流量、脑组织的水含量、脑细胞的机 能活动、脑神经生化的代谢紊乱、脑的形态结构和脑细胞的 Cay离子稳态等，从而保护脑缺血后继发神经元的损伤。3．由于胞内仇”超载是脑缺血后神经细胞损伤和死亡的“最后 共同通路”，结合本研究的实验结果，我们认为针刺调节钙稳 2针刺对脑缺血后神经元损伤保护作用的研究 中义摘要 态是针刺保护脑缺血后继发神经元损伤的最主要的作用机理。更多还原

【Abstract】 In traditional Chinese medicine, Ischemic Cerebral Vascular disease that categorized into wind stroke shows high rate of attack, death and disability, the prevention and treatment of which is an important subject on medicine and society for it?s terrible harm to people?s health. Acupuncture for ischemic stroke is much better than other treatments with convenience, availability, cheapness and convinced by both experts and patients of ischemic stroke all over the world. In order to study the action mechanism of acupuncture and moxibustion in treating this disease more systema-ically and comprehensively, the following context has several aspects. J.Literature research Tracing the originals, from the appearance of Yellow Emperior?s Internal Medicine as the first classical works of traditional Chinese medicine to the dynasties of Tang, Shong, Yuan, Ming and Qing, the predecessors had done much to ancient medical books in the aspects of the stroke?s term, etiology, pathogenesis and therapy. In the late years, many articles carefully explain much research of the disease such as clinical experiments, ischemic cerebral injury of pathological and physiological basis in modern science and acupuncture effect. All that has been done founds the theorical basis of further studying acupuncture for ischemic stroke. 2.Experiments research Thinking of the mechanism of pathology and physiology about the cerebral ischemia injury, we take up focal cerebral ischemia by occlusion of the middle cerebral artery (MCAO) in the rat brain as the experiment model. In the course many methods were used such as electrophysiology, morphology, biochemistry, cytochemistry etc. With carefully studying the subsequential neuronal?s injury for cerebral ischemia after acupuncturing the Du channel?s acupoints, we can deduce some conclusions as the following: 1) The part cerebral blood flow in the ischemia district diminishes rapidly after keeping the rats focal cerebral ischemia forl0, 60 and 120 minutes, which shows therapy of electro? acupuncture is able to improve the region cerebral blood flow (rCBF) in the ischemia district and prevent the blood flow from decreasing. 2) A lot of free radicals have been produced in the brain without enough blood. The therapy of electro-acupuncture, however, can restrain the production of free radicals in ischemia districts, enhance superoxide dismutase?s (SOD) activity of cerebral tissues, reduce malonyldialdehyde’s (MDA) content. Conse? quentialy it can prevent the injury of ischemia neuron, which caused by the reaction of lipid peroxidation. 3) The magnitude of nitric oxide (NO), nitrix oxide synthase (NOS) and endothelin?(ET-l) in the ischemia district of cerebral tissues goes up under cerebral ischemia. The electrotherapy can deteriorate this tendency so as to improve the cerebral blood flow and protect the ischemia neuron from being further injuried. 4) The nerve cells activity under cerebral ischemia is obviously restrained, but the electrontherapy can apparently improve the changes of spontaneous echoncephalography (EEG) and somatosensory evoked potential (SEP), so which proves that electrotherapy has the function of protecting the activity of nerve cells for cerebral ischemia. 5)更多还原