【作者】 徐博佳；

【导师】 孙申田；

【作者基本信息】 黑龙江中医药大学 ， 针灸推拿学， 2008， 博士

【摘要】 周围神经损伤后神经的再生和神经功能的恢复一直是医学及其相关领域研究的重点,具有重要的理论研究意义和临床应用价值。针刺已经被证明是一种有效的治疗周围神经损伤的手段,目前已经被广泛的应用于临床,用于周围神经损伤后促进周围神经功能恢复的康复治疗。在临床中我们发现,治疗中患者的恢复情况与年龄有关,但是这种关系并不符合我们传统的“年龄越小,恢复越好;年龄越大,恢复越差”的观念,而是对于相同程度的周围神经损伤,幼年及老年患者的神经功能恢复均不及壮年患者。因此,本文研究年龄因素对急性周围神经损伤后神经功能修复的影响,以此为基础研究针刺对不同年龄组急性周围神经损伤修复的治疗作用和治疗方法。首先,通过动物实验研究年龄因素对大鼠急性实验性坐骨神经损伤后功能修复的影响以及针刺的治疗作用和方法。以大鼠为动物实验研究对象,应用钳夹法制作大鼠坐骨神经损伤模型,造模成功后,随机将幼年、壮年、老年组大鼠分为模型组、普通针刺组及本文方法(电针头针、背俞穴、神经干)治疗组。模型组造模成功后不进行任何治疗;普通针刺治疗组:受损部位局部取穴,针刺环跳及委中两穴;本文方法治疗组:电针刺激头部运动区、损伤神经脊髓相应位置及损伤神经干。两治疗组在造模成功后立即进行针刺治疗,持续时间30min,每天针刺治疗一次,直至处死。对比各组一周、两周、三周、四周时坐骨神经功能指数评分、神经传导速度、腓肠肌肌容量的变化,脊髓腰骶膨大活化caspas-3荧光值及脊髓腰骶膨大凋亡细胞百分比。结果显示模型组各时间段坐骨神经功能指数评分、神经传导速度变化不明显,腓肠肌明显萎缩,坐骨神经缺损症状幼年组重于壮年组,老年组重于壮年组,有明显的年龄差异P＜0.05;普通针刺组坐骨神经功能修复情况明显好于模型组P＜0.05,各年龄组坐骨神经功能缺损症状幼年组及老年组均重于壮年组P＜0.05,有明显的年龄差异;本文方法治疗组各年龄组坐骨神经功能指数明显减少、神经传导速度明显加快、腓肠肌萎缩不明显,坐骨神经功能缺损症状明显好于模型组及普通针刺组P＜0.05,各年龄组神经功能缺损症状差别不明显P＞0.05。各组坐骨神经损伤侧脊髓腰骶膨大活化caspas-3荧光值及脊髓腰骶膨大凋亡细胞百分比明显高于健侧P＜0.05,与模型组及普通针刺组比较,本文方法组caspas-3荧光值及凋亡细胞百分比明显降低P＜0.05,其作用幼年强于壮年,壮年强于老年。结果表明,年龄因素对大鼠急性实验性坐骨神经损伤后神经功能修复有明显的影响,幼年及老年大鼠坐骨神经功能修复较壮年组差,本文方法对大鼠急性实验性坐骨神经损伤有明显的治疗作用,并可以明显抑制由于坐骨神经损伤诱发的脊髓神经元的凋亡,改善年龄因素对急性实验性坐骨神经损伤的影响,具有较好的促进大鼠坐骨神神经功能修复的作用。其次,本文以动物实验为基础,从临床角度进一步验证本文方法对急性周围神经损伤的治疗作用及能否改善年龄因素对急性周围神经损伤后功能修复的影响。临床实验以周围性面神经麻痹急性期患者为研究对象,随机将不同年龄组患者随机分为普通针刺组及本文方法治疗组,治疗过程中通过对患者进行面神经运动功能量化评分及面神经功能分级的测定,来观察两种方法对不同年龄组周围性面神经麻痹患者的治疗作用,结果,两种针刺方法对周围性面神经麻痹急性期都有促进面神经恢复的功能,本文方法治疗组好于普通针刺组P＜0.05,两者有明显差异;幼年及老年普通针刺组与成年普通针刺组比较有明显差别P＜0.05;本文方法幼年、壮年、老年组患者面神经功能恢复情况无明显差别P＞0.05。结果表明,本文方法对各年龄组周围性面神经麻痹患者均有较好的促进面神经功能恢复的作用,并可以减轻由年龄因素对面神经功能恢复的影响。最后,本文通过上述实验研究得出结论,对于周围神经损伤早期应用电针刺激头部运动区、损伤神经脊髓相应位置及损伤神经干,可以促进神经功能的恢复,抑制因神经损伤诱发的脊髓神经细胞凋亡,可以克服年龄因素对周围神经损伤修复所带来的不利影响,从而使受损伤的周围神经处于理想的修复状态,更好的修复其功能。更多还原

【Abstract】 The nerve regeneration and the nerve function restoration after peripheral nerve damage have been a key point of the medicine and the related area research, and have the important fundamental research significance and the clinical practice value. The acupuncture has already been proved to be an effective treatment method of peripheral nerve damage, applied in clinical widely at present and applied to promote recovery treatment of the peripheral nerve function restoration after the peripheral nerve damage. We have discovered in clinical, the restoration situation of patients in treatment is related to their age, but this kind of relations do not conform to our tradition idea that the age is bigger and restoration is worse. However, regarding the peripheral nerve damage in the same degree, the childhood and the old age patients’ nerve function restoration are inferior to the mature patients’. Therefore, this article mainly investigates the influence of age factor to the function restores after acute peripheral nerve damage, taking this as basic investigate therapeutic action and method of acupuncture to different age groups acute peripheral nerve damage.First, we investigate the influence of age factor to the function restoration after acute peripheral nerve damage and the acupuncture therapeutic action and method through the animal experimentation. Taking the big mouse as the animal experimentation study object, using Clamps Method to make the big mouse sciatic nerve damage model, after having maked the model, the childhood, mature and the old age group big mouse divide into the model group, the ordinary acupuncture group and the article method treatment group stochastically. After the model group makeing the mold succeed, do not carry on any treatment; ordinary acupuncture treatment group: select an acupuncture point in the region of the illness, the acupuncture link jumps and in the committee two holes; this article method treatment group: stimulate using the piquada forehead motor area, damage nerve spinal cord relevant position and damage nerve root. Two treatment groups carry on the acupuncture treatment immediately after making the mold succeeds, lasting out 30min, acupuncture treat one time daily, and execute four weeks later. Contrast each group after 7 days, two weeks, three weeks and four weeks, the sciatic nerve function index grading, the nerve conduction speed, the fei intestines myo-capacity’s change, model group in various time section sciatic nerve function index grading, change of the nerve conduction speed is not obvious, the fei intestines myo-capacity atrophy obviously, the peripheral nerve damage symptom childhood group is more serious than the mature group, the old age group is more serious than the mature group, and there’s obvious age difference P<0.05; the ordinary acupuncture group is better than the model group obviously in peripheral nerve function restoration P<0.05, childhood group and the old age group are more serious than the mature group in the damage symptom of the nerve function P<0.05, and there is obvious age difference.The method treatment in article various age groups sciatic nerve function index obvious reduction, the nerve conduction speed speeds up, the fei intestines amyotrophy not to be obvious, nerve function damage symptom obvious is better than model group and ordinary acupuncture group P<0.05, the difference in the damage symptom of nerve function of each age groupis not obvious.The result indicated that this article method has the obvious therapeutic action to the acute peripheral nerve damage, and may improve the age factor to the acute peripheral nerve damage influence, has a better function in promoting nerve function restoration.Next, this article takes the animal experimentation as a foundation, from the clinical angle confirms this article method to the treatment function of acute peripheral nerve damage and whether to improve the age factor to the influence of the acute peripheral nerve damage’s therapeutic action after acute peripheral nerve damage the function restoring. The clinical experiment takes the periphery facial nerve paralysis acute stage patient as the object of study, divides stochastically different age groups patients into the ordinary acupuncture group and this article method treatment group, and in the course of treatment, through carrying on facial nerve movement function quantification grading and the facial nerve function graduation determination to the patient, observes two methods to the different age groups around the facial nerve paralytic’s therapeutic action. Finally, two acupuncture methods have the function to the periphery facial nerve paralysis acute stage the promotion facial nerve restores, this article method treatment group is better than ordinary acupuncture group P<0.05, both have obvious difference. The childhood and the old age ordinary acupuncture group have obvious difference with the grown-up ordinary acupuncture group comparison P<0.05. By this article method childhood, mature, the old age group in patient facial nerve function restores situation have not obvious difference P>0.05. The result indicated that this article method the facial nerve paralytic has the function which to various age groups around the good promotion facial nerve function restores, and may reduce the influence which restores by the age factor facial nerve function.Finally, this article draws the conclusion through the above-mentioned experimental study, in the earlier period, using the piquada stimulation forehead motor area, the damage nerve spinal cord relevant position and the damage nerve regarding the peripheral nerve damage may promote the restoration of nerve function, and may overcome the adverse effect which caused by the age factor to restoration of the peripheral nerve damage, thus make the peripheral nerve damage be at the ideal restoration condition, restore its function better.更多还原