【作者】 宋坚；

【导师】 倪光夏；

【作者基本信息】 南京中医药大学 ， 中医学， 2010， 硕士

【摘要】 目的：系统观察针药结合治疗脑梗死在不同时期的临床疗效。方法：将符合纳入标准的患者按入院时间分为超早期、急性期和恢复期分别进行观察。超早期：将符合纳入标准的18例患者归类为针药组8例和单纯溶栓组10例。在超早期单纯溶栓组仅以溶栓药物治疗,针药组在溶栓之后予以针刺治疗1次。2组在急性期均予以依达拉奉、丹参酮及奥扎格雷钠治疗。以14天为一个疗程,以神经功能缺损评分和FMA评分为评价指标,在治疗1天后及14天后进行临床疗效评价。急性期：将符合纳入标准的30例患者随机分为针药组14例和药物组16例,针药组予以依达拉奉、丹参酮及奥扎格雷钠治疗及针刺治疗,药物组仅予以上述西药治疗,以14天为一个疗程,以神经功能缺损评分和FMA评分为评价指标,在疗程结束后进行临床疗效评价。恢复期：将符合纳入标准的34例患者随机分为针药组12例,药物组12例,针刺组10例,针药组予以针剌疗法及乙酰谷酰胺、奥扎格雷钠、丹参酮治疗,药物组仅予以上述西药治疗,针刺组仅予以针刺治疗,以14天为1个疗程。以神经功能缺损评分和B I指数为评价指标,在疗程结束后进行临床疗效评价。结果：超早期：治疗14天后,2组均取得较好的临床疗效,针药组有效率为87.5%,单纯溶栓组有效率为90%,针药组与单纯溶栓组相比无统计学差异,P>0.05；治疗1天及14天后两组的神经功能缺损评分及肢体运动功能评分均无明显差异,P>0.05。急性期：治疗14天后,2组均取得较好的临床疗效,针药组有效率为100%,药物组有效率为87.5%,2组相比无统计学差异,P>0.05；两组的神经功能缺损评分及肢体运动功能评分均有统计学差异,P<0.05。恢复期：治疗14天后,3组均取得一定的临床疗效,针药组有效率为83.3%,针刺组为80%,药物组为41.3%。3组神经功能缺损评分、Barthel指数评分及临床疗效显示针药组与针刺组均优于药物组,均P<0.05,而针刺组与针药组比较无统计学差异,P>0.05。结论：对于脑梗死患者的治疗,①超早期(6h内)溶栓药物发挥了主要作用,针药结合优势不明显；②急性期(6h后至14天内)神经保护剂和针药结合均具有显著疗效,针药结合并未取得疗效优势,但在神经功能改善和运动功能康复方面仍有明显优势；③恢复期(14天至60天内)针灸发挥了主要的作用,针药结合优势不明显。更多还原

【Abstract】 Objective:To Systematic observation Acupuncture treatment of cerebral infarction in the clinical efficacy of different periods.Methods:The patients met the inclusion criteria were divided into two super-early admission, acute and convalescent phase were observed.Ultra-early:to meet the inclusion criteria of the 18 patients classified as acupun cture group and 8 cases of 10 patients with thrombolysis alone. Only thrombolytic therapy thrombolytic group, acupuncture group to be treated with acupuncture after thrombolytic 1.2 Groups will be in the acute phase of edaravone, Tan, and ozagrel treatment.14-day cycle, With neurological deficit score and FMA score assessed 1 day after treatment and 14 days after the change, respectively the treatment.Acute phase:the 30 cases meeting the inclusion criteria were randomly divided into acupuncture group and drug group in 14 cases,16 cases to be edaravone treated group, Tan and Ozagrel therapy and acupuncture therapy group to be the only Western treatment to 14 days for a treatment to neurological deficit score and FMA score for the evaluation of indicators, after the end of treatment clinical evaluation.Recovery:The 34 patients met the inclusion criteria were randomly divided into acupuncture group 12 cases,12 cases of simple drug group,10 cases of simple acupuncture group, Acupuncture and acetyl group to glutamine, ozagrel, Tan, western medicine to be simple drug group only treatment, only to be simple acupuncture acupuncture treatment to 14 days to a course of treatment. With neurological deficit score and the BI index for the evaluation, the clinical effect after the end of treatment evaluation.Result:Ultra-early:After 14 days of treatment,2 groups were simply made good clinical efficacy, acupuncture group was 87.5% effective, simple and effective rate of 90% of the thrombolytic group, acupuncture group compared with thrombolysis alone no significant difference, P> 0.05; treatment of 1 day and 2 weeks after the two groups of neurological deficit score and limb motor function score were not significantly different, P> 0.05.Acute phase:After 14 days of treatment,2 groups were achieved better clinical efficacy, acupuncture group was 100% effective, the effective rate of 87.5% drug group, compared with no significant difference between 2 groups P>0.05; two groups of nerve function deficit score and limb motor function score were signify cantly different,P<0.05.Recovery period:After 2 weeks of treatment, three groups have achieved a certain degree of clinical efficacy, acupuncture group was 83.3%, acupuncture group, 80%, drug group was 41.3%. Group 3 neurological deficit score Barthel Index score and the clinical efficacy have shown that needle acupuncture group was better than drugs and drug group, both P<0.05, while The acupuncture group and the acupuncture group showed no significant difference, P> 0.05.Conclusion:For the treatment of patients with cerebral infarction,①super early (6h period) played a major role in thrombolytic drugs, acupuncture combined with obvious advantages;②acute phase (6 hours to 14 days), and neuroprotective agents all have Acupuncture significant effect, Acupuncture efficacy advantage was not achieved, but neurological improvement and rehabilitation of motor function is still obvious advantage③In the recovery period (14 days to 60 days), played a major role in acupuncture, acupuncture combined with obvious advantages.更多还原