發(fā)布時(shí)間：2018-06-23 07:03

  本文選題：交叉電項(xiàng)針 + 腦出血��； 參考：《黑龍江中醫(yī)藥大學(xué)》2017年博士論文

【摘要】：目的:創(chuàng)立腦出血后氣切患者治療新針?lè)ā?交叉電項(xiàng)針",評(píng)價(jià)"交叉電項(xiàng)針"對(duì)腦出血后氣切插管患者咳嗽反射重塑、吞咽功能恢復(fù)的療效;通過(guò)豚鼠顱骨不同穿刺深度,不同自體血量注入,建立基底節(jié)腦出血后咳嗽反射障礙豚鼠模型。方法:1.采用隨機(jī)對(duì)照、單盲法,觀察交叉電項(xiàng)針治療腦出血后氣管切開(kāi)插管并留置胃管患者60例,隨機(jī)分為三組,分別為交叉電項(xiàng)針組、電針組、針刺組,每組20例。三組均給予相同穴位的頭針、體針及西醫(yī)抗炎、化痰、營(yíng)養(yǎng)神經(jīng)等基礎(chǔ)治療。交叉電項(xiàng)針組采用"項(xiàng)部交叉電針"配合基礎(chǔ)治療,交叉方式即對(duì)側(cè)風(fēng)池穴連接負(fù)極,同側(cè)的翳風(fēng)穴連接正極;電針組為同側(cè)風(fēng)池穴連接負(fù)極,同側(cè)翳風(fēng)穴連接正極;針刺組僅給予相同穴位針刺不接電針。三組均每次留針30分鐘,每日2次,周六、周日每日1次,療程4周。在治療前、治療后分別評(píng)價(jià)標(biāo)準(zhǔn)吞咽功能量表SSA、GFC咳嗽反射評(píng)分、格拉斯哥意識(shí)障礙評(píng)分GCS和神經(jīng)功能缺損評(píng)分NISS評(píng)分,然后進(jìn)行統(tǒng)計(jì)學(xué)分析。2.根據(jù)豚鼠基底節(jié)不同解剖深度,確定顱骨穿刺深度,將體重300±15g雄性純白SPF級(jí)豚鼠10只,采用戊巴比妥鈉(40mg/kg)腹腔麻醉,斷頭猝死,沿矢狀縫將顱骨切開(kāi),大腦分成左右兩半,以左側(cè)大腦半球穿刺造模為例,分別測(cè)量穿刺深度3mm;4mm;5mm;6mm;7mm和8mm,9mm。觀察不同穿刺深度穿刺針尖與基底節(jié)的位置關(guān)系。3.在明確穿刺進(jìn)針深度基礎(chǔ)上,進(jìn)行注血量研究。根據(jù)注射自體股動(dòng)脈血量的不同,將體重300 ± 15g雄性純白SPF級(jí)豚鼠70只,隨機(jī)分成7組,每組10只。分別為空白對(duì)照組;20 μL組;30 μL組;40 μL組;50μL組;60μL組和70μL組。將未肝素化的自體股動(dòng)脈血以20μL/min速度推進(jìn)基底節(jié)區(qū),留針10min,緩慢出針。4.采用"辣椒素引咳法"觀察基底節(jié)腦出血豚鼠咳嗽次數(shù),于造模后第2天開(kāi)始檢測(cè),計(jì)數(shù)10min內(nèi)咳嗽次數(shù),連續(xù)檢測(cè)7天,每天一次,并于造模后第14d、21d、28d分別檢測(cè)一次,觀察咳嗽次數(shù)變化。結(jié)果:1."交叉電項(xiàng)針"對(duì)吞咽功能的影響,選用標(biāo)準(zhǔn)吞咽功能量表(SSA量表)治療前三組比較,無(wú)統(tǒng)計(jì)學(xué)差異,具有可比性(p0.05)。(1)治療后第一步評(píng)價(jià)三組評(píng)分均有降低,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。交叉電項(xiàng)針組,有13例進(jìn)入第二步評(píng)價(jià),電針組有10例進(jìn)入第二步評(píng)價(jià),針刺組有7例進(jìn)入第二步評(píng)價(jià)。三組與治療前組內(nèi)比較,差異有統(tǒng)計(jì)學(xué)意義(p0.05)。(2)治療后第二步評(píng)價(jià),交叉電項(xiàng)針組有7例進(jìn)入第三步評(píng)價(jià);電針組有3例進(jìn)入第三步評(píng)價(jià)。針刺組有2例進(jìn)入第三步評(píng)價(jià)。差異有統(tǒng)計(jì)學(xué)意義(p0.05)。(3)治療后第三步評(píng)價(jià),三組比較,差異有統(tǒng)計(jì)學(xué)意義(p0.05)。2."交叉電項(xiàng)針"對(duì)咳嗽反射的影響,選用GFC咳嗽反射評(píng)分(GFC評(píng)分)(1)治療前三組無(wú)統(tǒng)計(jì)學(xué)差異,具有可比性(p0.05)。治療后GFC評(píng)分均有降低,差異有統(tǒng)計(jì)學(xué)意義(p0.05)。三組與療前組內(nèi)比較,差異均有統(tǒng)計(jì)學(xué)意義(p0.05)。(2)三組療效,交叉電項(xiàng)針組愈顯率90%;電針組愈顯率50%;針刺組愈顯率40%。經(jīng)X2檢驗(yàn),差異有統(tǒng)計(jì)學(xué)意義(p0.05)。3."交叉電項(xiàng)針"對(duì)意識(shí)障礙的影響,選用格拉斯哥意識(shí)障礙評(píng)分(GCS評(píng)分)(1)治療前三組無(wú)統(tǒng)計(jì)學(xué)差異,具有可比性(p0.05)。治療后GCS評(píng)分均有升高,交叉電項(xiàng)針組與電針組和針刺組比較,差異有統(tǒng)計(jì)學(xué)意義(p0.05)。(2)治療后電針組與針刺組比較,差異無(wú)統(tǒng)計(jì)學(xué)意義(p0.05)。4."交叉電項(xiàng)針"對(duì)神經(jīng)功能缺損的影響,選用神經(jīng)功能缺損評(píng)分(NISS評(píng)分)(1)治療前三組無(wú)統(tǒng)計(jì)學(xué)差異,具有可比性(p0.05)。療后NISS評(píng)分均有降低,差異無(wú)統(tǒng)計(jì)學(xué)意義(p0.05)。(2)三組與療前組內(nèi)比較,差異有統(tǒng)計(jì)學(xué)意義(p0.05)。5.基底節(jié)腦出血并咳嗽反射障礙豚鼠模型的建立進(jìn)針深度5mm-6mm恰好在基底節(jié)區(qū),符合造模要求,選取平均值5.5mm;基底節(jié)區(qū)注射血量20-40 μL組平均咳嗽次數(shù)/10min,大于平均咳嗽次數(shù)50%;60 μL和70μL組平均咳嗽次數(shù)/10min,小于平均咳嗽次數(shù)50%,但2周死亡率100%。50μL組既滿足平均咳嗽次數(shù)/10min,小于平均咳嗽次數(shù)50%,同時(shí)保證4周死亡率20%。50μ L組7d與28d咳嗽次數(shù)比較,無(wú)統(tǒng)計(jì)學(xué)差異(p0.05)。結(jié)論:1.創(chuàng)立了有效治療腦出血后氣切患者的新針?lè)ā?交叉電項(xiàng)針",即同側(cè)翳風(fēng)穴連接正極,對(duì)側(cè)風(fēng)池穴連接負(fù)極;2.交叉電項(xiàng)針能有效促進(jìn)腦出血后氣管切開(kāi)插管患者吞咽功能的恢復(fù);3.交叉電項(xiàng)針能有效促進(jìn)腦出血后氣管切開(kāi)插管患者咳嗽反射的重塑;4.交叉電項(xiàng)針能有效改善腦出血后氣管切開(kāi)插管患者的意識(shí)水平;5.交叉電項(xiàng)針能有效改善腦出血后氣管切開(kāi)插管患者神經(jīng)功能缺損癥狀;6.成功建立了基底節(jié)腦出血咳嗽反射障礙豚鼠模型,參數(shù):穿刺進(jìn)針深度為5.5mm,注血量為50μL,為進(jìn)一步研究針刺療效奠定了動(dòng)物模型基礎(chǔ)。
[Abstract]:Objective: to establish a new acupuncture method, "cross electric needle", to evaluate the effect of "cross electric needle" on the remolding of cough reflex and the recovery of swallowing function in patients with intracerebral hemorrhage after intracerebral hemorrhage, and to establish a guinea pig model of coughing reflex after basal ganglia intracerebral hemorrhage through different depth of puncture in the skull of the guinea pig and the injection of different blood volume. Method: 1. a randomized controlled, single blind method was used to observe 60 cases of tracheotomy intubation and indwelling gastric tube after intracerebral hemorrhage with a single blind method. The patients were randomly divided into three groups, namely, cross electric acupuncture group, electroacupuncture group, acupuncture group, 20 cases in each group. The three groups were given the same acupoint scalp, body acupuncture and Western medicine anti-inflammatory, phlegm, nutritive nerve and other basic treatment. The electroacupuncture group was treated with the "cross Electroacupuncture of the Department of the item" combined with the basic treatment. The cross mode was connected to the side of the wind pool point, the Yifeng acupoint of the same side was connected to the positive pole; the electroacupuncture group was connected to the same side of the wind pond, and the same side of the Yifeng acupoint was connected to the positive pole; the acupuncture group was only given the same acupuncture point without electroacupuncture. Three groups were left for 30 minutes each time, 2 times a day, week, week, week, week, week, week, week, week, week, week, week, week, week, week, week, week, week, week, week, week, week, week, week, and week. 1 times daily for 4 weeks. Before treatment, the standard swallowing function scale SSA, GFC cough reflex score, Glasgow consciousness disorder score GCS and nerve function defect score NISS score were evaluated, and then.2. was statistically analyzed according to the different anatomical depths of the basal ganglia in guinea pigs, and the depth of skull puncture was determined by 300 + 15g males. 10 pure white SPF guinea pigs were treated with pentobarbital sodium (40mg/kg) intraperitoneal anesthesia, sudden death with broken head, and craniotomy along the sagittal seams. The brain was divided into right and right sides. The puncture depth of the left cerebral hemisphere was taken as an example, and the puncture depth 3mm, 4mm; 5mm; 6mm; 7mm and 8mm, 9mm. observed the relationship between the needle tip of the puncture depth and the basal ganglia.3. in different puncturing depth.3. in the Ming Dynasty On the basis of the depth of the puncture needle, the volume of blood injection was studied. According to the difference of the blood volume of autologous femoral artery injection, 70 male guinea pigs of 300 15g male pure white SPF were randomly divided into 7 groups, 10 rats in each group, respectively, 20 u L group, 30 mu L group, 40 mu L group, 50 mu L group, 60 mu L group and 70 u L group. The unheparinated autologous femoral artery blood was treated with unheparin The speed of Mu L/min in the basal ganglia region, the needle retention 10min, the slow out of the needle.4. used "capsaicin coughing method" to observe the frequency of coughing in the basal ganglia intracerebral hemorrhage guinea pigs, and began to detect the coughing times of the basal ganglia in the second days after making the model, counted the number of coughs within 10min, once a day, once every day, 14d, 21d, 28d, respectively, to observe the change of the number of coughs. Results: 1. The effect of "cross electric needle" on swallowing function, the standard swallowing function scale (SSA scale) was selected in the first three groups, with no statistical difference (P0.05). (1) the first step of the evaluation of the three groups was reduced, the difference was statistically significant (P0.05). There were 13 cases in the cross term needle group, second step evaluation, and 10 cases in the electroacupuncture group. In the second step evaluation, 7 cases in the acupuncture group entered the second step evaluation. The difference between the three groups and the pre treatment group was statistically significant (P0.05). (2) second steps after treatment, 7 cases in the cross electric acupuncture group entered the third step evaluation, 3 in the electroacupuncture group and third steps were entered in the acupuncture group. There were 2 cases in the acupuncture group. The difference was statistically significant (the difference was statistically significant). (P0.05) (3) third steps after treatment, the three groups were compared, the difference was statistically significant (P0.05).2. "cross electric needle" effect on cough reflex, GFC cough reflex score (GFC score) (1) without statistical difference before treatment (P0.05). After treatment, the GFC score decreased, the difference was statistically significant (P0.05). Three groups and treatment. In the anterior group, the difference was statistically significant (P0.05). (2) the curative effect of the three groups, the healing rate of the cross electric acupuncture group was 90%, the healing rate of the electroacupuncture group was 50%, the healing rate of the acupuncture group was 40%. by X2 test, the difference was statistically significant (P0.05) the effect of the.3. "cross electric needle" on the disturbance of consciousness and the Glasgow consciousness barrier score (1) (1) before the treatment of the three groups did not The statistical difference was comparable (P0.05). The score of GCS increased after treatment. The difference was statistically significant (2). (2) there was no significant difference between the electroacupuncture group and the acupuncture group. (P0.05) the difference between the electroacupuncture group and the acupuncture group was not statistically significant (P0.05) the effect of the.4. "cross Electrical Needle" on the nerve function defect and the selection of the nerve function defect. Score (NISS score) (1) there was no statistical difference between the three groups before treatment (P0.05). After treatment, the NISS score decreased and the difference was not statistically significant (P0.05). (2) the difference was statistically significant (P0.05).5. basal ganglia intracerebral hemorrhage and coughing reflex disorder of guinea pig model established in the basal needle depth 5mm-6mm just in the basement In the section, the average value of 5.5mm was selected with the average value of 5.5mm, the average coughing times in the group of basal ganglia injection of 20-40 mu L were higher than that of the average cough times 50%, the average cough times in the 60 and 70 mu L groups were /10min, less than the average coughing times 50%, but the 2 week mortality rate 100%.50 u L group was not only full of average cough times /10min, less than 50% of average cough times. At the same time, there was no difference in the number of 7D and 28d coughs between group 7d and 28d in the 4 week mortality rate (P0.05). Conclusion: 1. a new needle method, "cross electric needle", which is an effective treatment for patients with cerebral hemorrhage after intracerebral hemorrhage, that is the connection of the same side to the positive pole of the Yifeng point, the negative pole to the side of the wind pond, and the 2. cross electric needle can effectively promote the tracheotomy and intubation after cerebral hemorrhage. The recovery of the swallowing function of the patients; the 3. cross electric needle can effectively promote the reshaping of the cough reflex in patients with tracheotomy intubation after intracerebral hemorrhage; the 4. cross electric needle can effectively improve the consciousness level of the patients with tracheotomy and intubation after intracerebral hemorrhage; 5. the cross electric needle can effectively improve the symptoms of nerve function defect in the patients with tracheotomy intubation after cerebral hemorrhage; 6. The guinea pig model of basal ganglia intracerebral hemorrhage and coughing reflex was established successfully. The parameters of the model were as follows: the penetration depth was 5.5mm and the blood injection amount was 50 mu L, which laid the animal model foundation for the further study of the acupuncture effect.
【學(xué)位授予單位】：黑龍江中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2017
【分類號(hào)】：R246.6

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