本文關(guān)鍵詞： 脊髓型頸椎病 補陽還五湯 血漿內(nèi)皮素 一氧化氮 Aβ蛋白　出處：《廣州中醫(yī)藥大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:通過探討補氣通絡(luò)法對脊髓型頸椎病術(shù)后血漿內(nèi)皮素、一氧化氮、Aβ蛋白表達的影響來研究人體脊髓型頸椎病脊髓損傷病理變化及術(shù)后中醫(yī)藥對脊髓型頸椎病脊髓損傷修復(fù)的干預(yù)機制。方法:選擇深圳平樂骨傷科醫(yī)院自2016年03月至2017年02月,確診的60例脊髓型頸椎病患者,經(jīng)過隨機化分組,分為A組(對照組)30例及B組(治療組)30例。兩組患者全部采用手術(shù)治療,A組:術(shù)后常規(guī)治療;B組:術(shù)后第2天予補陽還五湯口服+術(shù)后常規(guī)治療。檢測并記錄術(shù)前、術(shù)后第1天、術(shù)后1周、術(shù)后4周不同時間點血液中血漿內(nèi)皮素、一氧化氮、Aβ蛋白相關(guān)指標;頸椎JOA評分;術(shù)前與術(shù)后4周肌電圖檢測神經(jīng)根損傷情況;比較治療組和對照組間治療前后不同時間節(jié)點各個指標變化情況。結(jié)果:1.一般資料方面:治療組(B組)與對照組(A組)相比,性別、年齡,病程、責(zé)任椎體數(shù)、手術(shù)時間、術(shù)中出血量差異、手術(shù)方式無統(tǒng)計學(xué)意義(P0.05)。2.兩組患者術(shù)前血漿內(nèi)皮素(ET)、一氧化氮(NO)、Aβ蛋白含量無統(tǒng)計學(xué)意義(P0.05)。3.生化指標方面:治療組和對照組間患者在術(shù)后1天血液中血漿內(nèi)皮素(ET)、一氧化氮(NO)、Aβ蛋白含量對比,差異均無統(tǒng)計學(xué)意義(P0.05);治療組比較對照組,在術(shù)后1周、術(shù)后4周血液中血漿內(nèi)皮素(ET)、一氧化氮(NO)降低,且差異有統(tǒng)計學(xué)意義(P0.05);術(shù)后1周,血液中Aβ蛋白變化,差異無統(tǒng)計學(xué)意義(P0.05);術(shù)后4周,血液中血漿中Aβ蛋白降低,差異有統(tǒng)計學(xué)意義(P0.05)。4.臨床療效評價方面,治療組與對照組比較,術(shù)后第1天頸椎JOA評分無顯著性差異(P0.05);術(shù)后1周、術(shù)后4周頸椎JOA評分有顯著性差異(P0.05);治療組與對照組相比,術(shù)后4周肌電圖檢測神經(jīng)根損傷情況,治療組陽性患者3例,對照組陽性患者10例,有顯著性差異(P0.05)。結(jié)論:脊髓型頸椎病患者術(shù)后神經(jīng)損傷處于一個再生和修復(fù)的過程,采用中醫(yī)補氣通絡(luò)法,口服補陽還五湯能夠使術(shù)后患者血漿內(nèi)皮素(ET)降低;對術(shù)前脊髓型頸椎病患者血液中高濃度的一氧化氮(NO)指標具有調(diào)節(jié)作用;術(shù)后4周,Aβ蛋白降低;術(shù)后1周、術(shù)后4周的頸椎神經(jīng)功能JOA評分上升。說明補陽還五湯可以促進患者術(shù)后神經(jīng)功能恢復(fù),對脊髓型頸椎病術(shù)后神經(jīng)功能恢復(fù)具有臨床療效。
[Abstract]:Objective: to study the effect of tonifying qi and dredging collaterals on plasma endothelin in patients with cervical Spondylotic myelopathy after operation. Effects of nitric oxide A 尾 protein expression on spinal cord injury in patients with cervical Spondylotic myelopathy (cervical Spondylotic myelopathy) and the intervention mechanism of traditional Chinese medicine on the repair of cervical Spondylotic Spondylotic Spondylotic Myelopathy (CSM) after operation. From March 2016 to February 2017, Sixty patients with cervical Spondylotic myelopathy were randomly divided into two groups. Group A (30 cases in control group) and group B (30 cases in treatment group). All patients in two groups were treated by operation. Group A: routine treatment after operation: group B: oral routine therapy of Buyang Huanwu decoction on the second day after operation. Plasma endothelin, nitric oxide A 尾 protein, cervical JOA score, nerve root injury were detected by electromyography before and 4 weeks after operation at different time points after operation, 1 day after operation, 1 week after operation and 4 weeks after operation. Results: 1. General data: treatment group (group B) and control group (group A), sex, age, course of disease, number of responsible vertebrae, time of operation, Intraoperative bleeding volume difference, There was no significant difference in the operation methods between the two groups. There was no significant difference between the two groups in plasma endothelin A 尾 protein content and plasma endothelin A 尾 protein content before operation. The biochemical indexes were as follows: the plasma endothelin (et) in the blood of the patients in the treatment group and the control group was in the blood on the first day after operation, and no significant difference was found in the content of plasma endothelin A 尾 protein between the treatment group and the control group. Comparison of A 尾 protein content in nitric oxide. In the treatment group, the plasma endothelin (et), nitric oxide (no) in the blood decreased at 1 week and 4 weeks after operation, and the difference was statistically significant (P 0.05), and the A 尾 protein in the blood of the treatment group was changed 1 week after operation. There was no significant difference (P 0.05) between the treatment group and the control group, but there was no significant difference between the treatment group and the control group on the first day after operation (P 0.05), and at 1 week after operation, there was no significant difference between the treatment group and the control group in the JOA score of cervical vertebrae (P 0.05), the difference was statistically significant in the plasma A 尾 protein at the 4th week after operation, and the difference was statistically significant (P 0.05). There was significant difference in cervical JOA score at 4 weeks after operation (P 0.05). Compared with the control group, the nerve root injury was detected by electromyography 4 weeks after operation in the treatment group (3 cases) and the control group (10 cases). Conclusion: the nerve injury of patients with cervical Spondylotic myelopathy after operation is in a process of regeneration and repair. The method of tonifying qi and dredging collaterals of traditional Chinese medicine and oral buyang Huanwu decoction can make the plasma endothelin et (ETT) of postoperative patients lower than that of patients with cervical Spondylotic myelopathy. It can regulate the high concentration of nitric oxide (no) in the blood of patients with cervical Spondylotic myelopathy before operation, decrease the protein of A 尾 at 4 weeks after operation, and 1 week after operation. The JOA score of cervical vertebra nerve function increased 4 weeks after operation, which indicated that Buyang Huanwu decoction could promote the recovery of postoperative nerve function in patients with cervical Spondylotic myelopathy, and had clinical effect on the recovery of nerve function after operation of cervical Spondylotic myelopathy.
【學(xué)位授予單位】：廣州中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R274.9

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