“醒脑开窍”针刺法预防卒中相关性肺炎的临床研究

Clinical study on acupuncture “Xingnao Kaiqiao” for prevention of stroke-associated pneumonia

关键词:  醒脑开窍  卒中相关性肺炎  临床研究  美国国立卫生研究院卒中量表评分  格拉斯哥昏迷评分  功能性经口进食量表评分

Key words:  Xingnao Kaiqiao  stroke-associated pneumonia  clinical study  national institutes of health stroke scale score  glasgow coma score  functional oral intake scale score

摘要:

[目的] 观察“醒脑开窍”针刺法对卒中相关性肺炎（SAP）的预防疗效，进而从免疫炎症角度初步探讨“醒脑开窍”针刺法预防SAP的可能机制。[方法] 收集天津中医药大学第一附属医院发病24 h内的急性脑梗死患者，随机分为试验组与对照组，对照组采用西医常规治疗，试验组在对照组基础上加用“醒脑开窍”针刺法 每天每次30 min，共7 d。观察两组患者SAP发生率、美国国立卫生研究院卒中量表（NIHSS）评分、格拉斯哥昏迷（GCS）评分、功能性经口进食量表（FOIS）评分，检查两组患者外周血白细胞计数（WBC）、中性粒细胞百分比（NEUT%）、中性粒细胞绝对值（NEUT）、淋巴细胞绝对值（LYMPH）、C反应蛋白（CRP）、肿瘤坏死因子-α（TNF-α）、白细胞介素-6（IL-6）、白细胞介素-4（IL-4）、干扰素-γ（IFN-γ）水平。[结果] 最终纳入患者63例，对照组32例、试验组31例。与对照组比较，试验组卒中相关性肺炎发生率明显降低（P ＜0.05）。与治疗前比较，治疗后两组NIHSS评分显著降低（P ＜0.01），GCS评分与FOIS评分显著升高（P ＜0.01），且试验组的改善较对照组更为显著（P ＜0.01）。与治疗前比较，治疗后两组的WBC、NEUT%、NEUT、CRP均显著降低（P ＜0.01），且试验组的降幅大于对照组（P ＜0.05），而LYMPH水平明显上升（P ＜0.01），试验组的上升程度优于对照组（P ＜0.05）。与治疗前比较，治疗后两组的TNF-α、IL-4、IL-6水平均显著下降（P ＜0.01），而IFN-γ水平则明显上升（P ＜0.01），且试验组在改善这些细胞因子指标方面较对照组更为显著（P ＜0.01）。[结论] “醒脑开窍”针刺法可以预防SAP发生，可以改善意识状态、恢复神经系统功能、缓解吞咽功能障碍，其机制可能与调节免疫炎症状态有关。

Abstract:

[Objective] To observe the preventive effect of the “Xingnao Kaiqiao” acupuncture technique on stroke-associated pneumonia（SAP） and to preliminarily explore its potential mechanism from the perspective of immune inflammation. [Methods] Patients with acute cerebral infarction within 24 hours of onset were enrolled from the First Affiliated Hospital of Tianjin University of Chinese Medicine and randomly assigned to an experimental group or a control group. The control group received conventional Western medical treatment，while the experimental group received additional “Xingnao Kaiqiao” acupuncture for 30 minutes once daily for 7 days. The incidence of SAP，National Institutes of Health Stroke Scale（NIHSS） scores，Glasgow Coma Scale（GCS） scores，and Functional Oral Intake Scale（FOIS） scores were observed in both groups. Levels of peripheral white blood cell count（WBC），neutrophil percentage（NEUT%），absolute neutrophil count（NEUT），absolute lymphocyte count（LYMPH），C-reactive protein（CRP），tumor necrosis factor-α（TNF-α），interleukin-6（IL-6），interleukin-4（IL-4），and interferon-γ（IFN-γ） were measured. [Results] Sixty-three patients were finally included（control group：n=32；experimental group：n=31）. Compared with the control group，the experimental group showed a significantly lower incidence of SAP（P<0.05）. Compared with pre-treatment，post-treatment NIHSS scores decreased significantly（P<0.01），while GCS and FOIS scores increased significantly（P<0.01） in both groups，with greater improvement observed in the experimental group（P<0.01）. Compared with pre-treatment，WBC，NEUT%，NEUT and CRP levels decreased significantly（P<0.01） in both groups after treatment，with a greater reduction in the experimental group（P<0.05）. LYMPH levels increased significantly（P<0.01），with a superior increase in the experimental group（P<0.05）. Compared with pre-treatment，TNF-α，IL-4 and IL-6 levels decreased significantly（P<0.01），while IFN-γ levels increased significantly（P<0.01） post-treatment in both groups，and the improvement in these cytokine indicators was more pronounced in the experimental group（P<0.01）. [Conclusion] The “Xingnao Kaiqiao” acupuncture technique can effectively prevent SAP，improve consciousness，promote neurological recovery，and alleviate swallowing dysfunction. Its mechanism may be associated with the regulation of the immune-inflammatory response.