交叉电项针促进脑出血后气切插管患者咳嗽反射重塑的临床观察及豚鼠模型研究

发布时间：2018-06-23 07:03

本文选题：交叉电项针 + 脑出血　；参考：《黑龙江中医药大学》2017年博士论文

【摘要】：目的:创立脑出血后气切患者治疗新针法—"交叉电项针",评价"交叉电项针"对脑出血后气切插管患者咳嗽反射重塑、吞咽功能恢复的疗效;通过豚鼠颅骨不同穿刺深度,不同自体血量注入,建立基底节脑出血后咳嗽反射障碍豚鼠模型。方法:1.采用随机对照、单盲法,观察交叉电项针治疗脑出血后气管切开插管并留置胃管患者60例,随机分为三组,分别为交叉电项针组、电针组、针刺组,每组20例。三组均给予相同穴位的头针、体针及西医抗炎、化痰、营养神经等基础治疗。交叉电项针组采用"项部交叉电针"配合基础治疗,交叉方式即对侧风池穴连接负极,同侧的翳风穴连接正极;电针组为同侧风池穴连接负极,同侧翳风穴连接正极;针刺组仅给予相同穴位针刺不接电针。三组均每次留针30分钟,每日2次,周六、周日每日1次,疗程4周。在治疗前、治疗后分别评价标准吞咽功能量表SSA、GFC咳嗽反射评分、格拉斯哥意识障碍评分GCS和神经功能缺损评分NISS评分,然后进行统计学分析。2.根据豚鼠基底节不同解剖深度,确定颅骨穿刺深度,将体重300±15g雄性纯白SPF级豚鼠10只,采用戊巴比妥钠(40mg/kg)腹腔麻醉,断头猝死,沿矢状缝将颅骨切开,大脑分成左右两半,以左侧大脑半球穿刺造模为例,分别测量穿刺深度3mm;4mm;5mm;6mm;7mm和8mm,9mm。观察不同穿刺深度穿刺针尖与基底节的位置关系。3.在明确穿刺进针深度基础上,进行注血量研究。根据注射自体股动脉血量的不同,将体重300 ± 15g雄性纯白SPF级豚鼠70只,随机分成7组,每组10只。分别为空白对照组;20 μL组;30 μL组;40 μL组;50μL组;60μL组和70μL组。将未肝素化的自体股动脉血以20μL/min速度推进基底节区,留针10min,缓慢出针。4.采用"辣椒素引咳法"观察基底节脑出血豚鼠咳嗽次数,于造模后第2天开始检测,计数10min内咳嗽次数,连续检测7天,每天一次,并于造模后第14d、21d、28d分别检测一次,观察咳嗽次数变化。结果:1."交叉电项针"对吞咽功能的影响,选用标准吞咽功能量表(SSA量表)治疗前三组比较,无统计学差异,具有可比性(p0.05)。(1)治疗后第一步评价三组评分均有降低,差异有统计学意义(P0.05)。交叉电项针组,有13例进入第二步评价,电针组有10例进入第二步评价,针刺组有7例进入第二步评价。三组与治疗前组内比较,差异有统计学意义(p0.05)。(2)治疗后第二步评价,交叉电项针组有7例进入第三步评价;电针组有3例进入第三步评价。针刺组有2例进入第三步评价。差异有统计学意义(p0.05)。(3)治疗后第三步评价,三组比较,差异有统计学意义(p0.05)。2."交叉电项针"对咳嗽反射的影响,选用GFC咳嗽反射评分(GFC评分)(1)治疗前三组无统计学差异,具有可比性(p0.05)。治疗后GFC评分均有降低,差异有统计学意义(p0.05)。三组与疗前组内比较,差异均有统计学意义(p0.05)。(2)三组疗效,交叉电项针组愈显率90%;电针组愈显率50%;针刺组愈显率40%。经X2检验,差异有统计学意义(p0.05)。3."交叉电项针"对意识障碍的影响,选用格拉斯哥意识障碍评分(GCS评分)(1)治疗前三组无统计学差异,具有可比性(p0.05)。治疗后GCS评分均有升高,交叉电项针组与电针组和针刺组比较,差异有统计学意义(p0.05)。(2)治疗后电针组与针刺组比较,差异无统计学意义(p0.05)。4."交叉电项针"对神经功能缺损的影响,选用神经功能缺损评分(NISS评分)(1)治疗前三组无统计学差异,具有可比性(p0.05)。疗后NISS评分均有降低,差异无统计学意义(p0.05)。(2)三组与疗前组内比较,差异有统计学意义(p0.05)。5.基底节脑出血并咳嗽反射障碍豚鼠模型的建立进针深度5mm-6mm恰好在基底节区,符合造模要求,选取平均值5.5mm;基底节区注射血量20-40 μL组平均咳嗽次数/10min,大于平均咳嗽次数50%;60 μL和70μL组平均咳嗽次数/10min,小于平均咳嗽次数50%,但2周死亡率100%。50μL组既满足平均咳嗽次数/10min,小于平均咳嗽次数50%,同时保证4周死亡率20%。50μ L组7d与28d咳嗽次数比较,无统计学差异(p0.05)。结论:1.创立了有效治疗脑出血后气切患者的新针法—"交叉电项针",即同侧翳风穴连接正极,对侧风池穴连接负极;2.交叉电项针能有效促进脑出血后气管切开插管患者吞咽功能的恢复;3.交叉电项针能有效促进脑出血后气管切开插管患者咳嗽反射的重塑;4.交叉电项针能有效改善脑出血后气管切开插管患者的意识水平;5.交叉电项针能有效改善脑出血后气管切开插管患者神经功能缺损症状;6.成功建立了基底节脑出血咳嗽反射障碍豚鼠模型,参数:穿刺进针深度为5.5mm,注血量为50μL,为进一步研究针刺疗效奠定了动物模型基础。
[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.
【学位授予单位】：黑龙江中医药大学
【学位级别】：博士
【学位授予年份】：2017
【分类号】：R246.6

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