复元活血汤加减联合电针对脊髓损伤后神经功能康复的效果

目的:观察复元活血汤加减联合电针对脊髓损伤(SCI)神经功能康复的效果及对神经营养因子和炎症因子的影响。方法:将120例患者随机分为观察组61例和对照组59例。两组患者基础治疗,单唾液酸四己糖神经节苷脂钠注射液,200~400 mg,静脉滴注,1次/d,共6周;注射用鼠神经生长因子,20μg,肌肉注射,1次/d,共4周。对照组给予电针治疗,及口服通络化痰胶囊,3粒/次,3次/d。观察组电针治疗同对照组,并内服复元活血汤加减,1剂/d。两组疗程均为连续治疗12周。脊髓神经功能损伤程度采用美国脊柱损伤协会(ASIA)残损评分;采用脊髓损伤步行指数Ⅱ(WISCⅠⅡ)和10 m步行时间(10 MWT)评价下肢运动能力;日常生活功能采用Barthel指数(MBI),评价膀胱功能,检测外周血脑源性神经生长因子(BDNF),神经生长因子(NGF),星形胶质原性钙结合蛋白S-100β(S-100β),肿瘤坏死因子-α(TNF-α),和白细胞介素-1β(IL-1β)水平,以上指标均治疗前后各评价1次。结果:治疗后观察组患者ASIA量表感觉评分和运动评分均高于对照组(P<0.01);观察组患者WISCⅠⅡ评分高于对照组,10 MWT短于对照组(P<0.01);观察组日漏尿次数、尿失禁量和残余尿量均少于对照组,膀胱容量多于对照组(P<0.01);观察组患者日常生活功能好于对照组(Z=1.967,P<0.05);观察组BDNF和NGF水平均高于对照组,S-100β,TNF-α和IL-1β水平均低于对照组(P<0.01)。结论:在西医常规治疗的基础上,采用内服复元活血汤加减配合电针治疗SCI患者,可促进神经功能恢复,改善感觉和运功能力,提高膀胱功能和日常生活能力,并可促进神经营养因子的表达,抑制炎症反应。

Effect of Jiajian Fuyuan Huoxuetang Combined with Electroacupuncture on Neurological Rehabilitation After Spinal Cord Injury

Objective:To observe the effect of Jiajian Fuyuan Huoxuetang combined with electroacupuncture on neurological rehabilitation of patients with spinal cord injury,and to investigate its effect on neurotrophic and inflammatory factors.Method:One hundred and twenty patients were randomly divided into control group(59 cases)and observation group(61 cases)by random number table.Both groups’patients got monosialotetrahexosylganglioside by intravenous drip for 6 weeks,200-400 mg/time,1 time/day.Rat nerve growth factor for injection by intramuscular injection for 4 weeks,20μg/time,1 time/day.Patients in control group additionally got electroacupuncture treatment,and tongluo huatan capsule,3 caps/time,3 time/days.The patients in observation group additionally got Jiajian Fuyuan Huoxuetang combined with electroacupuncture,1 dose/day.The courses of treatment were 12 weeks in two groups.Scores of degree of spinal cord neurological impairment were graded by using impairment score of American Spinal Injury Association(ASIA).Lower extremity motor ability was discussed by using the walking index of spinal cord injuryⅡ(WISCⅠⅡ)and 10 minutes’walking time(10 MWT).Before and after treatment,functions of daily life were evaluated by using Barthel index(MBI).Bladder function was also discussed,and levels of brain-derived nerve growth factor in peripheral blood(BDNF),nerve growth factor(NGF),astrogenic calcium binding protein S-100β(S-100β),tumor necrosis factor-α(TNF-α)and interleukin-1β(IL-1β)were also detected.Result:After the treatment,scores of sensory and motor in ASIA scale in observation group were all higher than those in control group(P<0.01).Score of WISCⅠⅡin observation group was higher than that in control group,and 10 MWT was shorter than that in control group(P<0.01).Times of leakage of urine,urinary incontinence volume and residual urine volume were all less than those in control group,and bladder volume was more than that in control group(P<0.01).Functions of daily life in observation group were better than those in control group(Z=1.967,P<0.05),and the levels of BDNF and NGF were higher than those in control group,while levels of S-100β,TNF-αand IL-1βwere lower than those in control group(P<0.01).Conclusion:On the basis of routine comprehensive rehabilitation therapy of western medicine,Jiajian Fuyuan Huoxuetang combined with electroacupuncture can promote the recovery of nervous function,improve sensory and motor function,improve bladder function and daily living ability,and promote the expression of neurotrophic factors and inhibit inflammatory reaction in neurological rehabilitation for the patients with spinal cord injury.