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甘肃省中医院,兰州 730050
张维平,硕士,从事中医药在脊柱脊髓损伤中的应用研究,E-mail:zwp19891921@163.com
* 鄢卫平,主任医师,从事脊柱相关临床工作及脊髓损伤研究,E-mail:804988857@qq.com
收稿日期:2021-03-29,
网络出版日期:2021-07-21,
纸质出版日期:2021-09-20
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张维平,常雯茜,朱换平等.加味补阳还五汤联合电针治疗创伤性脊柱脊髓损伤气虚血瘀证的临床疗效[J].中国实验方剂学杂志,2021,27(18):88-93.
ZHANG Wei-ping,CHANG Wen-xi,ZHU Huan-ping,et al.Improving Effect of Modified Buyang Huanwutang Combined with Electroacupuncture on Traumatic Spinal Cord Injury due to Qi Deficiency and Blood Stasis[J].Chinese Journal of Experimental Traditional Medical Formulae,2021,27(18):88-93.
张维平,常雯茜,朱换平等.加味补阳还五汤联合电针治疗创伤性脊柱脊髓损伤气虚血瘀证的临床疗效[J].中国实验方剂学杂志,2021,27(18):88-93. DOI: 10.13422/j.cnki.syfjx.20211892.
ZHANG Wei-ping,CHANG Wen-xi,ZHU Huan-ping,et al.Improving Effect of Modified Buyang Huanwutang Combined with Electroacupuncture on Traumatic Spinal Cord Injury due to Qi Deficiency and Blood Stasis[J].Chinese Journal of Experimental Traditional Medical Formulae,2021,27(18):88-93. DOI: 10.13422/j.cnki.syfjx.20211892.
目的
2
观察加味补阳还五汤联合电针治疗创伤性脊柱脊髓损伤(TSCI)气虚血瘀证的临床疗效。
方法
2
将87例符合要求的TSCI患者随机分为观察组(44例)和对照组(43例)。两组均给予西医综合基础处理措施。对照组,口服五味通栓口服液,10 mL/次,3次/d,连续服用12周;电针,1次/d,6次/周,连续治疗6周。观察组,口服加味补阳还五汤,1剂/d,连续12周;电针措施同对照组。评价治疗前后美国脊髓损伤协会(ASIA)残损分级,改良Barthel指数(MBI),疼痛视觉模拟评分(VAS),Berg平衡量表(BBS)评分,Ashworth量表(MAS)评分,脊髓功能独立性评估量表-Ⅲ(SCIM-Ⅲ)评分,下肢关节活动度(ROM)和气虚血瘀证评分;记录治疗期间的并发症发生情况;检测治疗前后脑源性神经生长因子(BDNF),神经生长因子(NGF),血管内皮生长因子(VEGF),神经营养因子-3(NT-3),丙二醛(MDA)和超氧化物歧化酶(SOD)水平。
结果
2
观察组患者运动评分、轻触觉评分和针刺觉评分均高于对照组(
P
<
0.01);观察组患者MBI和BBS评分高于对照组(
P
<
0.01),VAS和MAS评分低于对照组(
P
<
0.01);观察组患者内收肌角和直腿抬高角均大于对照组(
P
<
0.01),气虚血瘀证评分低于对照组(
P
<
0.01);观察组患者SCIM-Ⅲ量表自我照顾、呼吸和括约肌管理和活动能力3个维度评分和总分均高于对照组(
P
<
0.01);观察组并发症累计发生率为34.09%,低于对照组的55.81%,组间差异有统计学意义(
χ
2
=4.149,
P
<
0.05);观察组患者BDNF,NGF,VEGF,NT-3和SOD水平高于对照组(
P
<
0.01),MDA水平低于对照组(
P
<
0.01)。
结论
2
加味补阳还五汤联合电针治疗TSCI可显著减轻脊髓损伤程度,促进了神经功能恢复,提高了日常生活活动能力和独立能力,并降低了并发症发生率,其作用机制可能与改善缺血、缺氧、抑制脂质过氧化反应,促进神经细胞修复再生有关。
Objective
2
To observe the clinical efficacy of modified Buyang Huanwutang combined with electroacupuncture (EA) in the treatment of traumatic spinal cord injury (TSCI) due to Qi deficiency and blood stasis.
Method
2
Eighty-seven TSCI patients who met the inclusion requirements were randomly divided into an observation group (
n
=44) and a control group (
n
=43). On the basis of comprehensive western medical treatments, patients in the control group were further provided with Wuwei Tongshuan oral liquid,10 mL per time,three times per day, while those in the observation group received modified Buyang Huanwutang,one bag per day,for 12 consecutive weeks. Besides, EA was performed in both groups in the same way, once per day, six times per week, for six weeks in total. The American Spinal Injury Association (ASIA) motor score, modified Barthel index (MBI),visual analog scale (VAS) pain score,Berg balance scale (BBS) score,modified Ashworth scale (MAS) score, spinal cord independence measure-Ⅲ(SCIM-Ⅲ) score, lower limb range of motion (ROM), and Qi deficiency and blood stasis syndrome score before and after treatment were evaluated, followed by the recording of the occurrence of complications during treatment. The brain-derived nerve growth factor (BDNF), nerve growth factor (NGF), vascular endothelial growth factor (VEGF), neurotrophic factor-3 (NT-3), malondialdehyde (MDA) and superoxide dismutase (SOD) levels before and after treatment were determined.
Result
2
The motor, light touch, needling sensation, MBI, and BBS scores of the observation group were higher than those of the control group (
P
<
0.01), while the AS and MAS scores were lower(
P
<
0.01). The angles of adductor and straight leg raising in the observation group were greater than those of the control group (
P
<
0.01),but the Qi deficiency and blood stasis syndrome score was lower(
P
<
0.01). Both the scores of self-care, respiration, and sphincter management in SCIM-Ⅲ and the total score in the observation group were elevated as compared with those of the control group (
P
<
0.01). The cumulative incidence of complications in the observation group was 34.09%,significantly lower than 55.81% in the control group (
χ
2
=4.149,
P
<
0.05). Compared with the control group, the observation group exhibited remarkably increased BDNF, NGF, VEGF, NT-3, and SOD (
P
<
0.01) and decreased MDA (
P
<
0.01).
Conclusion
2
Modified Buyang Huanwutang combined with EA is effective in alleviating spinal cord injury, promoting neural functional recovery, improving independence in activities of daily living, reducing the incidence of complications of patients with TSCI, which may be related to the amelioration of ischemia and hypoxia, inhibition of lipid peroxidation, and acceleration of nerve cell repair and regeneration.
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