【作者】 杨学平；

【导师】 陈为；

【作者基本信息】 广州中医药大学 ， 中医骨伤科学， 2007， 硕士

【摘要】 目的：观察电针治疗对急性颅脑损伤昏迷患者脑脊液中白介素8(IL-8)、细胞间黏附因子(sICAM-1)和血液中肿瘤坏死因子(TNF-a)含量的影响，并探讨电针治疗急性颅脑损伤昏迷的脑保护作用机制。方法：40例急性颅脑损伤昏迷患者随机分为对照组和治疗组。对照组(20例)应用常规治疗，治疗组(20例)在常规治疗基础上于入院后第1d起电针水沟、百会、内关、合谷、四神聪、涌泉、三阴交、风池，采用酶联免疫吸附方法(ELISA)检测患者伤后1、2、3、5、7d脑脊液中IL-8、sICAM-1和血液中TNF-a含量。同时记录第1、2、3、5、7d1)GCS计分变化、2)语言功能分级、3)运动功能分级。结果：①对照组脑脊液中IL-8、sICAM-1和血液中TNF-a含量在伤后1d升高．2d达高峰．3d开始下降．5d进一步下降．7d下降到正常水平；②治疗组脑脊液中IL-8、sICAM-1和血液中TNF-a含量在伤后1d升高，2d下降，3d继续下降，5d下降到正常水平；③治疗组伤后2、3、5d脑脊液中IL-8、sICAM-1和血液中TNF-a含量均低于对照组相应时相点脑脊液中IL-8．sICAM-1和血液中TNF-a含量(P＜0.05)；④治疗组伤后2、3、5、7d GCS评分均高于对照组(P＜0.05)；⑤治疗组伤后3、5、7d语言功能恢复好于对照组(P＜0.05)；⑥治疗组伤后7d运动功能恢复好于对照组(P＜0.05)。结论：电针可以有效抑制急性颅脑损伤昏迷患者脑脊液中IL-8，sICAM-1和血液中TNF-a的含量；可以减轻急性颅脑损伤(ACCI)后脑内炎症反应和因炎症反应引起的继发性脑损害，阻断恶性循环，减轻脑损伤后昏迷程度；有助于急性颅脑损伤昏迷患者神志、语言、运动功能的恢复。为重度颅脑损伤后的脑保护治疗提供了新途径。更多还原

【Abstract】 Objective: To observe the effect of electro-acupuncture on the levels of Interleukin-8(IL-8) and soluble intercellular adhesion molecule 1(sICAM-1) in the cerebrospinalfluid(CSF) and tumor or necrosis factor alpha(TNF-a) in the blood of patients withacute craniocerebral injury and coma and to investigate its cerebral protective mechanism.Methods Forty cases with STBI were randomly divided into the treatment group (20cases) treated with electro-acupuncture besides the conventional therapy from the first dayafter their admissions and the control group (20 cases) treated with the conventionaltherapy. The levels of Interleukin-8 (IL-8) and soluble intercellular adhesion molecule1(sICAM-1) in the cerebrospinal fluid(CSF) and tumor or necrosis factor alpha(TNF-a) inthe blood of were measured by enzyme-linked immunosorbent assay (ELISA)technique on the 1st,.2nd, 3rd, 5th, 7th day after injury.Meanwhile to observe the change ofGCS、ability to speak and the ability to move on the 1st,.2nd, 3rd,5th, 7th day after injury.Results:①In the control group the levels of IL-8 and sICAM-1 in the cerebrospinalfluid(CSF) and TNF-a in the blood were significantly increased on the 1st day afterinjury; the highest level was got on the 2nd day after injury,they decreased on the 3rd,5thday and were in the normal range on the 7th day;②In the treatment group,the levels ofIL-8 and sICAM-1 in the cerebrospinal fluid(CSF) and TNF-a in the blood increasedon the 1st day after injury while they decreased on the 2nd,3rd and got to the normal rangeon the 5th day after injury;③The levels of IL-8 and sICAM-1 in the cerebrospinalfluid(CSF) and TNF-a in the blood of treatment group were significantly lower than that ofthe control group on the 2nd, 3rd and 5th day after injury respectively (p＜0.05);④Thescores of GCS of treatment were higher than that of the control group on the 2nd,3rd,5thand 7th day(p＜0.05);⑤The scores of ability to speak of treatment were lower than that of the control group on the 3rd,5th and 7th day(p＜0.05);⑥The scores of ability to movetreatment were lower than that of the control group on the 7th day(p＜0.05).Conclusion: Electro-acupuncture can obviously reduce the inflammatory reaction forthe patients with acute craniocerebral injury, consequently it alleviates secondary braininjury. It contributed the reservations of consciousness and ability to speak and move. Itmight contribute to a new therapeutic strategy for cerebral protection.更多还原