补肾健髓汤对脊髓损伤康复的影响

Influence of Bushen Jiansui Decoction on Treating Spinal Cord Injury During Recovery Period

摘要:

目的: 探讨补肾健髓汤干预脊髓损伤(SCI)康复的疗效及对微循环炎症反应的影响. 方法: 64例SCI患者采用随机化分层开放试验方法分为对照组和观察组各32例.对照组采用膀胱功能训练、排便训练等康复训练;中枢性疼痛者,口服盐酸氟西汀胶囊,20 mg/次,1次/d和盐酸哌替啶片,50～100 mg/次,根据情况每天给予2～3次;并给予电针治疗.观察组,在对照组基础上采用补肾健髓汤治疗.两组疗程均为8周.进行下尿路症候群(LUTS)评分,进行国际 SCI 肠功能扩展数据集评估;采用McGill 疼痛问卷(SF-MPQ)评估疼痛;检测血栓素A₂(TXA₂)、内皮素-1(ET-1)、一氧化氮(NO)和细胞间黏附分子-1(ICAM-1),治疗前后各评价1次. 结果: ①神经性膀胱疗效 治疗后观察组LUTS评分低于对照组(P<0.01);经有序资料卡方检验,观察组排尿功能障碍的改善优于对照组(P<0.05);②神经源性肠道功能障碍疗效 治疗后观察组腹胀、便秘、药物依赖患者少于对照组(P<0.01),排便时间短于对照组(P<0.01);③疼痛疗效 治疗后观察组PRI,VAS和PPI评分及总分均低于对照组(P<0.01);④微循环炎症反应影响 治疗后观察组TXA₂,ET-1和ICAM-1水平低于对照组,NO水平高于对照组(P<0.01). 结论: 在常规康复治疗的基础上,补肾健髓汤能促进脊髓损伤患者神经性膀胱和肠道功能障碍的康复,减轻中枢性疼痛,其作用机制可能与改善微循环,抑制炎症反应有关.

Abstract:

Objective: To discuss the curative efficacy of Bushen Jiansui decoction in treating recovery of spinal cord injury (SCI) and the influence on inflammatory response of microcirculation. Method: Sixty-four patients with SCI were divided into control group (32 cases) and observation group (32 cases) using stratified blocked randomization. Patients in control group received rehabilitation training such as bladder functional training and toilet training, and patients with central pain took 20 mg tofluoxetine capsules orally once daily and 50 mg pethidine hydrochloride tablets 2 to 3 times daily according to their conditions. Patients in control group also received electroacupuncture treatment. Based on the treatment of control group, patients in observation group added Bushen Jiansui decoction. Patients in two groups received 8-week course of treatment. Lower urinary tract symptoms (LUTS) was graded. Extend dataset of bowel function of international SIC was evaluated. And pain was evaluated by short-from of McGill pain questionnaire (SF-MPQ). Thromboxane A₂(TXA₂), plasma endothelin-1 (ET-1), serous nitric oxide (NO) and intercelluar adhesion molecule were detected before and after the treatment. Result: ① Neuropathic bladder curative effect:LUTS scores in observation group were inferior to that in control group after the treatment (P<0.01). The improvement of voiding dysfunction in observation group was superior to that in control group via Chi-square test order information (P<0.05). ② Neurogenic bowel dysfunction curative effect:the number of patients with abdominal distension, constipation, drug dependence in observation group was less than theose in control group after the treatment (P<0.01). Besides, defecation time in observation group was shorter than that in control group (P<0.01). ③ Pain curative effect:PRI,VAS, PPI and total scores in observation group were lower than those in control group (P<0.01). ④ Microcirculation inflammatory effect:Levels of TXA₂, ET-1 and ICAM-1 in observation group were lower than those in control group, while the NO level in observation group was higher than that in control group after the treatment (P<0.01). Conclusion: Based on routine rehabilitation therapy, adopting Bushen Jiansui decoction can promote neuropathic bladder and bowel dysfunction recovery, reduce central pain with spinal cord injury patients. Its action mechanism may be related to improving microcirculation and inhibiting inflammatory reaction.