闫康　黄汝芹　李鹏　李爽　李二亮　王银歌　赵海恩　廖博　赵宁侠

摘要 目的：觀察二仙汤加减联合电针刺激对脊髓损伤患者术后恢复的临床疗效。方法：选取2017年1月至2018年12月空军军医大学第二附属医院收治的脊髓损伤手术患者96例作为研究对象，按照随机数字表法随机分为对照组和观察组，每组48例。所有患者均进行手术减压、骨折复位内固定治疗，对照组在术后常规处置基础上行电针刺激治疗，观察组在对照组基础上联合二仙汤加减治疗。治疗前、治疗后6个月定期评价临床疗效，Barthel量表（BI）生活能力测评，美国脊髓损伤协会（ASIA）神经功能评分，视觉模拟评分法（VAS）评分等变化;监测治疗前、治疗后1周血清炎症反应指标肿瘤坏死因子-α（TNF-α）、白细胞介素1β（IL-1β）、白细胞介素8（IL-8）、C反应蛋白（CRP）水平;测定治疗前、治疗后6个月血清神经生长因子（NGF）、脑源性神经营养因子（BDNF）水平。结果：与治疗前比较，2组患者治疗后的临床疗效、BI，ASIA神经功能评分、VAS评分均显著改善（P<0.05），观察组改善明显优于对照组，差异有统计学意义（P<0.05）。与治疗前比较，2组患者治疗后TNF-α、IL-1β、IL-8、CRP水平均显著降低，NGF、BDNF水平均显著增高，差异均有统计学意义（均P<0.05），观察组治疗后指标改善明显优于对照组，差异有统计学意义（P<0.05）。结论：二仙汤加减联合电针刺激在脊髓损伤术后恢复方面疗效突出，具有较大临床应用价值。二仙汤加减对脊髓损伤的疗效与降低机体炎症反应和提高神经营养因子水平相关。深入全面研究其作用机制，对于该组方及其治疗方案优化具有重要意义。

关键词 脊髓损伤;二仙汤;电针刺激;术后恢复;神经营养因子;炎症反应

Abstract Objective：To observe the clinical efficacy of modified Erxian decoction combined with electrical stimulation on postoperative recovery of patients with spinal cord injury.Methods：A total of 96 patients with spinal cord injury admitted to The Second Affiliated Hospital of Air Force Military Medical University from January 2017 to December 2018 were selected as the research subjects，and according to the random number table method，they were randomly divided into a control group and an observation group with 48 in each group.All patients were treated with surgical decompression，open reduction and internal fixation of fractures.The control group received electrical stimulation on the basis of prior routine treatment，while the observation group received modified Erxian decoction on the basis of the control group intervention.Before treatment and 6 months after treatment，the clinical efficacy，Barthel Index（BI） life ability assessment，American Spinal Injury Association（ASIA） neurological function score，visual analog scale（VAS） score and other changes were regularly evaluated.The serum levels of tumor necrosis factor-α（TNF-α），interleukin-1β（IL-1β），interleukin-8（IL-8） and C-reactive protein（CRP） were monitored pre-operatively and at 1-week follow-up.The serum levels of nerve growth factor（NGF） and brain-derived neurotrophic factor（BDNF） were measured pre-operatively and at 6-month follow-up.Results：Compared with before treatment，the clinical efficacy，Barthel Index，ASIA nerve function score and VAS score of 2 groups were significantly improved after treatment（P<0.05）.Additionally，these clinical indicators in the observation group were better than those in the control group，and the difference was statistically significant（P<0.05）.After treatment the levels of inflammatory response factors TNF-α、IL-1β、IL-8、CPR in the 2 groups were significantly decreased，and the levels of neurotrophic factors（NGF） and BDNF were significantly increased，and the difference was statistically significant（all P<0.05）.The improvement in the observation group was significantly better than that in the control group，and the difference was statistically significant（P<0.05）.Conclusion：Modified Erxian decoction combined with electrical stimulation is effective in postoperative recovery of spinal cord injury，which provides great clinical values.The effects of modified Erxian decoction on spinal cord injury is related to the decrease of inflammatory reaction and the increase the level of neurotrophic factor.To probe into the mechanism on modified Erxian decoction combined with electrical stimulation comprehensively is of great importance in optimizing this prescription and therapeutic schedule on patients with spinal cord injury.

Keywords Spinal cord injury; Erxian decoction; Electrical stimulation; Postoperative recovery; Neurotrophic factor; Inflammatory response

中图分类号：R245;R289.5文献标识码：Adoi：10.3969/j.issn.1673-7202.2021.18.020

脊髓损伤（Spinal Cord Injury，SCI）通常发生在高能量或低能量损伤机制之后，局部神经细胞渐进性破坏并诱发一系列继发性损伤，可能导致截瘫或四肢瘫痪[1]。脊髓损伤作为脊柱骨折最严重的并发症，往往导致终身残疾甚至死亡。目前，通过手术解除神经压迫可有效改善患者功能和降低死亡率，是脊髓损伤首选的临床治疗手段[2]。然而，手术时复位和固定等操作的二次打击可激活机体炎症反应，患者术后并发症风险增高[3]。……