(3.210.184.142) 您好!臺灣時間:2021/05/09 08:57
字體大小: 字級放大   字級縮小   預設字形  
回查詢結果

詳目顯示:::

我願授權國圖
: 
twitterline
研究生:高宗桂
研究生(外文):Kao, Tsung-Kuei
論文名稱:電針對腦中風急性期的動物實驗與臨床研究
論文名稱(外文):Animal model and Clinical Study in effects of electroacupuncture on Acute Cerebrovascular Accident
指導教授:林昭庚林昭庚引用關係郭重雄郭重雄引用關係張永賢張永賢引用關係謝慶良謝慶良引用關係
指導教授(外文):Lin, Jaung-GengKuo, Jon-SonChang, Yung-HsienHsieh, Ching-Liang
學位類別:博士
校院名稱:中國醫藥學院
系所名稱:中國醫學研究所
學門:醫藥衛生學門
學類:醫學學類
論文種類:學術論文
論文出版年:2001
畢業學年度:89
語文別:中文
論文頁數:110
中文關鍵詞:電針中風新腎上腺素多巴胺醒腦開竅法人中內關三陰交
外文關鍵詞:electroacupuncturecerebrovascular accidentnoradrenalinedopaminexing shen kai qiaoGv 26Pc 6Sp 6
相關次數:
  • 被引用被引用:0
  • 點閱點閱:268
  • 評分評分:系統版面圖檔系統版面圖檔系統版面圖檔系統版面圖檔系統版面圖檔
  • 下載下載:0
  • 收藏至我的研究室書目清單書目收藏:0
中 文 摘 要
醒神開竅針刺法是近年傳統醫學臨床用於治療中風的有效方法。本研究之目的是以動物試驗探查醒神開竅針刺法在缺血性中風急性期是否扮演著提高學習記憶能力與促進肢體運動之作用。另以昏迷指數、血壓、顱內壓、及經絡皮膚電阻等變化來評估醒神開竅法針刺對腦實質內出血型中風術後是否具有降低顱內壓,改善腦循環,促進肢體功能的作用。
本研究的動物實驗部分,以右側中腦動脈及雙側頸總動脈阻塞做缺血性中風模型,使用「條件反射測定裝置」與紅外線矩陣式動物行為測量系統進行動物學習記憶觀察及自發運動量之比較,探查醒神開竅針刺法在缺血性中風後,是否扮演著提高學習記憶、促進肢體運動能力之角色。另取其右側大腦皮質,以高速液相層析儀(HPLC)測量左右大腦皮質noradrenaline(NA)、dopamine(DA)、serotonin(5-HT)的濃度。臨床方面,篩選腦實質內出血型中風術後24小時患者,於手術室中裝置顱內壓、中央靜脈壓、動脈導管的測定儀器後,以醒神開竅法針刺人中穴、雙側內關穴、雙側三陰交穴並附加電針。我們於針刺前後測量顱內壓、昏迷指數、中央靜脈壓、心跳、血壓以及十二經絡良導點皮膚電阻之變化。
動物實驗結果顯示,在頸總動脈與右中腦動脈血流阻斷之前30分鐘針刺0.5小時或腦缺血30分鐘之後針刺0.5小時,腦梗塞體積都明顯地比單純缺血模型組小。缺血模型組滯留於亮度空間的時間、局部自發運動各項參數與NA、DA、5-HT等三種腦部神經傳遞物質濃度皆比假手術組低,而有經過針刺的缺血組其參數皆比單純缺血組有統計意義的提高。臨床研究結果顯示針刺可以短暫降低腦實質內出血型中風患者術後顱內壓及短暫提高十二經良導絡值,血比容與血小板濃度皆可下降,昏迷指數在針刺後亦明顯提高。 結論:腦血管病變急性期應用醒神開竅法電針可以縮減腦梗塞體積,改善大鼠腦缺血所致的記憶喪失與肢體運動能力,對於缺血性痴呆與行動能力具有治療作用。又醒神開竅法電針可以短暫提高甦醒指標,短暫降低腦血管阻力,減低凝血作用,促進血液回流心臟,並提高十二經絡能量。由以上研究我們認為醒神開竅法電針有利於腦中風急性期的治療。

Seeking the method to prevent stroke or to pursue the effective treatments in the emergency was the aim of modern medicine. Xing Shen Kai Qiao acupuncture was one of the effective method to treat stroke in these years. The purpose of this study were to detect the effect upon increasing memory ability by the model of ischemic rats. Another goal is to decrease the intracranial pressure by the cases after cerebral hemorrhage operation.
Adult, male Sprague-Dawley rats were devided into Acupuncture, Non-Acupuncture , and Sham operation groups in animal study. Besides the latest groups , animals were anesthesized with chloral hydrate and subjected occlusions of bilateral common carotid artery and right middle cranial artery for 24 hours and 72 hours . Xing Shen Kai Qiao electroacupuncture was performed in two groups, 30 minutes pre-occlusion group and 30 minutes post-occlusion group so as to decide better animal model . Rats were sacrificed 24 hrs after reperfusion. The infarct volume was measured by 2,3,5-triphenyltetrazolium chloride staining and determined by Computer Optica Imagine System. “Conditioned-response determine device” was used to detect memory . In another group of testing , local motor activitit was recorded by IR Animal Activity meter for 30 mins in order to record horizontal, vertical activities, distance, gait direction etc. The cortical concentration of noradrenaline, dopamine and serotonin were determined by High Performance Liquid Chromatography with electrochemical detector.
In Intensive Care Unit, thirty CVA patients post-craniotomy for removed cranial hematocele were selected in this study. All subjects receved continuous respiratory, cardiac and blood pressure monitoring.Intracranial pressure and central vein pressure were also measured continuously. Xing Shen Kai Qiao acupoints, such as Gv26, Pc6 (both) and Sp6(both) were punctured by No. 30 needle and electroacupuncture for 30 minutes. In addition, the electric resistance of the 12 electro-permable points were measured before and after the treatment. Treatment was given once a day in 3 concessive days.
The results showed that without electroacupuncture, severe and wide infarction was observed at brain cortex of rat. In contrast , treated by acupuncture before or after occlusion, only a small infarction was recognized. Compared with after occlusion , less infarction was discovered when we electroacupunctured before CCA and MCA occlusion. Passive escape response,locomotor activity and concentration of cerebral cortical monoamines of ischemic group are lower than those of sham group and acupuncture group. Clinical study showed that intracranil pressure and central vein pressure were decreased. Both hematocrit and concentration of platelet were decreased too. These coordinate with the increase of Glasgow Coma Scale and hemodynamics in statistics.The ryodoraku value of electro- permable points after acupuncture was elevated.
Conclusion: electroacupuncture not only improved themotor
activity, memory, increased concentration of cerebral biogenic
monoamines but also decreased the intracranial pressure , improved the hemodynamics of hemorrhagic stroke patients, increased their electroconductivity of permeable point of twelve meridian. These findings may suggest that this kind of acupuncture method is helpful to improve syndrome related to stroke such as dementia , anxiety and move ability. It means that electroacupuncture on Xing Shen Kai Qiao acupoints
has the effects to improve general weakness after cerebralvascular accident.

目 錄
第一章 前言 1
第二章 文獻探討 3
第一節 中國醫學對腦中風病名與病因的探討 3
一、腦中風病名考略 3
二、腦中風病因的探討4
第二節 現代醫學對腦中風病因的探討12
第三節 影響針刺治療中風的因素15
一、疾病診斷、病變性質與療效的關係15
二、處方用穴與療效的關係16
三、針刺手法和刺激劑量與療效的關係17
四、針刺時機與療效的關係18
第四節 針刺對腦缺血作用機理之文獻考察20
一、減少腦組織損傷體積20
二、增加腦血流21
三、調整血液流變學異常22
四、調整血脂異常23
五、改善腦電活動23
六、改善腦細胞代謝24
七、維持腦細胞內外電解質穩定25
八、調整神經生化機能26
九、減少自由基,改善腦水腫27
第五節 醒神開竅針刺處方之由來與其特點28
一、醒神開竅針刺處方由來28
二、醒神開竅針刺處方特點29
三、穴位解說31
第六節 醒神開竅針刺處方主穴之現代研究32
一、穴位解剖位置32
二、醒神開竅法主穴生理作用之考察36
第三章 材料與方法43
第一節 醒神開竅針刺法對局部腦梗塞大鼠的影響43
一、實驗動物43
二、局部腦血管梗塞動物模型的建立43
三、比較血流阻斷前後施行醒神開竅針刺法的效用44
四、腦梗塞面積的測定48
五、腦缺血動物的行為觀察50
六、腦皮質單胺濃度測定50
七、動物實驗之統計分析55
第二節 醒神開竅針刺法對出血型中風手術後
顱內壓與經絡電阻之影響54
一、對象54
二、監視54
(一)顱內壓測定54
(二)皮膚電阻的測定55
三、醒腦開竅針刺法56
四、人體試驗之統計分析58
第四章 結果59
第一節 醒神開竅針刺法對局部腦梗塞大鼠的效應59
一、醒神開竅法對腦梗塞面積的影響59
二、醒神開竅法對局部腦梗塞大鼠學習記憶能力之觀察61
三、醒神開竅法對缺血性腦梗塞大鼠自發運動量的影響63
四、醒神開竅法對腦梗塞大鼠大腦皮質單胺濃度的效用66
第二節 醒神開竅針刺法對ICH手術後
顱內壓與經絡電阻之影響68
一、醒神開竅法針刺對ICH手術後昏迷指數的影響68
二、醒神開竅法針刺對ICH手術後血壓的效用69
三、醒神開竅法針刺對ICH手術後血比容與血小板的影響70
四、醒神開竅法針刺對ICH手術後顱內壓的效用71
五、醒神開竅法針刺對ICH手術後良導點導電度的效用72
第五章 討論74
第一節 醒神開竅針刺法對腦缺血大鼠動物行為的效應74
一、醒神開竅針刺法可以改善腦梗塞面積74
二、醒神開竅法針刺可以改善學習記憶與自發運動量75
三、醒神開竅法針刺可以提高腦皮質NA、 DA、5-HT
的濃度75
第二節 醒神開竅針刺法對腦中風手術後顱內壓與經絡
電阻之影響78
一、醒神開竅法電針可以提昇ICH 手術後昏迷指數78
二、醒神開竅法電針可以減緩ICH手術後血壓78
三、醒神開竅法電針可以改善ICH手術後血比容與血小板濃度
四、醒神開竅法電針可以降低ICH手術後顱內壓
五、醒神開竅法電針可以降低手術後皮膚電阻
第六章 結論83
參考文獻84
英文摘要108

:H589-593.
149. Motonobu Kameyama, Jiro Suzuki, Reizou Shirane and Akira Ogawa. A new model of Bilateral hemispheric Ischemic in the Rat
-- Three vessel. Stroke 1984;16(3):489-493.
150.Garcia JH. Experimental ischemic stroke:a review. Stroke 1984, 15:5-14.
151.林文注、王佩:實驗針灸學,上海科學技術出版社,上海 1994;
pp.286-290.
152.李辭蓉、華興邦、周浩良 宋大魯、胡元亮:豚鼠針灸穴位圖譜的研製,上海針灸雜誌 1992;11(2):28-30.
153. Ito WD, Schaarschmidt S, Klask R, Hansen H,Schafer HJ,Mathey D,
Bhakdi S. Infarct size measurement by Triphenyltetrazonium ChlorideStaining versus in vivo injection of Propidium Iodide. Mol Cell Cardiol 1997;29:2169-2175.
154.Lin TN, He YY, Wu G,Khan M,Hsu CY. Effect of brain edema on infarct volume in a focal cerebral ischemia model in rats. Stroke 1993;24:117-121.
155.Nakashima M, Niwa M, Iwai T, Uematsu T. Involvement of free radical in cerebral vascular reprofusion injury evaluelated in a transient focal cerebral ischemia model of rat. Free Radi Biol& Med 1999;26(5):722-729
156.周金黃、王筠默:中藥藥理學。上海科技出版社,上海 1986;pp.181
157.李儀奎:中藥藥理實驗方法學。上海科技出版社,上海 1991;pp.355-356
158.Hsieh MT, Tsai HH, Chen CF, Lin WC. The pharmacological studies on the interactions of Taiwanese Veratri Formosani Rhizoma and Sophorae Radix on central nervous system. In:China Medical College Annual Bulletin 1982;13:217-249.
159.中國中醫研究院針灸研究所:標準針灸穴位圖冊,將門文物,
台北 1996;pp.65-169.
160.Robinson RG. Differential behavior and biochemical effects of right and left hemispheric infarction in the rat. Science 1979;205:707-710.
161.Yang Y, Shuaib A, Li Q. Quantification of infarct size on focal cerebral ischemia model of rats using a simple and economical method. J Neurosci Meth 1998;84:9-16.
162.賀小燕、楊桂萍、曹序茂:電針治療腦梗塞的實驗研究。中西醫結合雜誌 1991;( 增刊 ) 198-200.
163.Yamori Y, Horie R, Handa H. Pathogenic similarity of strokein stroke prone spontaneously hypertensive rats and humans. Stroke 1976;7:46-53.
164.Waltz AG, Sundt TM. The microvasculature and microcirculation of the cerebral cortex after arterial occlusion. Brain, 1967;90:681-696.
165.Joshua B. Bederson ,Lawrence H. Pitts, Miles Tsuji .,MerrycC. Nishimura., Richard L. Davis. Rat Middle cerebral Artery occlusion :Evaluation of the model and Development of a Neurologic Examination . Stroke, 1986;17(3):472-476.
166. Lin YC, Hsieh MT, Wu LY, Peng WH. Effect of Tang-Kuei-Pu-
Hsueh-Tangs on the impairment of passive avoidance learning in rats exposed to cerebral ischemia. Chin Med Coll J 1998;7(3):157-163.
167.傅仁杰:腦血管性痴呆的辨症與治療經驗。北京中醫 1988;(5):27-29 .
168.胡杰一:活血化瘀治療腦血管性痴呆體會。河南中醫 1992;12(5):226-227.
169.傅仁杰:多發腦梗塞性痴呆中醫治療體會。中醫雜誌 1991;32(4):24-25.
170.鄧振明:中風痴呆病。中國醫藥學報 1991;6(3):141-143.
171.袁應堅:補腎益腦湯治療中風痴呆的臨床觀察。中醫雜誌 1991;32(11):34-36.
172.薛啟螟:神經系統的生理和病理化學,科學出版社,北京 1978;pp.641.
173.劉清國:中風痴呆的現代中醫研究及針灸治療評述。中國針灸 1999;19(5):313-317.
174.傅仁杰:中醫藥治療老年呆病的臨床研究述評。北京中醫藥大學學報 1994;17(3):146-152.
175.張雪梅、顏壽琪:5-羊巠 色胺轉運體研究進展。生理科學進展 1997;28(4):345-348.
176.張殿明、徐隆紹:神經內分泌學。中國醫藥科技出版社,北京 1991;pp.97-101.
177.Berstein JG.Receptors, drugs,and neurotransmitters. In:Berstein JG ed. Handbookof Drug Therapy in Psychiatry. Mosby-Year Book Inc., USA , 1995;pp.1-22.
178.杜元灝、翟娜、李談、鄭灝泳、石學敏:針刺對急性腦梗塞模型鼠腦微血管壁5-HT及SP的影響。中國天津第五屆國際針灸暨中醫臨床學術大會論文集。1998;pp.150-152.
179.Schildkraut JJ, Roffman M, Orsulak PJ, Schatzberg AF, Kling MA, Reigle TG. Effects of short-and long-term administration of tricyclic antidepressants and lithium on norepinephrine turnover in brain. Pharmacopsychiatry 1976;9:193-202.
180.夏鎮夷、翟書濤、徐韜圓:臨床精神醫學。湖南科學技術出版社,湖南 1984;400-440.
181.韓濟生:神經科學綱要,北京醫科大學、中國協和醫科大學聯合出版社,北京 1993;344-398.
182.Hu RJ, Reus VI,Freimer NB. Neurobehaviral chemistry and physiology. In:Goldman HH eds. Review of General Psychiatry. Prentice-Hall International Inc., USA 1995 ; 875 — 915.
183.蔡景高、任光榮、江國榮:健憶口服液改善老年人學習記憶功能的臨床與實驗研究。中國中西醫結合雜誌 1994;14 (14) : 203-206.
184.王輝、陳興金、王建國:醒神開竅針刺法治療中風後遺症46例。中醫研究 1997;10(4):44-45.
185.李力、石學敏:醒神開竅針刺法治療穩定期中風50例臨床研究。中西醫結合雜誌 1989;9(11):653-655.
186.賈少微、王凡、鄭溪園:用SPECT研究針刺對腦血流量和腦功能的影響。中國針灸 1996;16(12):1-4.
187.史仁華、姬廣臣、趙魯明:電針及針刺捻轉補瀉手法對軟腦膜微循環血流量的影響。中醫雜誌1997;38(1):25-26.
188.章鳳杰、吳悅:高血壓病經顱多普勒檢測結果與辨證分型關係探討。江蘇中醫 1997;18(8):41-42.
189.Evan DH, Macpherson DS. Some aspects of the relationship between instantaneous volumetric blood flow and continuous wave Doppler ultrasound recording. 2. A comparison between mean and maximum velocity waveforms in a canine model. Ultrasound Med Biol 1982;8:611-615.
190.Lindegaard KF, Bakke SJ, Sorteberg W, Nakstad P, Nornes H. A noninvasive Doppler ultrasound method for the evaluation of patients with subarachnoid hemorrhage. Acta Radio (Diagn) 1986; (suppl 369):96-98.
191.Lindegaard K-F, Lundar T, Wiberg J, Sjoberg D, Aaslid R, Nornes H. Variations in middle cerebral artery blood flow investigated with noninvasive transcranial Doppler blood velocity measurements. Stroke 1987;18:1025-1030.
192.Brass LM, Pavlakis SG, De Vivo D, Piomelli S, Mohr JP. Transcranial Doppler measurements of the middle cerebral artery Effect of hematocrit. Stoke 1988;19:1466-1469.
193.Weber M, Grolimund P, Seiler RW. Evaluation of posttraumatic cerebral blood flow velocities by transcranial Doppler ultrasounography. Neurosurgery 1990;27:106-112.
194.靳宇、孫士靜:醒神開竅法治療腦出血術後53例臨床報告。第三屆天津國際針灸臨床學術會議論文匯編 1994;pp.16-19.
195.賈少微、王凡、鄭溪園:用SPECT研究針刺對腦血流量和腦功能的影響。中國針灸 1996;16(12):1-4.
196.金紫萍:頭針治療腦血管意外30例臨床療效和腦血流圖變化觀察。福建中醫藥 1986;17(5):37-38.
197.胡國強、王崇秀、周繼增:醒腦開竅法針刺治療急性中風病人血液流變學變化及療效觀察。中國針灸 1987;2(1):13-16.
198.張存生、周繼曾、武連仲、將戈利:針刺治療假性延髓麻痺325例臨床研究。中國醫藥學報 1995;10(2):18-20.
199.王舒、石學敏、李軍、高智莉、周穎:醒神開竅針法對腦梗塞患者顱底血流動力學影響的動態觀察。第三屆天津國際針灸臨床學術會議論文匯編 1994;pp.318-328.
200.John P.R, John L, Robert C.L, Neal HC. Organ Transplantation. In: Critical Care Diagnosis & Treatment. First Edition, edited by Bongard FS, Sue DY, Paramount Publishing Business and Professional Group, USA. 1994;pp.412-413.
201.Villanueva P A, Ruben B H, Greenberg J:Neurologic injury :prevention and initional care. In:Critical Care, Third Edition, edited by Joseph M,Civetta,Robert WT,and Robert RK, Lippincott-Raven Publishers ,Philadelphia, New York 1977;pp.1195-1217.
202.Niboyet JEH. La moindre resistence à lèlectricitè de surface puncitiformeset de trajects cutanés concordant avec les points et les meridians, bases de l΄acupuncture. Traité d΄acupuncture. Maisonneuve, Paris 1970;pp.121-345.
203.河南中醫中藥研究所:關於經絡學說實質的探討。河南中醫研究所,資料匯編(第二輯) 1959
204.張協和、譚書田:經絡測定儀的診病原理及其使用方法。中醫雜誌 1958;(9):579-592.
205.曾兆麟、張令耀:皮膚穴位導電量與溫度正常值的測定及在周身分布情況的研究。上海中醫藥雜誌 1958;(12):33-37
206.Fieldman E J. Diagnostic acupuncture using a new skin conductance
monitor. Am J Acup 1975;3(2):161-162.
207.Saita H S. Modern scientific medical acupuncture. J Am Osteopath Assoc 1973;72:685-696.
208.Voll R. Topographic positions on the measurement points in
electro-acupuncture. Am J Acup 1970;5(2):3-2 .
209.Voll R. Twenty years of electro-acupuncture diagnosis in Germany, a
progress report. Am J Acup 1975;3(1):7-8.
210.祝總驤、郝金凱:針灸經絡生物物理學-中國第一大發明的科學驗證。北京出版社,北京 1989;pp.189-237.
211.中谷義雄:良導絡研究的全貌。漢方的臨床 3 (7):1956.
212.Bergsmann O:Difference in electrical conductivity between acupuncture points and adjacent skin areas. Am J Acup 1973;1:27.
213.包鳳芝: J-1型經絡電圖儀臨床初步應用。第一屆世界針灸學術大會針灸論文摘要選編。1987;pp.217.
214.嚴節、林亞平、曾亞南:經絡阻抗測定與經絡、臟腑、氣血的相關性。湖南中醫學院學報 1992;12:44-46.
215.高宗桂、張永賢、吳昇光:電腦測定經絡能量之研究。中國針灸 1995;15(增):162.
216.Kao TK, Chang YH. Study between Chinese medical diagnostication and the meridian electric resistance on the disease of digestive system. Chin Med Assoc Acup 2000;66-82.

QRCODE
 
 
 
 
 
                                                                                                                                                                                                                                                                                                                                                                                                               
第一頁 上一頁 下一頁 最後一頁 top
系統版面圖檔 系統版面圖檔