中西結合治療腦中風療效的回溯性分析

Chinese Medicine Treatment in Patients with Severe Cerebrovascular Disease in Acute Phase-Retrospective Research

10.6516/TJTCM.2017.20(2)01

陳相如(Hsiang-Ju Chen)；陳建仲(Jian-Jung Chen)；蔡孟蓁(Meng-Jen Tsai)；林瓊娥(Qion-e Lin)；黃仲諄(Chung-Chun Huang)

梗塞型中風 ； 出血型中風 ； 腦中風 ； 急性期 ； 中醫 ； Ischemic stroke ； Hemorrhagic stroke ； Stroke ； Acute phase ； Traditional Chinese medicine

中醫藥研究論叢

20卷2期（2017 / 09 / 30）

1 - 8

繁體中文

背景：腦中風高居已開發國家之前三大死因並且造成國家重大負擔，以中醫針灸或中藥照護可明顯提升照護品質與恢復速度，然而醫界對中醫治療於急性期介入仍持保留態度，故本研究分析中醫於急性期介入進行中西醫合併治療重度腦中風患者之前後療效。材料與方法：選擇本院2016 年1 月到2016 年12 月符合ICD-9(430-438) 診斷，加入「全民健康保險西醫住院病患中醫特定疾病輔助醫療計畫」之病患，進行回朔分析。結果：依照本研究之納入及排除條件篩後，選出急性期合併中醫介入重度腦中風個案，共23 人納入分析，（男性13 人，女性10 人，平均年齡65.10±11.05 歲）。本研究針對重度腦中風患者急性期介入進行治療前後分析，發現經中西醫結合治療後NIHSS 總分與巴氏量表於治療前後總分有大幅度改善達顯著差異(P＜0.01)，多個分項亦有顯著差異。結論：腦中風發病7 日內中醫介入治療可能有利於中風患者之恢復。

Background: Cerebrovascular disease is often one of top three major causes of death in developed country and cause great financial burden to society. Chinese medicine or acupuncture treatment can significantly improve the quality of care and recovery, so this study aim to figure out the effect of TCM treatment in acute phase of severe cerebrovascular disease. Methods and methods: Patients with ICD-9 (430-438) diagnosis from January 2016 to December 2016 who joined the ＂National Health Insurance of Western medicine hospitalized patients with Chinese medicine specific disease auxiliary medical program ＂ and meet all inclusion and exclusion criteria were selected, and SPSS(V18)were used to analyze NIHSS and Barthel index. Results: 23 patients (13 males and 10 females, mean age 65.10±11.05) were analyzed. Patients with severe cerebrovascular disease (NIHSS ≧15) showed significant improvement in NIHSS and Barthel index when receiving combine care of TCM in acute phase. (P＜0.01**) Conclusions: NIHSS scores of 96.65% (22/23) patients with severe cerebrovascular disease (NIHSS ≧15) were significantly improved and showed significant difference in pretest and posttest(p＜0.01**). And there was no significant difference in NIHSS change in two weeks between receiving TCM treatment in 0-3day-group or 4-7-day-group , which indicated the correctness and safety of TCM treatment in the acute phase of cerebrovascular disease.

1. 劉耕豪、黃悅翔、李宗海、陳星諭、劉祥仁、張寓智、張健宏、陳玉昇(2013)。針灸輔助治療對亞急性期腦中風患者之療效評估：回溯性研究。中醫藥雜誌，24(2)，251-259。
   連結：
2. Chang, CC,Chen, TL,Chiu, HE,Hu, CJ,Yeh, CC,Tsai, CC,Lane, HL,Sun, MF,Sung, FC,Liao, CC,Lin, JG,Shih, CC(2016).Outcomes after stroke in patients receiving adjuvant therapy with traditional Chinese medicine: A nationwide matched interventional cohort study.J Ethnopharmacol.,177,46-52.
3. Chen, Li-fang,Fang, Jian-Qiao,Ma, Rui-Jie,Gu, Xu-Dong,Li, Jian-Hua,Chen, Lina,Xu, Shou-Yu(2016).Additional effects of acupuncture on early comprehensive rehabilitation in patients with mild to moderate acute ischemic stroke: a multicenter randomized controlled trial.BMC Complementary and Altern. Med.,16,226.
4. Chen, Li-fang,Fang, Jian-Qiao,Ma, Rui-Jie,Ronen, Froym,Gu, Xu-Dong,Li, Jian-Hua,Chen, Lina,Xu, Shou-Yu,Ji, Cong-Hua(2014).Acupuncture for acute stroke: study protocol for a a multicenter randomized controlled trial.Trials,15,214.
5. Harvey, RL(2015).Predictors of Functional Outcome Following Stroke.Phys Med Rehabil Clin N Am.,26(4),583-598.
6. Kwakkel, G,Kollen, BJ(2013).Predicting activities after stroke: what is clinically relevant?.Int J Stroke.,8(1),25-32.
7. Li, Xin,Wang, Qiang(2013).Acupuncture Therapy for Stroke Patients.Int Rev Neurobiol,111,159-79.
8. Nakashima, T,Minematsu, K(2009).Prospects of thrombolytic therapy for acute ischemic stroke.Brain Nerve.,61(9),1003-12.
9. Wade, DT,Hewer, RL,Wood, VA(1984).Stroke: influence of patient's sex and side of weakness on outcome.Arch Phys Med Rehabil.,65(9),513-516.
10. Zhang, Y,Jin, H,Ma, D,Fu, Y,Xie, Y,Li, Z,Zou, Y(2013).Efficacy of Integrated Rehabilitation Techniques of Traditional Chinese Medicine for Ischemic Stroke: A Randomized Controlled Trial.Am J Chin Med.,41(5),971-981.
11. 宋田、張亞清、周永、趙性泉(2010)。急性腦梗死早期預後的影響因素。中國臨床保健雜誌，13(5)，460-462。
12. 胡漢華(2008)。台灣腦中風防治指引2008。台北:台灣腦中風協會。
13. 徐永南、洪雅琳、郭憲文、陳穎潔(2009)。腦中風患者個案管理模式之住院成本估計與效果之評價。台灣醫學，13(4)，331-340。
14. 蔡宜秀、孫明輝、洪麗珍、郭憲文(2008)。影響某區域醫院缺血性腦中風初患病患住院醫療費用之相關因素。中臺灣醫學科學雜誌，13(3)，143-151。

1. 曾育慧,陳品璇,許中華(2022)。中醫居家醫療之現況與展望。台灣公共衛生雜誌，41(1)，16-35。
2. 黃小茹,唐偉誠,王育才(2019)。橋腦缺血性中風之中醫急症病例報告。中醫內科醫學雜誌，17(2)，21-31。
3. 簡士傑,謝仕福,張淑媚(2019)。針灸輔助治療住院復健中的缺血性腦中風患者：病例報告。醫學與健康期刊，8(1)，143-149。
4. 廖啟卉,馮已榕,許堯欽,徐偉展,林慧娟,任東輝,王瑜婷(2020)。中醫針灸治療對於出血型腦中風住院患者之療效評估：回溯性分析。中華針灸醫學會雜誌，23(1-2)，1-11。
5. 歐虹汝,林經偉,朱清蘭(2021)。小細胞肺癌合併腦轉移性腫瘤出血之病例報告。中醫藥研究論叢，24(3)，69-79。
6. 冼鴻曦,吳重儀,朱建福(2019)。針灸可增進腦中風急性後期照護之成效。中醫藥研究論叢，22(2)，11-24。