院前急救中井穴放血联合穴位注射对中风患者神经功能影响的实证研究

An Empirical Study on the Effect of Well Point Bloodletting Combined with Acupoint Injection on Neurological Function of Stroke Patients in Pre-Hospital First Aid

摘要: 目的：评价院前急救阶段井穴放血联合曲池穴位注射维生素B12对急性脑卒中患者神经功能缺损及残疾程度的干预效果与安全性。方法：采用单中心、前瞻性、随机对照设计，将2025年1~8月珠海市中西医结合医院120接诊、发病 ≤ 4.5 h的急性卒中患者225例按1:1:1分入TA组(井穴放血 + 穴位注射)、CB组(单用井穴放血)和CC组(常规院前急救)。主要结局为NIHSS评分变化(T0现场基线、T1到院即刻、T2 24h、T3第7天)；次要结局包括第7天和第90天mRS及生命体征波动；并记录3个月内不良事件。结果：与CB组和CC组相比，TA组在T1、T2、T3时间点的NIHSS评分改善幅度均显著更优(均P < 0.05)。至第90天随访时，TA组的mRS评分也显著低于两个对照组(均P < 0.05)，表明其功能预后更好。三组在生命体征监测指标上总体相似，但TA组在心率控制方面表现出一定优势。所有组别均未报告严重不良事件。结论：院前井穴放血联合穴位注射可安全、快速减轻卒中神经功能缺损并改善90 d功能结局，为中西医结合院前急救提供了可操作、易推广的新方案。

Abstract: Objective: To evaluate the intervention effect and safety of bloodletting at well point combined with injection of vitamin B12 at Quchi point in pre-hospital emergency treatment on neurological deficit and disability in patients with acute stroke. Methods: A single-center, prospective, randomized controlled design was adopted, and 225 patients with acute stroke who were admitted to Zhuhai Hospital of Integrated Traditional Chinese and Western Medicine from January to August 2025 and whose onset was less than ≤4.5 h were divided into TA group (bloodletting at well point + acupoint injection), CB group (bloodletting at well point only) and CC group (routine pre-hospital first aid) according to the ratio of 1:1:1. The main outcome was the change of NIHSS score (at baseline at T0, immediately after arrival at hospital at T1, at 24 h at T2, and at 7th day at T3). Secondary outcomes included mRS and vital signs fluctuation on the 7th and 90th day. And record the adverse events within 3 months. Results: Compared with CB group and CC group, the improvement of NIHSS score in TA group was significantly better at T1, T2 and T3 (all P < 0.05). At the 90th day of follow-up, the mRS score of TA group was also significantly lower than that of the two control groups (both P < 0.05), indicating that its functional prognosis was better. The three groups are generally similar in vital signs monitoring indicators, but TA group shows certain advantages in heart rate control. None of the groups reported serious adverse events. Conclusion: Pre-hospital well point bloodletting combined with acupoint injection can safely and quickly alleviate the neurological deficit of stroke and improve the functional outcome for 90 days, which provides a new feasible and easy-to-popularize scheme for pre-hospital emergency treatment of integrated traditional Chinese and western medicine.