常规理疗联合针刺对重症手足口病中枢神经系统受损致神经肌肉系统功能异常患儿运动功能障碍的干预效果
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摘要
背景手足口病(HFMD)是一种好发于5岁以下婴幼儿的急性发疹性传染病,可由20多种肠道病毒感染引起,以发热及手、足、口腔、臀部等部位出现疱疹、斑丘疹或溃疡为主要临床症状,大多经治疗后可缓解,不留后遗症,但重症HFMD可造成周围神经麻痹、中枢神经系统损伤,甚至危及患儿的生命,因此,采取有效的干预措施是非常必要的。目的研究常规理疗联合针刺对重症HFMD中枢神经系统受损致神经肌肉系统功能异常患儿运动功能障碍的干预效果。方法选取2014年6月—2017年12月在郑州大学附属儿童医院就诊的重症HFMD中枢神经系统受损致神经肌肉系统功能异常患儿88例。将患儿随机分为对照组和观察组,每组44例。两组患儿均给予常规西医治疗(包括抗病毒、抗感染、促受损神经恢复及维持水、电解质和酸碱平衡),对照组加用常规理疗,观察组加用常规理疗联合针刺治疗,两组治疗周期均为1个月。比较两组临床疗效,治疗前后粗大运动功能量表(GMFM)、Berg平衡量表(BBS)评分,中枢神经系统受损的相关症状(包括呕吐、易惊、肢体抖动、肌无力、嗜睡)消失时间,治疗前后生化指标[白介素6(IL-6)、超敏C反应蛋白(hs-CRP)、白细胞计数(WBC)、肌酸激酶(CK)水平]及不良反应发生情况。结果观察组临床疗效优于对照组(P<0.05)。治疗后,观察组GMFM、BBS评分高于对照组(P<0.05);治疗后两组GMFM、BBS评分高于本组治疗前(P<0.05)。观察组呕吐、易惊、肢体抖动、肌无力、嗜睡消失时间短于对照组(P<0.05)。治疗后,观察组IL-6、hs-CRP、WBC、CK水平低于对照组(P<0.05);治疗后两组IL-6、hs-CRP、WBC、CK水平低于本组治疗前(P<0.05)。两组治疗期间未出现明显的不良反应。结论常规理疗联合针刺治疗重症HFMD中枢神经系统受损致神经肌肉系统功能异常患儿,可显著改善患儿运动功能,缩短病程,减轻炎性反应,且无明显不良反应。
Background Hand-foot-mouth disease(HFMD) is an acute eruptive infectious disease that occurs in infants and young children under 5 years old. It can be caused by more than 20 kinds of enterovirus infections,and its main clinical symptoms are fever and herpes,maculopapule or ulcer in hands,feet,mouth and buttocks,and most can be relieved after treatment without sequelae,but severe HFMD can cause peripheral nerve palsy,central nervous system damage,and even endanger the lives of children patients. Therefore,effective intervention is necessary.Objective To explore the intervention effects of routine physiotherapy combined with acupuncture on motor dysfunction in children with neuromuscular system dysfunction caused by central nervous system damage of severe HFMD.Methods A total of 88 children with neuromuscular system dysfunction caused by central nervous system damage of severe HFMD in Children's Hospital Affiliated of Zhengzhou University from June 2014 to December 2017 were selected and randomly divided into control group and observation group,each with 44 subjects.Both groups were given conventional western medicine(including antiviral,anti-infection and promotion of damaged nerve recovery,maintenance of water,electrolytes and acid-base balance),the control group was additionally given routine physiotherapy,and the observation group given routine physiotherapy and acupuncture.The two groups were treated for 1 months.The clinical efficacy,scores of gross motor function measure(GMFM) and Berg balance scale(BBS) before and after treatment,disappearance time of related symptoms(including vomiting,frightening,limb shaking,muscle weakness,somnolence) of central nervous system damage,levels of biochemical indexes[interleukin-6(IL-6),high-sensitivity C-reactive protein(hs-CRP),white blood cell count(WBC) and creatine kinase(CK)] before and after treatment,occurrence of adverse reactions were compared between the two groups.Results The clinical efficacy in observation group was significantly higher than that in control group(P<0.05).After treatment,the scores of GMFM and BBS in observation group were higher than those in control group(P<0.05).The scores of GMFM and BBS in the two groups after treatment were higher than those before treatment(P<0.05).The disappearance times of vomiting,frightening,limb shaking,muscle weakness and somnolence in observation group were significantly shorter than those in control group(P<0.05).After treatment,the levels of IL-6,hs-CRP,WBC and CK in observation group were lower than those in control group(P<0.05).The levels of IL-6,hs-CRP,WBC and CK in the two groups were lower than those before treatment(P<0.05).There was no obvious adverse reactions occurred during treatment in the two groups.Conclusion Routine physiotherapy combined with acupuncture can significantly improve the motor function,shorten course of disease and reduce inflammatory reactions without obvious adverse reactions in the treatment of children with neuromuscular system dysfunction caused by central nervous system damage of severe HFMD.
Background Hand-foot-mouth disease(HFMD) is an acute eruptive infectious disease that occurs in infants and young children under 5 years old. It can be caused by more than 20 kinds of enterovirus infections,and its main clinical symptoms are fever and herpes,maculopapule or ulcer in hands,feet,mouth and buttocks,and most can be relieved after treatment without sequelae,but severe HFMD can cause peripheral nerve palsy,central nervous system damage,and even endanger the lives of children patients. Therefore,effective intervention is necessary.Objective To explore the intervention effects of routine physiotherapy combined with acupuncture on motor dysfunction in children with neuromuscular system dysfunction caused by central nervous system damage of severe HFMD.Methods A total of 88 children with neuromuscular system dysfunction caused by central nervous system damage of severe HFMD in Children's Hospital Affiliated of Zhengzhou University from June 2014 to December 2017 were selected and randomly divided into control group and observation group,each with 44 subjects.Both groups were given conventional western medicine(including antiviral,anti-infection and promotion of damaged nerve recovery,maintenance of water,electrolytes and acid-base balance),the control group was additionally given routine physiotherapy,and the observation group given routine physiotherapy and acupuncture.The two groups were treated for 1 months.The clinical efficacy,scores of gross motor function measure(GMFM) and Berg balance scale(BBS) before and after treatment,disappearance time of related symptoms(including vomiting,frightening,limb shaking,muscle weakness,somnolence) of central nervous system damage,levels of biochemical indexes[interleukin-6(IL-6),high-sensitivity C-reactive protein(hs-CRP),white blood cell count(WBC) and creatine kinase(CK)] before and after treatment,occurrence of adverse reactions were compared between the two groups.Results The clinical efficacy in observation group was significantly higher than that in control group(P<0.05).After treatment,the scores of GMFM and BBS in observation group were higher than those in control group(P<0.05).The scores of GMFM and BBS in the two groups after treatment were higher than those before treatment(P<0.05).The disappearance times of vomiting,frightening,limb shaking,muscle weakness and somnolence in observation group were significantly shorter than those in control group(P<0.05).After treatment,the levels of IL-6,hs-CRP,WBC and CK in observation group were lower than those in control group(P<0.05).The levels of IL-6,hs-CRP,WBC and CK in the two groups were lower than those before treatment(P<0.05).There was no obvious adverse reactions occurred during treatment in the two groups.Conclusion Routine physiotherapy combined with acupuncture can significantly improve the motor function,shorten course of disease and reduce inflammatory reactions without obvious adverse reactions in the treatment of children with neuromuscular system dysfunction caused by central nervous system damage of severe HFMD.
引文
[1]姚学君,金鹏飞,嵇红,等.肠道病毒71型和柯萨奇病毒A组16型所致手足口病相关特征分析[J].中华疾病控制杂志,2015,19(4):385-388.DOI:10.16462/j.cnki.zhjbkz.2015.04.017.YAO X J,JIN P F,JI H,et al.A comparison of the characteristics of diseases caused by enterovirus 71 or coxsackievirus A16[J].Chinese Journal of Disease Control,2015,19(4):385-388.DOI:10.16462/j.cnki.zhjbkz.2015.04.017.
[2]崔素英.小儿手足口病的症状、治疗和预防分析[J].中国医药指南,2015,13(22):167.DOI:10.15912/j.cnki.gocm.2015.22.122.CUI S Y.Analysis of symptoms,treatment and prevention of handfoot-mouth disease in children[J].Guide of Chinese Medical,2015,13(22):167.DOI:10.15912/j.cnki.gocm.2015.22.122.
[3]赵文轩,张瑞娟,苏海生,等.重症手足口病临床特征及危险因素分析[J].现代仪器与医疗,2015,21(6):88-90.DOI:10.11876/mimt201506035.ZHAO W X,ZHANG R J,SU H S,et al.Analysis of clinical characteristics and risk factors of severe hand foot mouth disease[J].Modern Instruments and Medical Treatmeant,2015,21(6):88-90.DOI:10.11876/mimt201506035.
[4]娄普,娄欣霞,朱敏杰,等.早期康复治疗对重症手足口病合并肢体瘫痪儿童的临床疗效[J].中国疗养医学,2017,26(11):1148-1149.DOI:10.13517/j.cnki.ccm.2017.11.009.LOU P,LOU X X,ZHU M J,et al.Clinical effect of early rehabilitation treatment on children with severe hand-foot-mouth disease and limb paralysis[J].Chinese Journal of Convalescent Medicine,2017,26(11):1148-1149.DOI:10.13517/j.cnki.ccm.2017.11.009.
[5]胡亚美,江载芳.诸福棠实用儿科学[M].8版.北京:人民卫生出版社,2012.HU Y M,JIANG Z F.Practical pediatrics of Zhufutang[M].8th ed.Beijing:People's Health Publishing House,2012.
[6]潘家华.实用小儿手足口病诊疗指南[M].合肥:安徽科学技术出版社,2010.PAN J H.Practical guidelines for the diagnosis and treatment of handfoot-mouth disease in children[M].Hefei:Anhui Science and Technology Press,2010.
[7]张健,赵澎.电针灸配合针刺治疗手足口病合并急性弛缓性瘫痪疗效观察[J].北京中医药,2017,36(7):607-610.DOI:10.16025/j.1674-1307.2017.07.007.ZHANG J,ZHAO P.Observation on the curative effect of electroacupuncture combined with acupuncture in the treatment of hand-foot-mouth disease combined with acute flaccid paralysis[J].Beijing Traditional Chinese Medicine,2017,36(7):607-610.DOI:10.16025/j.1674-1307.2017.07.007.
[8]张勇,张翠平,张喜芳.针刺治疗手足口病致急性弛缓性瘫痪21例[J].中国针灸,2012,32(11):979-980.DOI:10.13703/j.0255-2930.2012.11.009.ZHANG Y,ZHANG C P,ZHANG X F.Acupuncture treatment of21 cases of acute flaccid paralysis caused by hand-foot-mouth disease[J].Chinese Acupuncture,2012,32(11):979-980.DOI:10.13703/j.0255-2930.2012.11.009.
[9]陈怡澎,陈佐明.粗大运动功能测试量表的简化及最优路径[J].新乡医学院学报,2015,32(12):1110-1114,1118.DOI:10.7683/xxyxyxb.2015.12.014.CHEN Y P,CHEN Z M.Simplification and optimal path of chunda motor function test scale[J].Journal of Xinxiang Medical College,2015,32(12):1110-1114,1118.DOI:10.7683/xxyxyxb.2015.12.014.
[10]杨雅琴,周亚楠,邢德利,等.Berg平衡量表应用于帕金森病患者的信度分析[J].中国康复理论与实践,2016,22(3):303-305.DOI:10.3969/j.issn.1006-9771.2016.03.014.YANG Y Q,ZHOU Y N,XING D L,et al.Berg balance scale applied to the reliability analysis of patients with Parkinson's disease[J].Chinese Rehabilitation Theory and Practice,2016,22(3):303-305.DOI:10.3969/j.issn.1006-9771.2016.03.014.
[11]蒋豪明,顾承萍.小儿危重病例评分对重症手足口病病情评估和病情进展的预测作用[J].儿科药学杂志,2016,22(2):8-10.DOI:10.13407/j.cnki.jpp.1672-108X.2016.02.003.JIANG H M,GU C P.The predictive effect of pediatric critical case score on the evaluation and progression of severe HFMD[J].Journal of Pediatric Pharmacology,2016,22(2):8-10.DOI:10.13407/j.cnki.jpp.1672-108X.2016.02.003.
[12]杨铂,王小利,刘倩.论重症手足口病中医病因病机[J].中国中医药信息杂志,2013,20(9):94.DOI:10.3969/j.issn.1005-5304.2013.09.041.YANG B,WANG X L,LIU Q.Etiology and pathogenesis of severe hand-foot-mouth disease in Chinese medicine[J].Chinese Journal of Information on Traditional Chinese Medicine,2013,20(9):94.DOI:10.3969/j.issn.1005-5304.2013.09.041.
[13]王欢,陈明岭.“肺合皮毛”思想皮肤科临床应用举隅[J].实用中西医结合临床,2014,14(1):59-60.DOI:10.13638/j.issn.1671-4040.2014.01.043.WANG H,CHEN M L.Clinical application of"lung and fur"in dermatology[J].Practical Clinical Journal of Integrated Traditional Chinese and Western Medicine,2014,14(1):59-60.DOI:10.13638/j.issn.1671-4040.2014.01.043.
[14]邹桂芝,郝建军,张介眉.张介眉教授运用“治痿独取阳明”临证心得[J].实用中西医结合临床,2017,17(9):124-125.DOI:10.13638/j.issn.1671-4040.2017.09.076.ZOU G Z,HAO J J,ZHANG J M.Professor Zhang Jiemei's experience in the treatment of impotence and taking Yang Ming alone[J].Practical Combination of Chinese and Western Medicine in Clinical Practice,2017,17(9):124-125.DOI:10.13638/j.issn.1671-4040.2017.09.076.
[15]李彦毕,刘景珍.清解透表汤联合针刺治疗小儿手足口病的疗效观察[J].湖北中医药大学学报,2018,20(1):89-91.DOI:10.3969/j.issn.1008-987x.2018.01.23.LI Y B,LIU J Z.Effect observation of qingjie toubiao decoction and acupuncture on children with hand-foot-mouth disease[J].Journal of Hubei University of Chinese Medicine,2018,20(1):89-91.DOI:10.3969/j.issn.1008-987x.2018.01.23.
[16]陈洪琳,关放.醒脑开窍、疏通经络针刺法对脑梗死急性期患者血液循环、运动功能及日常生活能力的影响研究[J].陕西中医,2016,37(4):488-489.DOI:10.3969/j.issn.1000-7369.2016.04.052.CHEN H L,GUAN F.A study on the effects of acupoint acupuncture on blood circulation,motor function and daily life of patients with acute cerebral infarction[J].Shaanxi Traditional Chinese Medicine,2016,37(4):488-489.DOI:10.3969/j.issn.1000-7369.2016.04.052.
[17]陈冬梅,田庆玲,张双,等.清解透表汤联合针刺治疗小儿手足口病的疗效观察[J].中国中医急症,2016,25(7):1375-1377.DOI:10.3969/j.issn.1004-745X.2016.07.035.CHEN D M,TIAN Q L,ZHANG S,et al.Effect observation of qingjie toubiao decoction and acupuncture on children with handfoot-mouth disease[J].Journal of Emergency in Traditional Chinese Medicine,2016,25(7):1375-1377.DOI:10.3969/j.issn.1004-745X.2016.07.035.
[18]刘德芳,赵波,吕云利,等.针刺治疗对脑梗死急性期患者血液循环、神经功能及日常生活能力的影响[J].现代中西医结合杂志,2015,24(28):3095-3097.DOI:10.3969/j.issn.1008-8849.2015.28.008.LIU D F,ZHAO B,LYU Y L,et al.Effect of acupuncture treatment on the blood circulation,neurologic function and daily life ability in patients with acute cerebral infarction[J].Journal of Modern in Tegrated Traditional Chinese and Western Medicine,2015,24(28):3095-3097.DOI:10.3969/j.issn.1008-8849.2015.28.008.
[19]冯吉杰,王珂,陈彤宇,等.针刺调控炎性反应在抗缺血再灌注损伤中的研究进展[J].针刺研究,2017,42(6):552-556.DOI:10.13702/j.1000-0607.2017.06.017.FENG J J,WANG K,CHEN T Y,et al.Research on acupuncture in regulating the inflammatory reaction in antiischemia-reperfusion injury[J].Acupuncture Research,2017,42(6):552-556.DOI:10.13702/j.1000-0607.2017.06.017.
[2]崔素英.小儿手足口病的症状、治疗和预防分析[J].中国医药指南,2015,13(22):167.DOI:10.15912/j.cnki.gocm.2015.22.122.CUI S Y.Analysis of symptoms,treatment and prevention of handfoot-mouth disease in children[J].Guide of Chinese Medical,2015,13(22):167.DOI:10.15912/j.cnki.gocm.2015.22.122.
[3]赵文轩,张瑞娟,苏海生,等.重症手足口病临床特征及危险因素分析[J].现代仪器与医疗,2015,21(6):88-90.DOI:10.11876/mimt201506035.ZHAO W X,ZHANG R J,SU H S,et al.Analysis of clinical characteristics and risk factors of severe hand foot mouth disease[J].Modern Instruments and Medical Treatmeant,2015,21(6):88-90.DOI:10.11876/mimt201506035.
[4]娄普,娄欣霞,朱敏杰,等.早期康复治疗对重症手足口病合并肢体瘫痪儿童的临床疗效[J].中国疗养医学,2017,26(11):1148-1149.DOI:10.13517/j.cnki.ccm.2017.11.009.LOU P,LOU X X,ZHU M J,et al.Clinical effect of early rehabilitation treatment on children with severe hand-foot-mouth disease and limb paralysis[J].Chinese Journal of Convalescent Medicine,2017,26(11):1148-1149.DOI:10.13517/j.cnki.ccm.2017.11.009.
[5]胡亚美,江载芳.诸福棠实用儿科学[M].8版.北京:人民卫生出版社,2012.HU Y M,JIANG Z F.Practical pediatrics of Zhufutang[M].8th ed.Beijing:People's Health Publishing House,2012.
[6]潘家华.实用小儿手足口病诊疗指南[M].合肥:安徽科学技术出版社,2010.PAN J H.Practical guidelines for the diagnosis and treatment of handfoot-mouth disease in children[M].Hefei:Anhui Science and Technology Press,2010.
[7]张健,赵澎.电针灸配合针刺治疗手足口病合并急性弛缓性瘫痪疗效观察[J].北京中医药,2017,36(7):607-610.DOI:10.16025/j.1674-1307.2017.07.007.ZHANG J,ZHAO P.Observation on the curative effect of electroacupuncture combined with acupuncture in the treatment of hand-foot-mouth disease combined with acute flaccid paralysis[J].Beijing Traditional Chinese Medicine,2017,36(7):607-610.DOI:10.16025/j.1674-1307.2017.07.007.
[8]张勇,张翠平,张喜芳.针刺治疗手足口病致急性弛缓性瘫痪21例[J].中国针灸,2012,32(11):979-980.DOI:10.13703/j.0255-2930.2012.11.009.ZHANG Y,ZHANG C P,ZHANG X F.Acupuncture treatment of21 cases of acute flaccid paralysis caused by hand-foot-mouth disease[J].Chinese Acupuncture,2012,32(11):979-980.DOI:10.13703/j.0255-2930.2012.11.009.
[9]陈怡澎,陈佐明.粗大运动功能测试量表的简化及最优路径[J].新乡医学院学报,2015,32(12):1110-1114,1118.DOI:10.7683/xxyxyxb.2015.12.014.CHEN Y P,CHEN Z M.Simplification and optimal path of chunda motor function test scale[J].Journal of Xinxiang Medical College,2015,32(12):1110-1114,1118.DOI:10.7683/xxyxyxb.2015.12.014.
[10]杨雅琴,周亚楠,邢德利,等.Berg平衡量表应用于帕金森病患者的信度分析[J].中国康复理论与实践,2016,22(3):303-305.DOI:10.3969/j.issn.1006-9771.2016.03.014.YANG Y Q,ZHOU Y N,XING D L,et al.Berg balance scale applied to the reliability analysis of patients with Parkinson's disease[J].Chinese Rehabilitation Theory and Practice,2016,22(3):303-305.DOI:10.3969/j.issn.1006-9771.2016.03.014.
[11]蒋豪明,顾承萍.小儿危重病例评分对重症手足口病病情评估和病情进展的预测作用[J].儿科药学杂志,2016,22(2):8-10.DOI:10.13407/j.cnki.jpp.1672-108X.2016.02.003.JIANG H M,GU C P.The predictive effect of pediatric critical case score on the evaluation and progression of severe HFMD[J].Journal of Pediatric Pharmacology,2016,22(2):8-10.DOI:10.13407/j.cnki.jpp.1672-108X.2016.02.003.
[12]杨铂,王小利,刘倩.论重症手足口病中医病因病机[J].中国中医药信息杂志,2013,20(9):94.DOI:10.3969/j.issn.1005-5304.2013.09.041.YANG B,WANG X L,LIU Q.Etiology and pathogenesis of severe hand-foot-mouth disease in Chinese medicine[J].Chinese Journal of Information on Traditional Chinese Medicine,2013,20(9):94.DOI:10.3969/j.issn.1005-5304.2013.09.041.
[13]王欢,陈明岭.“肺合皮毛”思想皮肤科临床应用举隅[J].实用中西医结合临床,2014,14(1):59-60.DOI:10.13638/j.issn.1671-4040.2014.01.043.WANG H,CHEN M L.Clinical application of"lung and fur"in dermatology[J].Practical Clinical Journal of Integrated Traditional Chinese and Western Medicine,2014,14(1):59-60.DOI:10.13638/j.issn.1671-4040.2014.01.043.
[14]邹桂芝,郝建军,张介眉.张介眉教授运用“治痿独取阳明”临证心得[J].实用中西医结合临床,2017,17(9):124-125.DOI:10.13638/j.issn.1671-4040.2017.09.076.ZOU G Z,HAO J J,ZHANG J M.Professor Zhang Jiemei's experience in the treatment of impotence and taking Yang Ming alone[J].Practical Combination of Chinese and Western Medicine in Clinical Practice,2017,17(9):124-125.DOI:10.13638/j.issn.1671-4040.2017.09.076.
[15]李彦毕,刘景珍.清解透表汤联合针刺治疗小儿手足口病的疗效观察[J].湖北中医药大学学报,2018,20(1):89-91.DOI:10.3969/j.issn.1008-987x.2018.01.23.LI Y B,LIU J Z.Effect observation of qingjie toubiao decoction and acupuncture on children with hand-foot-mouth disease[J].Journal of Hubei University of Chinese Medicine,2018,20(1):89-91.DOI:10.3969/j.issn.1008-987x.2018.01.23.
[16]陈洪琳,关放.醒脑开窍、疏通经络针刺法对脑梗死急性期患者血液循环、运动功能及日常生活能力的影响研究[J].陕西中医,2016,37(4):488-489.DOI:10.3969/j.issn.1000-7369.2016.04.052.CHEN H L,GUAN F.A study on the effects of acupoint acupuncture on blood circulation,motor function and daily life of patients with acute cerebral infarction[J].Shaanxi Traditional Chinese Medicine,2016,37(4):488-489.DOI:10.3969/j.issn.1000-7369.2016.04.052.
[17]陈冬梅,田庆玲,张双,等.清解透表汤联合针刺治疗小儿手足口病的疗效观察[J].中国中医急症,2016,25(7):1375-1377.DOI:10.3969/j.issn.1004-745X.2016.07.035.CHEN D M,TIAN Q L,ZHANG S,et al.Effect observation of qingjie toubiao decoction and acupuncture on children with handfoot-mouth disease[J].Journal of Emergency in Traditional Chinese Medicine,2016,25(7):1375-1377.DOI:10.3969/j.issn.1004-745X.2016.07.035.
[18]刘德芳,赵波,吕云利,等.针刺治疗对脑梗死急性期患者血液循环、神经功能及日常生活能力的影响[J].现代中西医结合杂志,2015,24(28):3095-3097.DOI:10.3969/j.issn.1008-8849.2015.28.008.LIU D F,ZHAO B,LYU Y L,et al.Effect of acupuncture treatment on the blood circulation,neurologic function and daily life ability in patients with acute cerebral infarction[J].Journal of Modern in Tegrated Traditional Chinese and Western Medicine,2015,24(28):3095-3097.DOI:10.3969/j.issn.1008-8849.2015.28.008.
[19]冯吉杰,王珂,陈彤宇,等.针刺调控炎性反应在抗缺血再灌注损伤中的研究进展[J].针刺研究,2017,42(6):552-556.DOI:10.13702/j.1000-0607.2017.06.017.FENG J J,WANG K,CHEN T Y,et al.Research on acupuncture in regulating the inflammatory reaction in antiischemia-reperfusion injury[J].Acupuncture Research,2017,42(6):552-556.DOI:10.13702/j.1000-0607.2017.06.017.