针刺结合Brunnstrom分期对中风后上肢运动功能、脑动脉血流速度及脑功能重塑的影响

Effects of acupuncture combined with Brunnstrom staging on upper-limb motor function,cerebral arterial blood flow velocity,and brain function remodeling after stroke

目的:探讨针刺结合Brunnstrom分期对中风后上肢运动功能、脑动脉血流速度及脑功能重塑的影响.方法:选择2017年1月至2019年12月就诊的77例中风患者进行前瞻性研究,根据随机数字表法将纳入研究的病例分为观察组和对照组.两组患者均行常规中风对症治疗并根据Brunnstrom分期进行功能锻炼.观察组在Brunnstrom分期疗法的基础上行针刺疗法,治疗6周后统计疗效.对比两组患者治疗前后头晕目眩、头痛、肢体麻木、言语蹇涩的中医症状评分.根据Fugl-Meyer运动功能评定量表(FMA)对比治疗前后上肢运动功能,对比两组患者治疗前后大脑前动脉、大脑中动脉以及大脑后动脉收缩期平均血液流速.根据高级中枢损伤严重程度评分量表(MESSS)对比治疗前后神经功能.结果:观察组总有效率为94.9%,明显高于对照组的79.0%(P<0.05).治疗后,两组头晕目眩、头痛、肢体麻木、言语蹇涩的中医症状评分均降低,且观察组明显低于对照组(P<0.05).两组上肢FMA评分均升高,且观察组明显高于对照组(P<0.05).两组大脑前动脉、大脑中动脉以及大脑后动脉收缩期平均血液流速均升高,且观察组明显高于对照组(P<0.05).两组MESSS评分均降低,且观察组明显低于对照组(P<0.05).结论:针刺结合Brunnstrom分期对中风患者疗效较好,可有效改善上肢运动功能,提高脑动脉血液流速,促进脑功能重塑及神经功能恢复.

Objective:To explore the effects of acupuncture combined with Brunnstrom staging on upper-limb motor function,cerebral arterial blood flow velocity,and brain function remodeling after stroke.Methods:A total of 77 patients after stroke were selected between January 2017 and December 2019 to perform a prospective study.All cases were divided into an observation group and a control group by the random number table method.Both groups were treated with conventional symptomatic treatment for stroke and functional exercise according to the Brunnstrom staging.The observation group was treated with additional acupuncture treatment based on the Brunnstrom staging therapy.The therapeutic efficacy was evaluated after six-week treatment.The traditional Chinese medicine(TCM)symptom scores of dizziness,headache,limb numbness,and language disorders before and after the treatment in the two groups were compared.According to the Fugl-Meyer motor function assessment(FMA),the upper-limb motor function before and after the treatment was compared.And the average systolic blood flow velocity of the anterior cerebral artery(ACA),middle cerebral artery(MCA),and posterior cerebral artery(PCA)in the two groups before and after the treatment were compared.According to the modified Edinburgh-Scandinavia stroke scale(MESSS),the nerve function before and after the treatment was compared.Results:The total effective rate of the observation group was 94.9%,significantly higher than 79.0%of the control group(P<0.05).After the treatment,the TCM symptom scores of dizziness,headache,limb numbness,and language disorders in both groups decreased,and the scores in the observation group were all significantly lower than those in the control group(P<0.05).The FMA score of upper limbs in both groups increased,and the score in the observation group was significantly higher than that in the control group(P<0.05).The average systolic blood flow velocities of the ACA,MCA and PCA in both groups increased,and were significantly higher in the observation group than in the control group(P<0.05).The MESSS score in both groups decreased,and the score in the observation group was significantly lower than that in the control group(P<0.05).Conclusion:Acupuncture combined with Brunnstrom staging is effective for patients after stroke.It can effectively improve the upper-limb motor function and cerebral artery blood flow velocity,promote brain function remodeling,and restore nerve function.