针刺足三里和悬钟治疗缺血性脑卒中

Treatment of ischemic stroke by acupuncture at Zusanli and Xuanzhong

目的:观察针刺足三里、悬钟2穴对缺血性脑卒中脑血管功能的影响,分析其可能的作用机制,并对临床疗效做出评价。方法:选择2004-11/2006-05湖北中医药高等专科学校附属古城医院针灸科、荆州市第五人民医院中医康复科、荆州市第三人民医院中医科3单位缺血性脑卒中患者合适病例160例,采用查随机数字表的方法,将其随机分为对照组和针刺组,各80例。对照组采用现代医学常规干预方法进行治疗:卧床,保持呼吸道通畅,预防感染,控制颅内压、血压,维持水电解质平衡。针刺组在此基础上加针刺足三里、悬钟2穴,采用慢速捻转进针法针刺,留针20～30min,每隔5min行针1次。1次/d。两组患者治疗30d。并以经颅多普勒检测观察缺血性脑卒中患者治疗前后脑血管舒缩反应能力、脑血流自动调节功能、大脑半球侧枝循环代偿功能的变化,同时以治疗前后神经功能缺损程度为指标评价其临床疗效。结果:160例病例全部进入结果分析。①针刺组与治疗前相比,脑血管舒缩反应能力明显加强,差异有显著性意义(t=2.97,P<0.05),且优于对照组(t=2.45,P<0.05)。②针刺组与治疗前相比,脑血流自动调节能力明显改善,差异有非常显著性意义(t=8.01,P<0.01),且优于对照组(t=7.67,P<0.05)。③针刺组与治疗前相比,大脑半球侧枝循环代偿功能得到加强,差异有显著性意义(t=3.15,P<0.05),且优于对照组(t=5.16,P<0.05)。④针刺组与治疗前相比,神经功能缺损积分明显降低,差异有非常显著性意义(t=4.83,P<0.01),且优于对照组(t=5.43,P<0.05)。结论:针刺足三里、悬钟2穴对缺血性脑卒中患者脑血管舒缩反应能力、脑血流自动调节功能、大脑半球侧枝循环代偿功能有明显改善作用,并能促进神经功能的恢复。

AIM： To explore the effect of acupuncture at Zusanfi （ST36） and Xuanzhong （GB39） on the cerebrovascular function of ischemic stroke, and analyze the possible mechanism, so as to evaluate the clinical therapeutic effect. METHODS： Totally 160 patients with ischemic stroke were selected from Gucheng Hospital affiliated to Hubei High Training School of Traditional Chinese Medicine and Pharmacy, Department of Rehabilitation, the Fifth Hospital of Jingzhou City, and Department of Traditional Chinese Medicine, Third Hospital of Jingzhou City between November 2004 and May 2006. They were randomly divided into control group and acupuncture group with 80 patients in each group. The control group was treated with modern routine intervention： lying in bed to keep smooth of the respiratory tract; to prevent infection, control the intracranial pressure, blood pressure, and maintain water-electrolyte balance. The acupuncture group was given the acupuncture at Zusanli and Xuanzhong besides the previous treatment. Slowly inserting technique acupuncture was adopted and remained for 20-30 minutes, once every other 5 minutes and once daily. Both groups were treated for 30 days. Transcranial Doppler ultrasound was used to observe the changes of cerebral vasomotorial response, auto-regulation, and collateral circulation before and after treatment; meanwhile, the clinical effect was evaluated by the ameliorations of nervous function impairment. RESULTS： All 160 patients were involved in the result analysis. （1）Compared with that before treatment, the cerebral vasomotodal response of the acupuncture group were improved apparently with significant differences （t =2.97, P 〈 0.05）, and superior to the control group （t =2.45, P 〈 0.05）. （2）Compared with that before treatment, the auto-regulation of the acupuncture group were improved very apparently with obvious differences （t =8.01, P 〈 0.01）, and superior to the control group （t =7.67, P 〈 0.05）. （3）Compared with that before treatment, the establishment of collateral circulation of the acupuncture group were improved remarkably with significant differences （t =3.15, P 〈 0.05）, and superior to the control group （t =5.16, P 〈 0.05）. （4）Compared with that before treatment, the nervous function of the acupuncture group were improved apparently with significant differences （t =4.83, P 〈 0.01）, and superior to the control group （t =5.43, P 〈 0.05）. CONCLUSION： Acupuncture at Zusanli and Xuanzhong can ameliorate the function of cerebral blood flow automatic regulation and collateral circulation compensation of cerebral hemisphere, improve the ability of cerebral vessels vasomotor, and promote the recovery of nervous function.