醒脑开窍针刺加头针早期介入治疗脑梗死的磁共振弥散加权成像对照研究

A control study of magnetic resonance diffusion weighted imaging of patients with acute cerebral infarction and early(<48 hours) intervention with resuscitating and scalp acupuncture therapies(醒脑开窍针刺加头针法)

目的采用磁共振弥散加权成像(DWI)和神经功能缺损评定评价醒脑开窍针刺加头针法早期介入(48 h以内)治疗脑梗死的疗效及安全性。方法48 h内开始针刺治疗,在神经科常规药物治疗的基础上,观察醒脑开窍针刺加头针法(治疗组,20例)和单纯常规药物治疗法(对照组,20例)治疗前后DWI缺血面积及美国国立卫生院脑卒中量表(NIHSS)评分的变化,并比较疗效及评价安全性。分别于治疗前及治疗7 d各进行一次DWI扫描,并计算各个时间点缺血最大层面的缺血面积变化程度;同时于治疗前及治疗7 d和14 d进行NIHSS评分并评估疗效。结果与对照组比较,治疗组治疗后缺血面积扩大的例数少(8比15,P<0.05),且平均缺血面积较小〔(4.26±1.33)cm2比(6.92±1.53)cm2,P<0.05〕。对照组治疗后14 d NIHSS评分显著下降,治疗组治疗后7 d起即显著下降,且与对照组比较,差异有统计学意义(P均<0.05);两组安全性评价差异无统计学意义(P>0.05)。结论醒脑开窍针刺加头针法早期介入能够有效控制DWI缺血面积的扩大,同时改善神经功能缺损程度,从而控制脑梗死病情的进展,且安全性好。

Objective To evaluate the effects and safety of early intervention （〈 48 hours） with resuscitating and scalp acupuncture therapies （醒脑开窍针刺加头针法） in patients with acute cerebral infarction by using magnetic resonance diffusion weighted imaging （DWI） and nerve defect function evaluation （National Institutes of Health Stroke Scale, NIHSS）o Methods Patients with acute cerebral infarction （〈48 hours） were divided randomly into two groups （each n = 20）： resuscitating and scalp acupuncture combined with routine drug treatment group and routine drug treatment group. The extent of DWI ischemic area, NIHSS scores and the therapeutic effect and safety were assessed before and after treatment respectively. DWI scans were performed before and after treatment for 7 days. Then at the time point, the changes of the degree of maximum layer ischemic area were calculated; in the mean time, before the treatment and 7 and 14 days after the treatment, NIHSS scores were evaluated, and therapeutic effects were assessed. Results After treatment, the cases with enlargement of ischemic area were less （8 vs. 15, P〈0.05） and the mean ischemic area was smaller in the treatment group than those in the control group [（4.26 ± 1.33） cm^2 vs. （6.92±1.53） cm^2, P〈0.05]. The NIHSS scores were declined significantly after treatment for 14 days in the control group, while the NIHSS scores in the treatment group were declined significantly after treatment for 7 days （all P〈0.05）; the safety evaluation in the two groups had no significant difference （P〉0.05）. Conclusion Early intervention of resuscitating and scalp acupuncture therapies can efficiently control ischemic area enlargement and improve neurologic impairment. Therefore, the combination of resuscitating acupuncture and scalp acupuncture can control the development of cerebral infarction, and its safety is well.