不同针刺方案对脑梗死偏瘫患者康复及病灶侧大脑中动脉平均血流速度的影响

Effects of different acupuncture treatment on mean blood flow velocity of middle cerebral artery on the affected side and rehabilitation of hemiparalysis caused by cerebral infarction

目的:观察两种不同针刺方案对脑梗死偏瘫患者早期的康复作用及脑血流速度的影响。方法:将80例患者随机分为交替针刺组和常规针刺组,每组40例。两组在采用相同的神经内科常规药物治疗和良肢位摆放的同时均给予针刺治疗。交替针刺组采用巨刺与非巨刺交替运用的方法,即每日2次、健侧与患侧腧穴交替使用;常规针刺组每日1次、仅取患侧腧穴针刺。评价两组治疗前后临床神经功能缺损程度(SSS)评分,并利用经颅多普勒超声仪监测两组患者治疗第1天及治疗最后1天针刺前及针刺过程中病灶侧大脑中动脉(MCA)的平均血流速度。结果:交替针刺组的愈显率为65.0%,优于常规针刺组的37.5%(P<0.01);交替针刺组治疗后的改良SSS评分低于常规针刺组(P<0.01);交替针刺组与常规针刺组在治疗第1天及最后1天针刺过程中均可使病灶侧MCA平均血流速度下降(均P<0.05);治疗最后1天交替针刺组针刺前MCA平均血流速度与常规针刺组针刺前比较差异有统计学意义(P<0.05)。结论:交替针刺组在提高临床疗效方面优于常规针刺组,扩张脑血管、改善脑灌注是针刺治疗脑梗死后偏瘫的机制之一。

Objective To observe the effects of two different acupuncture treatment on cerebral blood flow velocity and early rehabilitation of hemiparalysis caused by cerebral infarction. Methods Eighty patients were randomly divided into an alternate acupuncture group （n=40） and a routine acupuncture group （n= 40）. Both of the groups were treated with routine neurology medicine and appliaction of good limb position combined with acupuncture. The patients in the alternate acupuncture group were treated by opposing needling and non-opposing needling, i.e. acupuncture at acupoints on both the healthy and affected sides alternately, twice each day, respectively. The routine acupuncture group was treated by acupuncture at the affected side, once daily. Scores of Scandinavian Stroke Scale （SSS） were evaluated before and after treatment in the two groups, and the mean blood flow velocity of middle cerebral artery （MCA） on the affected side was monitored during two different acupuncture treatment by using Transcranial Doppler （TCD）. Results The cured and markedly effective rate was 65.0% in the alternate acupuncture group and 37.5% in the routine acupuncture group with a significant difference between the two groups （P〈0.01）. After treatment, the SSS score in the alternate acupuncture group was significantly lower than that in the routine acupuncture group （P〈0.01）. The mean blood flow velocity of MCA during two different acupuncture treatment was both decreased significantly （both P〈0.05） and the mean blood flow velocity of MCA before the last treatment was decreased significantly in the alternate acupuncture group than those in the routine acupuncture group （P〈0.05）. Conclusion The therapeutic effect of the alternate acupuncture program for hemiparalysis caused by cerebral infarction is superior to that of the routine acupuncture program. It is suggested that the mechanism of acupuncture in treating hemiparalysis caused by cerebral infarction is to dilate cerebral blood vessels and improve cerebral perfusion.