不同方法治疗脑梗死的优选方案及机制

The Optimum Program of Different Methods and the Mechanisms for the Treatment of Cerebral Infarction

目的：探讨治疗脑梗死的优选方案及其机制。方法：将64例脑梗死病人按正交设计方案随机分组,分别采用行针次数（A）、结合康复（B）、针刺时机（C）、穴位（D）等4因素及相应的2水平进行治疗,观察治疗前后的神经功能缺损积分和胰岛素抵抗（IR）的改变。结果：对神经功能缺损积分的改善方面,A、B、C、D 4个因素均为显著因素（P〈0.05）。B1C1D1A2（即结合康复、病程1-7天、头针丛刺法、捻针2次）为治疗脑梗死的最佳方案;对胰岛素抵抗的影响方面,A因素、C因素、D因素为显著因素（P〈0.01）,C1D1A2B1（即病程在1-7天、头针丛刺法、捻针2次、结合康复）为治疗的最佳方案。结论：患者病程在1-7天,运用头针丛刺法,捻转2次,并结合康复治疗脑梗死在临床上可以有效的改善神经功能缺损的症状。患者病程在1-7天,运用头针丛刺法,并且捻针2次刺激针刺部位,对改善胰岛素抵抗（IR）有显著作用。针刺在1-7天、头针丛刺法和捻转2次是本实验治疗的最佳方案,而对IR的良性调节作用是其获效的机理之一,这也为针刺在治疗缺血性脑血管病的二级预防上提供了重要的治疗方法。

Objective：To study the optimum program of acupuncture treatment and the mechanism for the treatment of cerebral infarction.Methods：Sixty-four cases were randomly devided into eight groups.The four factors were the time of manipulation（A）,incorporating rehabilitation（B）,acupuncture opportunity（C） and acupoints（D）,and their corresponding two levels for the treatment,which were adopted respectively in the treatment of every group.Then nerve function deficiency integral and insulin resistance were observed before and after treatment.Results：The acupuncture opportunity,the time of manipulation,rehabilitation and acupoints have significant effects on nerve function deficiency（P〈0.05）;The time of manipulation,acupuncture opportunity and acupoints have significant effects on insulin resistance（P〈0.05）.Conclusion：During the acute stage（1~7Days）,employing the method of the cluster needling of scalp point,twisting twice combined with the rehabilitation of cerebral infarction can improve the symptom of the deficiency of nerve function effectively and regulate the effect of acupuncture on insulin resistance.The method of the cluster needling of scalp point and twisting twice are the best therapeutic program in the experiment.And its regulative effect on IR is one of the effective mechanisms.It also provides an important acupuncture treatment for ischemic cerebrovascular disease in the sencondary prevention