电针刺激头皮感觉区联合感觉再训练治疗脑卒中感觉障碍的fMRI分析

Electro-acupuncture of the scalp combined with sensory re-education for the functional rehabilitation of stroke patients

目的采用功能性磁共振成像（fMRI）观察电针刺激头皮感觉区联合感觉再训练对脑卒中患者感觉障碍的影响。方法采用随机数字表法将40例脑卒中患者分为治疗组和对照组。2组患者均给予感觉再训练治疗，治疗组在此基础上辅以电针刺激头皮感觉区。于治疗前、治疗6周后采用Fugl-Meyer量表四肢感觉功能部分对2组患者偏瘫侧感觉功能进行评定；并于上述时间点对2组患者进行fMRI全脑扫描，在fMRI扫描期间2组患者均针刺患侧踝部（非穴位处）以获取针刺刺激时的脑功能激活图。结果2组患者分别经6周治疗后，发现其感觉功能均较治疗前明显改善（P〈0．05），其中治疗组感觉功能评分[（16．52±2．31）分]明显优于对照组水平[（12．21±2．42）分]（P〈0．05）；通过fMRI扫描发现，治疗组患者治疗后其患侧感觉运动皮质区（SMG）激活出现率（80．0％）明显高于对照组（50．0％），组间差异具有统计学意义（P〈0．05）。结论电针刺激头皮感觉区联合感觉再训练能促进脑卒中患者躯干感觉皮质及大脑感觉皮质兴奋性改变，提示fMRI对研究电针刺激头皮感觉区的作用机制具有重要价值。

Objective To investigate the effectiveness of electro-acupuncture of the scalp combined with sensory re-education in the functional rehabilitation of stroke patients. Methods Forty stroke patients were divided randomly into a treatment group （n = 20） and a control group （n = 20）. Both groups received sensory re-education, and the treatment group was also treated with electro-acupuncture stimulation of the upper and lower limb sensation area on the scalp. All patients were assessed with the Fugl-Meyer sensory assessment scale and scanned at 1.5 Tesla in an MRI scanner while they were acupunctured on the ipsilateral ankle （not an acupuncture point） at the beginning and six weeks later. Results The Fugl-Meyer sensory assessment scores of both groups increased significantly after treatment, with the average score in the treatment group significantly higher than that of the control group. Six weeks later the contralateral sensory and motor cortex activation of the patients in the treatment group had increased significantly more than that of the control group. Conclusion Electro-acupuncture of the sensory area of the scalp combined with sensory re-education can evoke fMRI responses in the somatosensory cortex after stroke. Functional MRI is valuable for exploring electro-acupuncture＇s mechanisms.