针刺治疗急性脑梗死后弛缓性瘫痪研究进展

Research Progress of Acupuncture in the Treatment of Flaccid Paralysis After Acute Cerebral Infarction

针刺治疗急性脑梗死(acute cerebral infarction,ACI)后弛缓性瘫痪的主要方法有:头针、体针、电针。就目前研究来看,针刺治疗急性脑梗死后弛缓性瘫痪尚存在以下问题:①当前针刺治疗方法多样,无论从选穴、手法、介入时机、补泻、刺激量、留针时间和疗程等方面均有差异,暂无统一操作标准和疗效评定规范;②有效样本量少,尚无公开的循证康复医学指南可依;③目前对于中风后弛缓性瘫痪的研究主要集中于恢复期,而对急性期的研究较少;④医师在治疗过程中,忽视了中风病不同病理阶段的病因病机,而始终沿用同一治疗方案,这对病程某一阶段疗效或许较好,但远期疗效却并不尽如人意,从而影响针刺疗法在本病临床治疗中的推广运用。今后的研究应从以下几方面开展:①从循证医学角度出发,实施大样本、多中心的随机对照临床研究,科学严谨地观察针刺疗法治疗ACI后弛缓性瘫痪的确切疗效;②进一步研究不同针刺方法,制定规范统一的治疗方案和疗效评定标准,便于针刺疗法在本病中的推广和应用;③深入探索针刺疗法治疗本病更有效的治疗手段,在选择针刺疗法治疗本病时可参照现代康复医学理论的Brunnstrom分期理论,根据不同阶段的运动模式而选用最佳治疗方案,促使ACI弛缓性偏瘫患者早日康复。

The main methods of acupuncture in the treatment of flaccid paralysis after acute cerebral infarction(ACI)include scalp acupuncture,body acupuncture and electroacupuncture.According to the current research,the following problems still need to be solved in the treatment of flaccid paralysis after ACI by Acupuncture:①At present,there are many kinds of acupuncture treatment methods,no matter from point selection,manipulation,intervention time,tonic and purgative,stimulation amount,needle retention time and treatment course,there is no unified operation standard and efficacy evaluation standard.②There are few effective samples,and there is no evidence-based rehabilitation medical guidelines to follow.③At present,the research on post-stroke flaccid paralysis mainly focuses on the recovery period,but less on the acute period.④In the course of treatment,doctors often ignore the etiology and pathogenesis of different pathological stages of stroke,and always use the same treatment plan,which may be better for a certain stage of the course of disease,but the long-term effect is not satisfactory,thus affecting the promotion and application of acupuncture therapy in the clinical treatment of the disease.Therefore,future research should be carried out from the following aspects:①From the perspective of evidence-based medicine,large sample,multicenter randomized controlled clinical research should be carried out to observe the exact efficacy of acupuncture therapy in the treatment of flaccid paralysis after ACI scientifically and rigorously;②We should further study on different acupuncture methods,formulate standardized and unified treatment plan and efficacy evaluation standards,so as to facilitate the promotion of acupuncture therapy in this disease and application;③We should explore more effective treatment means with acupuncture for this disease.When choosing acupuncture treatment for this disease,we can refer to Brunnstrom stage theory of modern rehabilitation medicine,and choose the best treatment plan according to the movement mode of different stages,so as to promote the early rehabilitation of patients with ACI flaccid hemiplegia.