早期针刺治疗对急性脑梗死患者肢体功能的影响

Effect of early acupuncture treatment on the improvement of limb function in patients with acute cerebral infarction

目的探讨早期针刺对急性脑梗死(acute cerebral infarction, ACI)患者肢体功能的影响。方法将符合入选标准的2018年3月-2019年3月本院114例首发ACI患者采用随机数字表法分为3组,每组38例。对照组采用西医常规疗法治疗,试验A组、B组在对照组基础上分别于入院后3、10 d给予针刺治疗。3组均治疗2周。采用美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale, NIHSS)评价神经功能缺损程度,采用肢体运动功能Fugl-Meyer量表(Fugl-Meyer Assessment of Motor Function, FAM)评价肢体运动功能,采用Barthel指数(Barthel Index, BI)评价日常生活能力,依据肌力分级评价患者康复情况;采用ELISA法检测神经生长因子(nerve growth factor, NGF)、脑源性神经营养因子(brain derived neurotrophic factor, BDNF)水平,评价临床疗效。结果试验A组总有效率为94.7%(36/38)、试验B组为84.2%(32/38)、对照组为73.7%(28/38),3组比较差异有统计学意义(χ^2=14.748,P<0.01)。3组治疗后NIHSS评分均降低(F=97.619,P<0.01),且试验A组低于试验B组(t=12.580,P<0.01);FAM、BI评分及肌力均升高(F值分别为134.525、35.100、164.160,P值均<0.001),且试验A组高于试验B组(t值分别为8.634、7.260、20.305,P值均<0.001)。治疗后,试验A组、B组血清NGF[(148.80±22.17)pg/ml、(132.14± 20.40)pg/ml比(125.82±18.31)pg/ml,F=12.926]、BDNF[(5.01±1.14)ng/ml、(4.10±1.09)ng/ml比(3.92±0.95)ng/ml,F=11.481]水平均高于对照组(P<0.01),且试验A组高于试验B组(t值分别为5.046、5.277,P值均<0.01)。结论早期针刺治疗可提高ACI患者血清NGF、BDNF水平,减轻神经功能损伤,促进肢体功能恢复,且入院后3 d的针刺疗效优于入院后10 d的疗效。

Objective To investigate the effect of early acupuncture treatment on limb function in patients with acute cerebral infarction(ACI).Methods A total of 114 patients with first-episode ACI in our hospital from March 2018 to March 2019 were selected and randomly divided into three groups,38 cases in each group.The control group was treated with conventional western medicine therapy,while the experimental group A and group B were given acupuncture treatment on the basis of the control group.The group A started treatment at 3rd days and the group B started at 10th day after admission.All three groups were treated for 2 weeks.The National Institute of Health Stroke Scale(NIHSS)was used to evaluate the degree of neurological deficit.The Fugl Meyer assessment of motor function(FAM)was used to evaluate the motor function.The Barthel Index(BI)was used to evaluate the activities of daily living,and the rehabilitation status was evaluated according to muscle strength grading.The levels of nerve growth factor(NGF)and brain-derived neurotrophic factor(BDNF)were detected by ELISA to evaluate the clinical efficacy.Results The total effective rate was 94.7%(36/38)in group A,84.2%(30/38)in group B and 73.7%(22/38)in control group.The difference was statistically significant(χ^2=14.748,P<0.01).After treatment,NIHSS scores of three groups were significantly decreased(F=97.619,P<0.01),and the scores of FAM,BI and muscle strength in group A were significantly lower than those in the group B(t=12.580,P<0.01);FAM,BI scores and muscle strength of three groups were significantly increased(F=134.525,35.100,164.160,all Ps<0.001),and those of group A were significantly higher than those in group B(t=8.634,7.260,20.305,all Ps<0.001).After treatment,serum NGF(148.80±22.17 pg/ml,132.14±20.40 pg/ml vs.125.82±18.31 pg/ml,F=12.926),BDNF(5.01±1.14 ng/ml,4.10±1.09 ng/ml vs.3.92±0.95 ng/ml,F=11.481)in the group A and group B were significantly higher than those in the control group(P<0.01),and serum NGF,BDNF in group A were significantly lower than those in the group B(t=5.046,5.277,all Ps<0.01).Conclusions Early acupuncture treatment can increase the levels of serum NGF and BDNF,promote the recovery of nerve factors and limb function,and the curative effect of acupuncture treatment starting at 3rd days after admission is better than 10th day.