电针对急性缺血性卒中后运动障碍及皮质脊髓束损伤程度的影响

Influence of Electroacupuncture on Motor Dysfunction and Corticospinal Tract Injury After Acute Ischemic Stroke

目的应用三重刺激技术(TST)评价急性缺血性卒中(AIS)后皮质脊髓束的损伤程度,观察电针阳明经穴对AIS后运动障碍的影响。方法纳入的73例AIS患者按照随机数字表法分为治疗组(37例)与对照组(36例)。治疗组在西医治疗基础上予电针患侧肢体阳明经穴,对照组仅予相同的西医治疗。治疗前后分别采用三重刺激技术检测皮质脊髓束损伤程度(TST test/TST control)、美国国立卫生研究院卒中评分量表(NIHSS)评价神经功能缺损症状、简化Fugl-Meyer运动功能量表(FMA)评价运动功能、改良Barthel指数(MBI)评定日常生活活动能力。结果ASI患者TST test/TST control比值较健康人群显著下降(P<0.05)。治疗前,两组TST test/TST control比值、NIHSS评分、FMA评分、MBI评分比较,差异无统计学意义(P>0.05)。治疗后,两组NIHSS积分均较治疗前显著降低(P<0.05),而TST test/TST control比值、FMA评分和MBI评分均较治疗前显著升高(P<0.05)。治疗组治疗后TST test/TST control比值、NIHSS评分、FMA评分、MBI评分的改善均优于对照组(P<0.05)。治疗过程中未发生不良反应。结论在西医治疗基础上,电针阳明经穴可明显改善急性缺血性卒中患者皮质脊髓束损伤程度、运动功能、神经功能及日常生活能力,推测与修复皮质脊髓束和重建神经传导通路有关。

Objective To estimate the severity of corticospinal tract injury after acute ischemic stroke(AIS)using triple stimulation technique(TST)and observe the effect of electroacupuncture(EA)at Yangming Meridian acupoints on motor dysfunction in AIS.Method Seventy-three AIS patients were recruited and allocated to a treatment group(37 cases)and a control group(36 cases)using random number table method.The treatment group was given EA at the Yangming Meridian acupoints on the affected side in addition to the Western medicine treatment,while the control group was only given the same Western medicine treatment.Before and after treatment,TST was used to detect the corticospinal tract injury severity(TST test/TST control),National Institute of Health Stroke Scale(NIHSS)was used to evaluate the neurologic deficit symptoms,short-form Fugl-Meyer Assessment(FMA)was adopted to evaluate motor function,and Modified Barthel Index(MBI)was used to estimate the activities of daily living(ADL).Result The TST test/TST control ratio dropped significantly in ASI patients compared with the healthy people(P<0.05).Before treatment,there were no significant differences in the TST test/TST control ratio,and NIHSS,FMA and MBI scores between the two groups(P>0.05).After treatment,the NIHSS score dropped significantly in both groups(P<0.05),while the TST test/TST control ratio,and the FMA and MBI scores increased significantly(P<0.05).The post-treatment improvements in the TST test/TST control ratio,and the scores of NIHSS,FMA and MBI were more significant in the treatment group than in the control group(P<0.05).There were no adverse reactions during treatment.Conclusion Based on Western medicine treatment,EA at the Yangming Meridian acupoints can notably improve the corticospinal tract injury,motor function,neurologic function and ADI in AIS patients,which is supposed to be associated with the repair of corticospinal tract and reconstruction of nerve pathways.