电针头穴治疗脑卒中后肩手综合征Ⅰ期的即刻效应研究和多功能磁共振成像研究

Immediate Effect Study and fMRI Study of Electroacupuncture on Scalp Acupuncture Treatment of Shoulder-Hand Syndrome after Stroke

目的观察电针顶颞前斜线中2/5和顶颞后斜线中2/5治疗脑卒中后肩手综合征Ⅰ期的临床疗效即刻效应,并应用多功能磁共振成像(functional magnetic resonance imagine, fMRI)技术观察其中枢效应并探讨其作用机理。方法选取80例符合纳入标准的脑卒中后肩手综合征Ⅰ期患者按随机数字表法分为观察组和对照组各40例。对照组给予常规针刺加电针治疗,观察组给予电针头穴治疗。评价两组即刻治疗效果,观察两组治疗前、针刺后10 min、电针后10 min上肢运动功能评分(FMA)、VAS疼痛指数评分、改良Barthel指数(MBI)的变化情况。并在观察组中按编号随机选取5例患者行fMRI检查。结果 (1)观察组总有效率为95.00%(38/40),对照组总有效率为82.50%(33/40),差异有统计学意义(P<0.05)。(2)头针对上肢功能的改善优于对疼痛症状的改善,而电针对疼痛症状的改善优于对上肢功能的改善;(3)fMRI扫描分析显示观察组激活的脑功能区以中央前回中部、中央后回中部、颞叶、小脑为主;电针后激活强度进一步增强。结论头针缓解脑卒中后肩手综合征Ⅰ期患者上肢疼痛症状即刻疗效更加显著,并能即刻改善肩部功能,电针疗效更加明显,提示机理可能与中央前回、中央后回、小脑等区域在疼痛接受、处理、加工、反馈等环节发挥重要作用相关。

Objective To observe the immediate clinical effect of electroacupuncture at 2/5 in the anterior parietal temporal oblique and 2/5 in the posterior parietal oblique in the treatment of post-stroke shoulder-hand syndrome stage 1, and apply multifunctional magnetic resonance imaging(functional magnetic resonance imagine, fMRI) technology to observe the central effect and explore its mechanism. Methods Eighty patients with post-stroke shoulder-hand syndrome stage 1 who met the inclusion criteria were selected and divided into observation group and control group with 40 cases in each according to the random number table. The control group was given conventional acupuncture and electroacupuncture, and the observation group was given electroacupuncture on the scalp points. The immediate treatment effect of the two groups was evaluated. The changes of upper limb motor function score(FMA), VAS pain index score and modified Barthel index(MBI) were observed before treatment. 10 minutes after acupuncture and 10 minutes after electroacupuncture, 5 patients in the observation group were randomly selected for fMRI examination according to their numbers. Results(1)The total effective rate of the observation group was 95.00%(38/40), and that of the control group was 82.50%(33/40). The difference was statistically significant(P<0.05).(2)The improvement of head-oriented upper limb function was better than the improvement of pain symptoms, and the improvement of electrical acupuncture pain symptoms was better than the improvement of upper limb function.(3)The fMRI scan analysis showed that the activated brain functional areas in the observation group were mainly the middle of anterior central gyrus, middle of posterior central gyrus, temporal lobe and cerebellum. The activation intensity was further enhanced after electroacupuncture. Conclusion The immediate effect of scalp acupuncture in relieving the upper limb pain symptoms of patients with shoulder-hand syndrome stage 1 after stroke is more significant, and can immediately improve shoulder function, and the effect of electroacupuncture is more obvious, suggesting that the mechanism may be related to the central anterior gyrus, central posterior gyrus, cerebellum, etc. Regions play an important role in pain acceptance, treatment, processing and feedback.