耳迷走神经刺激联合温针灸对卒中患者肢体痉挛及睡眠质量的影响

Effects of Transcutaneous Auricular Vagus Nerve Stimulation Combined with Needle-warming Moxibustion on Limb Spasticity and Sleep Quality in Stroke Patients

目的观察耳迷走神经刺激联合温针灸治疗对卒中患者肢体痉挛及睡眠质量的影响。方法选取卒中患者84例,随机分为对照组和观察组,每组42例。两组均进行常规药物治疗和康复治疗,对照组予温针灸治疗,观察组予耳迷走神经刺激联合温针灸治疗。观察两组患者治疗前后Fugl-Meyer运动功能(FMA)、日常生活活动能力(ADL)、卒中患者运动功能评估量表(MAS)、匹茨堡睡眠质量指数(PSQI)和睡眠状况自评量表(SRSS)评分的变化,观察两组治疗前后血清炎症因子[白介素-7(IL-7)、肿瘤坏死因子-α(TNF-α)和超敏C反应蛋白(hs-CRP)]水平的变化,比较两组临床疗效。结果治疗后,两组下肢和上肢FMA评分以及ADL评分均高于同组治疗前(P<0.05),且观察组均高于对照组(P<0.05)。治疗后,两组MAS、PSQI和SRSS评分均低于同组治疗前(P<0.05),且观察组均低于对照组(P<0.05)。治疗后,两组血清IL-7、TNF-α和hs-CRP水平均低于同组治疗前(P<0.05),且观察组均低于对照组(P<0.05)。观察组总有效率明显高于对照组(P<0.05)。结论在常规药物治疗和康复治疗基础上,耳迷走神经刺激联合温针灸可缓解卒中患者四肢痉挛,改善睡眠质量,疗效优于单纯温针灸治疗。

Objective To observe the effects of transcutaneous auricular vagus nerve stimulation plus needle-warming moxibustion on limb spasticity and sleep quality in stroke patients.Method Eighty-four stroke patients were randomized into a control group and an observation group,with 42 cases in each group.Basic medication and rehabilitation treatments were given to both groups.In addition,the control group received needle-warming moxibustion,and the observation group received transcutaneous auricular vagus nerve stimulation and needle-warming moxibustion.The two groups were observed using the Fugl-Meyer assessment(FMA),activities of daily living(ADL),motor assessment scale(MAS),Pittsburgh sleep quality index(PSQI),and self-rating scale of sleep(SRSS)before and after the treatment.The serum levels of interleukin-7(IL-7),tumor necrosis factor-α(TNF-α),and hypersensitive C-reactive protein(hs-CRP)were detected before and after the treatment.Clinical efficacy was also compared.Result After the treatment,the lower-limb and upper-limb FMA and ADL scores were higher than those before the treatment in both groups(P<0.05)and were higher in the observation group than in the control group(P<0.05).The MAS,PSQI,and SRSS scores were lower than those before the treatment in the two groups(P<0.05)and were lower in the observation group than in the control group(P<0.05).After the intervention,the serum levels of IL-7,TNF-α,and hs-CRP were lower than those before the treatment in both groups(P<0.05)and were lower in the observation group than in the control group(P<0.05).The total effective rate in the observation group was significantly higher than that in the control group(P<0.05).Conclusion Based on the conventional medication and rehabilitation treatments,transcutaneous auricular vagus nerve stimulation plus needle-warming moxibustion can mitigate spasticity of upper and lower extremities,improve sleep quality,and produce more significant efficacy than needle-warming moxibustion alone in treating stroke patients.