针刺对脑梗死患者rt-PA静脉溶栓出血性转化及运动功能的影响:前瞻性队列研究

Effects of acupuncture on hemorrhagic transformation and motor function in stroke patients after intravenous thrombolysis with rt-PA:a prospective cohort study

目的:观察醒脑开窍针刺法对脑梗死患者重组组织型纤溶酶原激活物(rt-PA)静脉溶栓后出血性转化及肢体运动功能的影响。方法:将130例脑梗死rt-PA静脉溶栓患者按照是否介入针刺治疗分为针刺组(58例,脱落1例)和非针刺组(72例,脱落7例),采用倾向评分匹配法(PSM)进行匹配,每组38例。非针刺组予rt-PA(注射用阿替普酶)静脉溶栓等西医基础治疗;在非针刺组治疗基础上,针刺组予醒脑开窍针刺法治疗,穴取水沟、双侧内关及患侧三阴交、尺泽等,每日1次,治疗14 d。比较两组患者发病30 d内出血性转化发生率;分别于入组时及发病30 d、6个月、1年时观察两组患者Fugl-Meyer运动功能(FMA)评分、日常生活活动能力(ADL)评分;记录两组发病6个月及1年时的残疾率,并评定两组安全性。结果:针刺组出血性转化发生率为5.3%(2/38),低于非针刺组的21.1%(8/38,P<0.05)。发病30d、6个月及1年时,两组患者FMA、ADL评分均较入组时升高(P<0.01),且针刺组高于非针刺组(P<0.01);针刺组发病1年残疾率为10.5%(4/38),低于非针刺组的28.9%(11/38,P<0.05)。两组患者不良反应发生率比较差异无统计学意义(P>0.05)。结论:醒脑开窍针刺法可降低脑梗死rt-PA静脉溶栓患者出血性转化发生率和远期致残率,提高其运动功能及日常生活能力。

Objective To observe the effects of the Xingnao Kaiqiao(regaining consciousness and opening orifices)acupuncture on hemorrhagic transformation and limb motor function after intravenous thrombolysis with recombinant tissue plasminogen activator(rt-PA)in stroke patients.Methods A total of 130 stroke patients after rt-PA thrombolytic were divided into an acupuncture group(58 cases,1 case dropped off)and a non-acupuncture group(72 cases,7 cases dropped off)according to whether they received acupuncture treatment.Propensity score matching(PSM)was used to match each group,with 38 patients in each group.The patients in the non-acupuncture group received rt-PA thrombolytic therapy and western medical basic treatment.In addition to the basic treatment,the patients in the acupuncture group received Xingnao Kaiqiao acupuncture at Shuigou(GV 26),bilateral Neiguan(PC 6),and ipsilateral Sanyinjiao(SP 6),Chize(LU 5),once a day for 14 days.The incidence of hemorrhagic transformation within 30 days after onset was compared between the two groups.The Fugl-Meyer assessment(FMA)score and activities of daily living(ADL)score were observed at baseline and 30 days,6 months,1 year after onset in the two groups.The disability rate at 6 months and 1 year after onset was recorded,and safety was evaluated in both groups.Results The incidence of hemorrhagic transformation in the acupuncture group was 5.3%(2/38),which was lower than 21.1%(8/38)in the non-acupuncture group(P<0.05).At 30 days,6 month,and 1 year after onset,the FMA and ADL scores of both groups were higher than those at baseline(P<0.01),and the scores in the acupuncture group were higher than those in the non-acupuncture group(P<0.01).The disability rate in the acupuncture group at 1 year after onset was 10.5%(4/38),which was lower than 28.9%(11/38)in the non-acupuncture group(P<0.05).There was no significant difference in the incidence of adverse events between the two groups(P>0.05).Conclusion The Xingnao Kaiqiao acupuncture method could reduce the incidence of hemorrhagic transformation in stroke patients after intravenous thrombolysis with rt-PA,improve their motor function and daily living ability,and reduce the long-term disability rate.