中风促通灸对脑梗死恢复期运动功能障碍患者运动功能及皮质脊髓束的影响

Effects of zhongfeng cutong moxibustion on motor function and corticospinal tract in the patients with motor dysfunction during the recovery period of cerebral infarction

目的:观察中风促通灸对脑梗死恢复期运动功能障碍患者运动功能与皮质脊髓束(CST)结构的影响,探讨中风促通灸改善患者运动功能的中枢机制。方法:将50例脑梗死恢复期运动功能障碍患者随机分为观察组(25例,脱落1例)和对照组(25例,脱落1例)。两组患者均行常规基础治疗,对照组于百会、水沟及患侧尺泽、内关、委中、三阴交等行针刺治疗,观察组在对照组基础上联合中风促通灸治疗,穴取百会、神阙及双侧足三里。针刺及中风促通灸均每日1次,每周5次,共治疗2周。比较两组患者治疗前后Fugl-Meyer运动功能评定量表(FMA)、美国国立卫生研究院卒中量表(NIHSS)评分,采用弥散张量成像技术检测两组患者治疗前后双侧全段、大脑皮层、内囊后肢、大脑脚CST各向异性分数(FA)值。结果:治疗后,两组患者FMA上肢、下肢评分及总分较治疗前升高(P<0.05),观察组FMA上肢评分及总分高于对照组(P<0.05);两组患者NIHSS评分较治疗前降低(P<0.01);观察组双侧内囊后肢及病灶侧全段CST的FA值较治疗前提高(P<0.05),对照组健侧全段CST的FA值较治疗前提高(P<0.05)。结论:中风促通灸能提高脑梗死恢复期运动功能障碍患者运动功能,改善神经功能缺损,可能与促进病灶侧全段及双侧内囊后肢CST白质纤维束结构重塑有关。

Objective To observe the effects of zhongfeng cutong moxibustion(moxibustion therapy for unblocking and treating stroke)on the motor function and the structure of corticospinal tract(CST)in the patients with motor dysfunction during the recovery period of cerebral infarction,and to explore the central mechanism of this moxibustion therapy for improving the motor function.Methods Fifty patients with motor dysfunction during the recovery period of cerebral infarction were randomly divided into an observation group(25 cases,1 case dropped out)and a control group(25 cases,1 case dropped out).The patients in both groups underwent the conventional basic treatment.In the control group,acupuncture was applied to Baihui(GV 20)and Shuigou(GV 26),as well as Chize(LU 5),Neiguan(PC 6),Weizhong(BL 40)and Sanyinjiao(SP 6)etc.on the affected side.Besides the intervention of the control group,in the observation group,zhongfeng cutong moxibustion therapy was combined at Baihui(GV 20),Shenque(CV 8)and bilateral Zusanli(ST 36).Both acupuncture and moxibustion therapies were delivered once daily,5 times a week,for 2 weeks.The scores of Fugl-Meyer assessment scale(FMA)and National Institutes of Health stroke scale(NIHSS)were compared between the two groups before and after treatment.The diffusion tensor imaging technique was used to observe the fractional anisotropy(FA)of CST at the bilateral whole segment,the cerebral cortex,the posterior limb of the internal capsule and the cerebral peduncle before and after treatment in the two groups.Results The scores of the upper and the lower limbs of FMA,as well as the total FMA score swere increased after treatment when compared with those before treatment in the two groups(P<0.05),the upper limb FMA score and the total FMA score in the observation group were higher than those in the control group(P<0.05),and NIHSS scores of the two groups were dropped compared with those before treatment(P<0.01).FA of CST at the bilateral sides of the posterior limb of the internal capsule and the whole segment on the focal side was improved in comparison with that before treatment in the observation group(P<0.05),and FA of CST at the healthy side of the whole segment was higher than that before treatment in the control group(P<0.05).Conclusion Zhongfeng cutong moxibustion improves motor function and reduces neurological deficits in the patients with motor dysfunction during the recovery period of cerebral infarction,which may be related to enhancing the remodeling of white matter fiber bundles in the corticospinal tract on the focal side of the whole segment and the bilateral posterior limb of the internal capsule.