头针不同留针时间对脑卒中后运动功能障碍和血清C反应蛋白、血糖、血脂的影响

Effects of Needle Retention Time for Scalp Acupuncture on Motor Dysfunction and Serum C-Reactive Protein,Blood Glucose and Blood Lipid of Post-Stroke Patients

【目的】观察头针不同留针时间对脑卒中患者运动功能障碍和血清C反应蛋白(CRP)、血糖、血脂的改善情况。【方法】将120例脑卒中后运动功能障碍患者随机分为对照组、观察1组、观察2组,每组各40例。3组患者均采取头针、体针及常规运动康复训练治疗,对照组头针留针30 min,观察1组头针留针1 h,观察2组头针留针2 h,每日1次,每周6次,连续治疗2周。比较3组患者的美国国立卫生研究院卒中量表(NIHSS)、Fugl-Meyer运动评定量表(FMA)、Berg平衡量表(BBS)、改良Barthel指数(MBI)评分以及外周血CRP、空腹血糖(FPG)、总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)的改善程度,并评价3组治疗方案的安全性。【结果】(1)量表评分方面,治疗后,3组患者的NIHSS评分均较治疗前降低(P<0.01),FMA、BBS、MBI评分均较治疗前升高(P<0.05或P<0.01);治疗后3组间比较,差异均有统计学意义(P<0.01),其中,观察2组对NIHSS评分的降低幅度及对FMA、BBS、MBI评分的升高幅度均明显优于对照组和观察1组(P<0.01),观察1组对FMA评分的改善幅度又明显优于对照组(P<0.01),对NIHSS、BBS、MBI评分的改善幅度均有优于对照组趋势,但差异均无统计学意义(P>0.05),表明头针运动治疗方案的疗效与头针留针时长呈正向时效关系。(2)实验室指标方面,治疗后,3组患者的外周血CRP、FPG水平和两观察组的TG、LDL-C水平以及观察2组的HDL-C水平均较治疗前改善(P<0.05或P<0.01);且治疗后3组间的外周血CRP、TG水平比较,差异均有统计学意义(P<0.05或P<0.01),其中,观察2组对CRP、TG水平的改善幅度明显优于对照组,对CRP水平的改善幅度又明显优于观察1组,差异均有统计学意义(P<0.05或P<0.01);而3组患者的TC水平治疗前后及组间比较,差异均无统计学意义(P>0.05)。(3)安全性方面,3组患者治疗期间均未发生晕针、断针、血肿等不良反应,且患者的生命体征均平稳,脉搏、血压、呼吸频率等均无明显异常变化。【结论】头针治疗可有效改善脑卒中患者的运动功能,且留针时长呈正向时效关系,以头针留针2 h方案疗效更显著。

Objective To observe the improvement of motor dysfunction and serum levels of C-reactive protein(CRP),blood glucose and blood lipid in post-stroke patients treated with scalp acupuncture at different needle retention time.Methods A total of 120 patients with motor dysfunction after stroke were randomly divided into control group,observation group 1 and observation group 2,with 40 cases in each group.The patients in the 3 groups were treated with scalp acupuncture,body acupuncture and routine rehabilitation exercise,once a day and 6 times a week,lasting for 2 weeks.The control group was given scalp acupuncture with retaining of needles for 30 minutes,the observation group 1 was given scalp acupuncture with retaining of needles for one hour,and the observation group 2 was given scalp acupuncture with retaining of needles for 2 hours.Before and after treatment,the 3 groups were observed in the changes of the scale scores of National Institutes of Health Stroke Scale(NIHSS),Fugl-Meyer Assessment(FMA),Berg Balance Scale(BBS)and modified Barthel Index(MBI),and the levels of laboratory indicators of peripheral blood CRP,fasting plasma glucose(FPG),total cholesterol(TC),triglyceride(TG),high-density lipoprotein cholesterol(HDL-C)and low-density lipoprotein cholesterol(LDL-C).After treatment,the clinical safety of the three groups was evaluated.Results(1)After treatment,the scale scores of NIHSS in the three groups were lower(P<0.01)and the scale scores FMA,BBS and MBI were higher than those before treatment(P<0.05 or P<0.01).The comparison of post-treatment scale scores showed that the differences among the three groups were statistically significant(P<0.01).The intergroup comparison showed that the decrease of NIHSS score and the increase of FMA,BBS and MBI scores in the observation group 2 were significantly superior to those in the control group and the observation group 1(P<0.01);the improvement of FMA score in the observation group 1 was significantly superior to that in the control group(P<0.01),while the improvement of NIHSS,BBS and MBI scores tended to be superior to that in the control group without statistically significant differences(P>0.05).The results indicated that the curative effect of scalp acupuncture plus exercise regimen was positively correlated with the duration of needle retention for scalp acupuncture.(2)After treatment,the laboratory indicator levels of CRP and FPG in the peripheral blood of the three groups,the levels of TG and LDL-C in the two observation groups and the level of HDL-C in the observation group 2 were improved compared with those before treatment(P<0.05 or P<0.01).Statistically significant differences were presented in the post-treatment levels of CRP and TG in peripheral blood among the three groups(P<0.05 or P<0.01).The intergroup comparison showed that the improvement of CRP and TG levels in the observation group 2 was significantly superior to that in the control group,and the improvement of CRP level in the observation group 2 was significantly superior to that in the observation group 1,the differences being statistically significant(P<0.05 or P<0.01).The TC level in the three groups after treatment did not differ from that before treatment,and there was no significant difference in TC level after treatment among the three groups either(P>0.05).(3)During the treatment,no adverse reactions such as fainting,needle breaking and hematoma occurred in the three groups,the vital signs of the patients were stable,and there were no obvious abnormal changes in pulse,blood pressure and respiratory rate.Conclusion Scalp acupuncture can effectively improve the motor function of post-stroke patients in a pasitive time-effect relationship with the needle retention,and better the curative effect can be achieved by retaining of the needle for 2 h.