针刺介入时机对急性缺血性脑卒中患者肢体运动功能障碍的影响——一项多中心前瞻性队列研究

The Effect of Acupuncture Intervention at Different Time on Limb Motor Dysfunction of Acute Ischemic Stroke:A Multicenter,Prospective Cohort Study

目的 分析缺血性脑卒中急性期内不同针刺介入时机对肢体运动功能障碍发病6个月后功能残障的影响。方法 纳入4家三级甲等医院的急性缺血性脑卒中患者,均接受西医基础治疗,疗程≥14天;在西医基础治疗上,予醒脑开窍针刺法治疗,穴取双侧内关、水沟及患侧三阴交等,每日1次,针刺治疗≥2次。以发病10天内针刺介入时机形成3组队列,分别为发病1~3天针刺组(195例)、发病4~7天针刺组(171例)、发病8~10天针刺组(96例)。使用R4.3. 3软件进行倾向性评分匹配,匹配后3组患者各89例。于治疗前、发病6个月后观察3组患者改良Rankin量表(mRS)评分、Fugl-Meyer量表(FMA)评分、欧洲五维健康量表(EQ-5D-5L)评分及良好功能结局比例。构建Logistic回归模型,分析针刺介入时机对缺血性脑卒中肢体运动功能障碍疗效的影响。结果 与本组治疗前比较,3组患者发病6个月后mRS、EQ-5D-5L评分均降低、FMA均升高(P<0.01),且发病1~3天针刺组、发病4~7天针刺组各项指标均优于发病8~10天针刺组(P<0.05)。发病1~3天针刺组、发病4~7天针刺组、发病8~10天针刺组良好功能结局比例分别为76.40%、80.90%、57.30%,发病1~3天针刺组、发病4~7天针刺组良好功能结局比例明显高于发病8~10天针刺组(P<0.05)。多因素Logistic回归分析显示,与发病8~10天针刺组比较,发病1~3天针刺组(OR=2.796,95%CI:1.340~5.836,P=0.006)、发病4~7天针刺组(OR=3.482,95%CI:1.647~7.362,P=0.001)增加了患者发病6个月后转变为非残障的可能性。结论 急性缺血性脑卒中发病1~7天内进行醒脑开窍针刺更有利于降低发病6个月后的残障率、改善患者肢体运动功能及生活质量。

Objectives To investigate the effect of acupuncture intervention at different time during the acute phase of ischemic stroke on limb motor dysfunction 6 months after onset.Methods The enrolled ischemic stroke patients from four tertiary hospitals all received western basic treatment for≥14 days;additionally,they were given the cleaning-mind and opening-orifices acupuncture method,with acupuncture at bilateral Neiguan(PC 6),Shuigou(GV 26),and Sanyinjiao(SP 6)of the affected side,once a day for at least 2 times.Three cohorts were formed by the timing of acupuncture intervention of the onset of the disease within 10 days,namely,the acupuncture group of 1-3 days after onset of the disease(195 cases),the acupuncture group of 4-7 days after onset of the disease(171 cases),and the acupuncture group of 8-10 days after onset of the disease(96 cases).Propensity score matching was performed using R4.3.3 software,and there were 89 patients in each of the three groups after matching.Modified Rankin Scale(mRS)score,Fugl-Meyer Scale(FMA)score,EuroQoL 5-Dimension 5-Level(EQ-5D-5L)score and the proportion of good functional outcome were observed in the 3 groups of patients before treatment and 6 months after onset.A logistic regression model was constructed to analyse the effect of the timing of acupuncture intervention on the effectiveness of acupuncture treatment for limb motor dysfunction in ischaemic stroke.Results Compared with the pre-treatment of this group,mRS and EQ-5D-5L scores decreased and FMA increased in all three groups 6 months after onset(P<0.01),and all the indexes of the onset 1-3 days acupuncture group and the onset 4-7 days acupuncture group were better than those of the onset 8-10 days acupuncture group(P<0.05).The proportions of good functional outcome in the onset 1-3 days acupuncture group,the onset 4-7 days acupuncture group,and the onset 8-10 days acupuncture group were 76.40%,80.90%,and 57.30%,respectively,and the proportions of good functional outcome in the onset 1-3 days acupuncture group and the onset 4-7 days acupuncture group were significantly higher than those in the onset 8-10 days acupuncture group(P<0.05).Multifactorial logistic analysis showed that compared with the group with 8-10 days of onset,the group with 1-3 days of onset(OR=2.796,95%CI:1.340~5.836,P=0.006),and the group with 4-7 days of onset(OR=3.482,95%CI:1.647~7.362,P=0.001)increased the likelihood that patients would be nondisabled 6 months after onset.Conclusion The intervention of cleaning-mind and opening-orifices acupuncture within 1-7 days of onset for patients with acute ischemic stroke can reduce the rate of disability 6 months after onset,improve limb motor function,and enhance the quality of life.