靳三针结合低频重复经颅磁刺激对痉挛型脑性瘫痪患儿睡眠障碍及脑电活动的影响

Effects of Jin's three-needles therapy combined with low-frequency repetitive transcranial magnetic stimulation on sleep disorders and EEG in children with spastic cerebral palsy

目的:探讨靳三针结合低频重复经颅磁刺激对痉挛型脑性瘫痪(CP)患儿睡眠障碍及脑电活动的影响。方法:招募100例痉挛型CP伴睡眠障碍患儿,采用分层随机分配法分为对照组和观察组,每组50例。对照组予药物、综合康复训练、低频重复经颅磁刺激治疗;观察组在对照组基础上予靳三针治疗,穴取颞三针、脑三针、智三针、四神针及双侧肝俞、肾俞、申脉、照海。每日1次,每周5次,治疗12周。观察两组患儿治疗前后匹兹堡睡眠质量指数(PSQI)、儿童睡眠习惯问卷(CSHQ)评分,改良Ashworth分级,Peabody运动发育量表2版(PDMS-2)发育商,及脑电活动δ、θ、β1、β2共4个频段的相对功率值,并评价治疗安全性。结果:治疗后,两组患儿PSQI、CSHQ评分降低(P<0.05),且观察组低于对照组(P<0.05);改良Ashworth分级情况改善(P<0.05),且观察组优于对照组(P<0.05);PDMS-2各维度发育商升高(P<0.05),且观察组高于对照组(P<0.05);脑电活动δ、θ相对功率值降低(P<0.05),且观察组低于对照组(P<0.05);脑电活动β1、β2相对功率值升高(P<0.05),且观察组高于对照组(P<0.05)。两组患儿均未发生明显不良反应。结论:靳三针结合低频重复经颅磁刺激可有效改善痉挛型CP伴睡眠障碍患儿的睡眠障碍、痉挛程度及运动功能,并能调节脑电活动指标,且安全性较好。

Objective To investigate the effects of Jin's three-needles therapy combined with low-frequency repetitive transcranial magnetic stimulation(rTMS)on sleep disorders and EEG activity in children with spastic cerebral palsy(CP).Methods By using stratified randomization method,100 children of spastic CP with sleep disorders were randomly assigned to a control group and an observation group,with 50 cases in each group.The patients in the control group were treated with medication,comprehensive rehabilitation training,and low-frequency rTMS,while the patients in the observation group were treated with Jin's three-needles therapy in addition to the interventions given to the control group.Acupoints selected included temporal three needles,brain three needles,intelligence three needles,four spirits needles,and bilateral Ganshu(BL 18),Shenshu(BL 23),Shenmai(BL 62),and Zhaohai(KI 6).Treatment was given once daily,five times a week,for 12 weeks.The Pittsburgh sleep quality index(PSQI)and children's sleep habits questionnaire(CSHQ)scores,modified Ashworth grade,Peabody developmental motor scales-2(PDMS-2)score,and relative power values ofδ,θ,β1,andβ2 frequency bands in EEG were observed before and after treatment in both groups.Treatment safety was also evaluated.Results Compared before treatment,PSQI and CSHQ scores were decreased in both groups after treatment(P<0.05),with lower scores in the observation group than the control group(P<0.05).The modified Ashworth grade showed improvement(P<0.05),with better results in the observation group(P<0.05).PDMS-2 scores were increased in all dimensions(P<0.05),with higher scores in the observation group(P<0.05).Relative power values ofδandθfrequency bands in EEG were decreased(P<0.05),with lower values in the observation group(P<0.05),while relative power values ofβ1 andβ2 frequency bands were increased(P<0.05),with higher values in the observation group(P<0.05).Children in both groups did not occurred obvious adverse reactions.Conclusion Jin's three-needles therapy combined with low-frequency rTMS can effectively improve sleep disorders,spasticity and motor function,regulate EEG activity in children with spastic CP and sleep disorder,and have good safety.