急性脑梗死与TIA的关系探讨

目的探讨急性脑梗死发病与发病前一过性缺血发作(transient ischaemic attack,TIA)发作及干预方式之间的关系。方法113例急性脑梗死患者临床资料作回顾性分析和研究。结果急性脑梗死发病前有TIA发作者具有年龄大,合并征多的特点;TIA发作未予治疗者急性脑梗死发病率较高;且在7d内发生的急性脑梗死致残率高,而TIA发作次数对后遗症无显著影响。结论对于TIA发作及时诊断和早期积极治疗,可减少急性脑梗死的发病率和致残率。

Muscle regions of meridians warm needling method plus pricking Jing-Well points for blood-letting in the treatment of shoulder-hand syndrome after stroke

Objective To observe the effect of muscle regions of meridians warm needling method plus pricking Jing-Well points for blood-letting in improving nail fold microcirculation in the patients with shoulder-hand syndrome(SHS)after stroke,and the effects on hemorrheology,calcitonin gene-related peptide(CGRP)and serum substance P(SP).Methods A total of 72 patients were randomized into an observation group and a control group by the random number table method,with 36 cases in each group.The control group was treated with physical rehabilitation training,and the observation group was treated with additional muscle regions of meridians warm needling method plus pricking Jing-Well points for blood-letting treatment.The treatment course lasted for 4 weeks.After treatment,the clinical efficacy of the two groups was compared.The changes in shoulder-hand syndrome scale(SHSS),simplified Fugl-Meyer assessment-upper extremity(FMA-UE),visual analog scale(VAS),activities of daily living(ADL),traditional Chinese medicine(TCM)syndrome score,nail fold microcirculation hemorheology indictors[whole blood viscosity(high-shear,low-shear),hematocrit,erythrocyte sedimentation rate(ESR)],CGRP and SP levels were observed.Results The total effective rate in the observation group was 86.1%,higher than 63.9%in the control group(P<0.05).The overall curative effect in the observation group was better than that in the control group(P<0.05).After treatment,the scores of pain sensation,edema,external turn and rotation of the arm in SHSS,and the total score were significantly decreased in both groups(all P<0.05),and each score in the observation group was lower than that in the control group(all P<0.05).After treatment,the scores of VAS and TCM syndrome in both groups decreased significantly(all P<0.05),and the scores of FMA-UE and ADL increased significantly(all P<0.05).The scores of VAS and TCM syndrome in the observation group were lower than those in the control group(both P<0.05),and the scores of FMA-UE and ADL were higher than those in the control group(both P<0.05).After treatment,the whole blood viscosity(high-shear and low-shear)and hematocrit in both groups decreased obviously(all P<0.05),and ESR increased obviously(both P<0.05),and the whole blood viscosity(high-shear and low-shear)and hematocrit in the observation group were lower than those in the control group(all P<0.05),and ESR was higher than that in the control group(P<0.05).After treatment,the peritubular state,loop shape,blood flow and total score of nail fold microcirculation in both groups decreased significantly(all P<0.05),and each score in the observation group was lower than that in the control group(all P<0.05).After treatment,SP in both groups decreased obviously(both P<0.05),CGRP increased obviously(both P<0.05),and SP in the observation group was lower than that in the control group(P<0.05),CGRP was higher than that in the control group(P<0.05).Conclusion Compared with conventional physical rehabilitation training,muscle regions of meridians warm needling method plus pricking Jing-Well points for blood-letting treatment can significantly reduce the clinical symptoms of SHS,promote the recovery of physical functions,improve the nail fold microcirculation and hemorrheology indictors,and regulate the serum cytokine levels such as CGRP and SP.

Treatment of 40 Cases of Poststroke Shoulder-Hand Syndrome by Acupuncture

Acupuncture and rehabilitation therapies were used to treat 40 cases of shoulder-hand syndrome, the results show that integration of acupuncture and rehabilitation can increase therapeutic effects and shorten treatment courses to accelerate recovery.