目的探讨急性／康复联合卒中单元对急性脑梗死患者日常生活活动能力的影响。方法185例急性脑梗死患者，随机分入急性，慷复联合卒中单元和普通病房。分别在入院和出院时进行Barthel指数（Barthel index，Bl）、Fugl-Meyer运动功能评定（...目的探讨急性／康复联合卒中单元对急性脑梗死患者日常生活活动能力的影响。方法185例急性脑梗死患者，随机分入急性，慷复联合卒中单元和普通病房。分别在入院和出院时进行Barthel指数（Barthel index，Bl）、Fugl-Meyer运动功能评定（Fugl-Meyer assessment，FMA）和美国国立卫生研究院卒中量表（U.S.National Institutes of Health Stroke Scale，NIHSS）评价，BI在随访至6个月时第3次评价，并应用SPSS13.0进行结果分析。结果治疗后，卒中单元组在出院时和6个月随访时的引改善值均高于普通病房组（20±18 VS 12±16，P〈0.01；44±20 VS 26±17，P〈0.01）。6个月时，卒中单元组生活基本自理的比例显著高于普通病房组（75.63％ VS 53.19％，P=0.003），而重度障碍率则低于普通病房组（12.09％ VS 21.28％，P=0.044）。两组出院时运动功能和神经功能均有改善，但改善值卒中单元组更大（P〈0.01）。结论与普通病房相比，急性／康复联合卒中单元能提高患者的日常生活活动能力，降低致残率，提高生活质量，提高运动功能，减少神经功能缺损。展开更多
ObjectiveTo investigate the clinical effect of acupuncture among patients with dysphagia after cerebral infarction, and the nerve remodeling of acupuncture using diffusion tensor imaging.MethodsOne hundred and twenty ...ObjectiveTo investigate the clinical effect of acupuncture among patients with dysphagia after cerebral infarction, and the nerve remodeling of acupuncture using diffusion tensor imaging.MethodsOne hundred and twenty patients with dysphagia after cerebral infarction were randomly assigned to either acupuncture group or sham-acupuncture group with a 1:1 ratio. All patients received usual care and swallowing function training of neurology department. Additionally, acupuncture was applied at Sìshéncōng (四神聪EX-HN1), Băihuì (百会GV20), Tàiyáng (太阳EX-HN5), Fēngchí (风池GB20) and Shésānzhēn (舌三针three-tongue needling points, Extra) in acupuncture group. The needles were retained for 30 min each time, and five times a week for three weeks as a course of treatment. Two courses of treatments were required in total. In sham-acupuncture group, the blunt needles were put into the needle sleeve, and the top of needle was fixed on the skin. During treatment the blunt needle tip only had slight contact with the skin without any penetration. The blunt needle tips were placed on EX-HN1, GV20, EX-HN5, GB20 and three-tongue needling points, respectively. The duration of treatment in sham-acupuncture group was the same as that in acupuncture group. Before and after treatment, all patients underwent Kubota water swallowing test to evaluate the clinical effect. Using diffusion tensor image (DTI), the nerve remodeling was detected.ResultsClinical effect: After treatment and assessed by water swallowing test, there were 38 cases of normal swallowing function in acupuncture group, higher than 15 cases in sham-acupuncture group (P < 0.05). Nerve remodeling: (1) apparent diffusion coefficient (ADC): before treatment, ADC in acupuncture group and sham acupuncture group were 1.76 ± 0.45 mm/s and 1.68 ± 0.51 mm/s, respectively. After treatment, ADC were 0.66 ± 0.15 mm/s and 0.74 ± 0.11 mm/s, respectively. The difference in ADC had no statistical significance between two groups after treatment (P > 0.05);(2) fractional anisotropy (FA): after treatment, FA of acupuncture group was 0.57 ± 0.06, which was significantly higher than that of sham-acupuncture group (P < 0.05);(3) observation of different infarct lesions: after treatment, ADC of temporal lobe infarction in acupuncture group was (0.57 ± 0.11) mm/s, lower than 0.82 ± 0.24 mm/s of sham acupuncture group, while FA in acupuncture group was 0.61 ± 0.07, higher than 0.45 ± 0.10 in sham-acupuncture group, both with statistical significance (both P < 0.05). Regarding the changes of FA maps for temporal lobe infarction before and after treatment, the transverse bundles of the white matter fibers increased remarkably in infarct lesions and on the healthy side of temporal lobe.ConclusionAcupuncture could improve the swallowing function of patients with dysphagia after cerebral infarction. It reduced ADC and increased FA, especially among patients with temporal lobe infarction after treatment. Acupuncture may have a remodeling effect on transverse cortical fibers after temporal lobe infarction.展开更多
文摘目的探讨急性／康复联合卒中单元对急性脑梗死患者日常生活活动能力的影响。方法185例急性脑梗死患者，随机分入急性，慷复联合卒中单元和普通病房。分别在入院和出院时进行Barthel指数（Barthel index，Bl）、Fugl-Meyer运动功能评定（Fugl-Meyer assessment，FMA）和美国国立卫生研究院卒中量表（U.S.National Institutes of Health Stroke Scale，NIHSS）评价，BI在随访至6个月时第3次评价，并应用SPSS13.0进行结果分析。结果治疗后，卒中单元组在出院时和6个月随访时的引改善值均高于普通病房组（20±18 VS 12±16，P〈0.01；44±20 VS 26±17，P〈0.01）。6个月时，卒中单元组生活基本自理的比例显著高于普通病房组（75.63％ VS 53.19％，P=0.003），而重度障碍率则低于普通病房组（12.09％ VS 21.28％，P=0.044）。两组出院时运动功能和神经功能均有改善，但改善值卒中单元组更大（P〈0.01）。结论与普通病房相比，急性／康复联合卒中单元能提高患者的日常生活活动能力，降低致残率，提高生活质量，提高运动功能，减少神经功能缺损。
基金Supported by Scientific research project of traditional Chinese medicine of Fujian Provincial Health Commission:No.202130220305Fujian Natural Science:No.13181526。
文摘ObjectiveTo investigate the clinical effect of acupuncture among patients with dysphagia after cerebral infarction, and the nerve remodeling of acupuncture using diffusion tensor imaging.MethodsOne hundred and twenty patients with dysphagia after cerebral infarction were randomly assigned to either acupuncture group or sham-acupuncture group with a 1:1 ratio. All patients received usual care and swallowing function training of neurology department. Additionally, acupuncture was applied at Sìshéncōng (四神聪EX-HN1), Băihuì (百会GV20), Tàiyáng (太阳EX-HN5), Fēngchí (风池GB20) and Shésānzhēn (舌三针three-tongue needling points, Extra) in acupuncture group. The needles were retained for 30 min each time, and five times a week for three weeks as a course of treatment. Two courses of treatments were required in total. In sham-acupuncture group, the blunt needles were put into the needle sleeve, and the top of needle was fixed on the skin. During treatment the blunt needle tip only had slight contact with the skin without any penetration. The blunt needle tips were placed on EX-HN1, GV20, EX-HN5, GB20 and three-tongue needling points, respectively. The duration of treatment in sham-acupuncture group was the same as that in acupuncture group. Before and after treatment, all patients underwent Kubota water swallowing test to evaluate the clinical effect. Using diffusion tensor image (DTI), the nerve remodeling was detected.ResultsClinical effect: After treatment and assessed by water swallowing test, there were 38 cases of normal swallowing function in acupuncture group, higher than 15 cases in sham-acupuncture group (P < 0.05). Nerve remodeling: (1) apparent diffusion coefficient (ADC): before treatment, ADC in acupuncture group and sham acupuncture group were 1.76 ± 0.45 mm/s and 1.68 ± 0.51 mm/s, respectively. After treatment, ADC were 0.66 ± 0.15 mm/s and 0.74 ± 0.11 mm/s, respectively. The difference in ADC had no statistical significance between two groups after treatment (P > 0.05);(2) fractional anisotropy (FA): after treatment, FA of acupuncture group was 0.57 ± 0.06, which was significantly higher than that of sham-acupuncture group (P < 0.05);(3) observation of different infarct lesions: after treatment, ADC of temporal lobe infarction in acupuncture group was (0.57 ± 0.11) mm/s, lower than 0.82 ± 0.24 mm/s of sham acupuncture group, while FA in acupuncture group was 0.61 ± 0.07, higher than 0.45 ± 0.10 in sham-acupuncture group, both with statistical significance (both P < 0.05). Regarding the changes of FA maps for temporal lobe infarction before and after treatment, the transverse bundles of the white matter fibers increased remarkably in infarct lesions and on the healthy side of temporal lobe.ConclusionAcupuncture could improve the swallowing function of patients with dysphagia after cerebral infarction. It reduced ADC and increased FA, especially among patients with temporal lobe infarction after treatment. Acupuncture may have a remodeling effect on transverse cortical fibers after temporal lobe infarction.
