针刺治疗周围性面瘫的大脑运动皮层功能重组研究  

Effects of acupuncture on the functional reorganization in brain motor cortex of patient with peripheral facial paralysis

作　　者：赵斌[1] 杨颖婷[2] 黄健澎 张慧[1] 陈嬿冰 陈晓曼[1] 邓红妹 严晓霞[1] 游惠[1] 彭艳辉[1] 刘健华[3] 许能贵[3] 

机构地区：[1]广州中医药大学,广州510405 [2]广州医科大学附属第五医院,广州510700 [3]广州中医药大学第二临床医学院,广东省中医院针灸重点实验室,广州510006

出　　处：《中华中医药杂志》2016年第5期1963-1966,共4页China Journal of Traditional Chinese Medicine and Pharmacy

基　　金：国家自然科学基金项目(No.81273675);广东省自然基金团队项目(No.9351040701000001);广东省中医院院内专项(No.2014KT1304)~~

摘　　要：目的:运用经颅磁刺激(TMS)技术观察周围性面瘫患者针刺治疗前后大脑运动皮层手区与面区的功能重组情况,探讨针刺治疗周围性面瘫的中枢机制。方法:纳入急性期周围性面瘫患者10例,分别于针刺治疗前和面瘫治愈后行TMS运动皮层定位检查,记录第一骨间背侧肌和口轮匝肌的运动诱发电位(MEPs)的振幅、潜伏期以及手区与面区的有效刺激面积,绘制二维皮层位域图,比较分析患者治愈前后自身手区与面区振幅、潜伏期和有效刺激面积的变化。结果:受试者面瘫同侧大脑运动皮层面区扩大较明显,手区的有效刺激面积扩大,且主要表现为手区与面区的交叉重叠区的扩大。其中手区MEPs潜伏期变短(P<0.05),振幅降低(P<0.05);面区MEPs潜伏期变短(P<0.05),振幅差异无统计学意义。结论:针刺可调整大脑运动皮层之间的功能重组;针刺作用通过调节运动皮层手区与面区之间的竞争性的活动依赖性,弱化手区的功能,促进面区的功能恢复,是实现针刺治疗周围性面瘫可能的中枢机制。Objective： To observe the effect of acupuncture on the functional reorganization in brain motor cortex of patient with peripheral facial paralysis by transcranial magnetic stimulation（TMS）, and explore the mechanism underlying the acupuncture treating peripheral facial paralysis. Methods： 10 cases of patients with acute peripheral facial paralysis were included and received acupuncture. Before and after treatment, TMS was preformed to record the amplitude and incubation period of motor evoked potentials（MEPs） in the first dorsal interosseous muscle and orbicular muscle as well as effective stimulus area in hand and face areas. Then, the two-dimensional cortex bit-field was mapped to analyze changes of amplitude, incubation period and effective stimulus area in hand and face areas. Results： The ipsilateral cerebral motor cortex in patients with facial paralysis expanded apparently, and the effective stimulus area in hand area also expanded, especially in the cross region of hand area and face area. Compared with before treatment, the MEPs incubation period in hand area after treatment was shortened（P〈0.05）, and the amplitude brought down（P〈0.05）. Additionally, Compared with before treatment, the MEPs incubation period in face area after treatment was shortened（P〈0.05）, but the amplitude had no statistical significance. Conclusion： Acupuncture can adjust brain functional reorganization in motor cortex. Acupuncture could regulate the competitive activity between the hand area and face area in motor cortex to weaken the function in hand area and promote functional recovery in face area, which may be the mechanism underlying the acupuncture treating peripheral facial paralysis.

关 键 词：针刺 周围性面瘫 功能重组 经颅磁刺激 

分 类 号：R246.6[医药卫生—针灸推拿学]