基于功能磁共振影像研究针灸治疗风痰瘀阻证中风偏瘫的疗效  

Efficacy of acupuncture on stroke hemiplegia with syndrome of wind-phlegm stasis based on functional magnetic resonance imaging

作　　者：贡志刚[1] 付志辉[1] 苏昭凤 张荣俊[1] 蒋文斌[1] GONG Zhigang;FU Zhihui;SU Zhaofeng;ZHANG Rongjun;JIANG Wenbin(Suzhou Hospital of Traditional Chinese Medicine Affiliated to Nanjing University of Tradition Chinese Medicine,Suzhou 215009,Jiangsu,China)

机构地区：[1]南京中医药大学附属苏州市中医医院,江苏苏州215009

出　　处：《现代中西医结合杂志》2022年第23期3269-3274,共6页Modern Journal of Integrated Traditional Chinese and Western Medicine

基　　金：苏州市临床重点病种诊疗技术专项项目(LCZX201915);苏州市2019年度科技发展计划项目(SYSD2019219)。

摘　　要：目的利用功能磁共振弥散张量成像技术分层研究针灸治疗风痰瘀阻证中风偏瘫患者的疗效。方法选择南京中医药大学附属苏州市中医医院中医经典病房2019年2月—2022年1月收治的59例风痰瘀阻证中风偏瘫患者,病情稳定1周后进行功能磁共振扫描,三维重建其脑内皮质脊髓束(CST)图像,按照CST受损程度对患者进行分级,然后给予针刺祛痰化湿相关穴位治疗3周。比较所有患者及CST不同分级患者针灸治疗前后Brunnstrom上肢、手、下肢评分以及NIHSS评分,评估针灸治疗疗效。结果磁共振检查发现CST 1级24例,2级28例,3级7例。CST 1级和2级的患者针灸治疗后Brunnstrom上肢评分、手评分、下肢评分以及NIHSS评分均较治疗前显著改善(P均<0.05),而CST 3级患者则只有NIHSS评分较治疗前明显改善(P<0.05)。CST 1级患者的治疗总有效率显著高于CST 3级患者[91.7%(22/24)vs 42.9%(3/7)],差异有统计学意义(P<0.05)。CST 1级的出血性中风患者治疗后Brunnstrom上肢评分、手评分以及NIHSS评分均较治疗前显著改善(P均<0.05),但是Brunnstrom下肢评分无明显改善(P>0.05)。结论针刺祛痰化湿相关穴位治疗风痰瘀阻证中风偏瘫患者的疗效与患者脑内CST受损程度密切相关,CST未完全断裂的患者肢体运动功能显著改善。对于CST无断裂的出血性中风患者,针刺有祛痰化湿功能的穴位可有效提高偏瘫侧上肢和手的运动功能,对偏瘫侧下肢运动功能影响不明显。Objective It is to study the efficacy of acupuncture on stroke hemiplegia with syndrome of wind-phlegm stasis based on diffusion tensor imaging of functional magnetic resonance imaging.Methods Fifty-nine patients with stroke hemiplegia with syndrome of wind-phlegm stasis admitted to the classical Chinese medicine ward of Suzhou Hospital of Traditional Chinese Medicine Affiliated to Nanjing University of Traditional Chinese Medicine from February 2019 to January 2022 were selected to undergo functional magnetic resonance scanning and three-dimensional reconstruction of their intracerebral corticospinal tract(CST)images after 1 week of stabilization.The patients were graded according to the degree of CST damage,and then were treated with acupuncture at the acupoints which could dispel phlegm and resolve dampness for 3 weeks.The Brunnstrom scores of upper extremity,hand,and lower extremity scores as well as NIHSS scores before and after acupuncture treatment in all patients and patients with different grades of CST were compared,and the efficacy of acupuncture was evaluated.Results Magnetic resonance examination revealed 24 patients with CST grade 1,28 patients with grade 2,and 7 patients with grade 3.The Brunnstrom scores of upper extremity,hand,lower extremity,and NIHSS score were significantly improved after acupuncture treatment in patients with CST grade 1 and 2 compared with pre-treatment(all P<0.05),only NIHSS score was significantly improved in patients with CST grade 3 compared with pre-treatment(P<0.05).The total effective rate of treatment was significantly higher in patients with CST grade 1 than that in patients with CST grade 3[91.7%(22/24),42.9%(37/)],the difference was statistically significant(P<0.05).The Brunnstrom scores of upper extremity and hand,and NIHSS score were significantly improved after treatment in patients with hemorrhagic stroke with CST grade 1 compared with those before treatment(all P<0.05),but the Brunnstrom scores of lower extremity were not significantly improved(P>0.05).Conclu

关 键 词：中风 弥散张量成像 针灸疗法 风痰瘀阻 

分 类 号：R255.2[医药卫生—中医内科学]