温阳补气针法结合肌电生物反馈对脑卒中康复患者脑影像结构和表面肌电特征及神经递质的影响  

Effects of warming-yang and tonifying-qi needling combined with electromyographic biofeedback on brain image structure, surface myoelectric characteristics and neurotransmitters in patients undergoing stroke rehabilitation

作　　者：窦静敏 窦丽辉 李鹏 刘俊英 王贵玲 Dou Jingmin;Dou Lihui;Li Peng;Liu Junying;Wang Guiling(Department of Rehabilitation Medicine,Xingtai Third Hospital,Xingtai 054000,Hebei,China)

机构地区：[1]邢台市第三医院康复医学科,河北邢台054000

出　　处：《中国中西医结合急救杂志》2023年第6期701-705,共5页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：河北省邢台市科技局重点研发计划(2020ZC257)。

摘　　要：目的观察温阳补气针法结合肌电生物反馈治疗(EMGBFT)对脑卒中康复患者脑影像结构、表面肌电特征及神经递质的影响.方法采用前瞻性研究方法,选择2021年2月至2022年2月邢台市第三医院收治的脑卒中康复患者200例作为研究对象,将患者按随机原则分为对照组和研究组,每组100例.两组均接受脑卒中常规治疗,对照组联合EMGBFT,研究组在对照组基础上联合温阳补气针法治疗,均连续治疗9周.观察两组临床疗效,比较两组患者治疗前后美国国立卫生研究院卒中量表(NIHSS)评分、中医症状评分、脑影像结构、血清神经递质水平及表面肌电水平的差异,并观察不良反应发生情况.结果研究组治疗有效率明显高于对照组(97.00%比87.00%,P<0.05).两组治疗后NIHSS评分、中医症状评分、肱二头肌和肱三头肌均方根(RMS)、协同收缩率(SCR)均较治疗前明显降低,丘脑和额叶脑血流(CBF)、各向异性分数(FA)及去甲肾上腺素(NE)、5-羟色胺(5-TH)、多巴胺(DA)水平均较治疗前明显升高,且治疗后研究组NIHSS评分(分:4.18±1.09比6.89±1.54)、中医症状评分(分:5.41±1.08比9.46±1.55)、肱二头肌RMS(μV:9.76±3.51比16.36±3.44)、肱三头肌RMS(μV:6.79±1.83比10.61±2.87)及SCR[(28.08±8.73)%比(33.08±9.31)%]均明显低于对照组(均P<0.05),丘脑CBF(mL·kg^(-1)·min^(-1):278.97±86.32比233.63±84.62)、额叶CBF(mL·kg^(-1)·min^(-1):299.31±75.54比262.81±87.18)、FA(分:0.57±0.18比0.48±0.14)及血清5-HT(ng/L:352.83±38.93比306.71±32.54)、NE(ng/L:160.83±17.25比122.81±12.41)和DA(μg/L:9.23±0.92比7.36±0.71)水平均明显高于对照组(均P<0.05).研究组不良反应发生率明显低于对照组(3.00%比14.00%,P<0.05).结论在EMGBFT基础上联合温阳补气针法能起到协同增效作用,可明显改善脑卒中康复患者的临床症状和脑影像结构,并提高其血清神经递质水平,且不良反应较少,值得推广.Objective To explore the effects of warming-yang and tonifying-qi needling combined with electromyographic biofeedback therapy(EMGBFT)on brain image structure,surface myoelectric characteristics and neurotransmitters in patients with stroke rehabilitation.Methods A prospective research method was conducted in which 200 stroke rehabilitation patients admitted to the Third Hospital of Xingtai City from February 2021 to February 2022 were selected as the study subjects.According to the random principle,the patients were divided into a control group and an study group,with 100 cases in each group.Both groups received routine treatment for stroke,while the control group received a combination of EMGBFT.The study group received a combination of warming-yang and tonifying-qi acupuncture based on the control group,and both groups continued to receive treatment for 9 weeks.Observe the clinical efficacy of two groups of patients and compare the differences in National Institutes of Health Stroke Scale(NIHSS)scores,traditional Chinese medicine symptom scores,brain image structures,serum neurotransmitter levels,and surface electromyography levels before and after treatment,and observe the occurrence of adverse reactions.Results The effective rate of treatment in the study group was significantly higher than that in the control group(97.00%vs.87.00%,P<0.05).Affer treatment,NIHSS score,traditional Chinese medicine symptom score,root-mean-square(RMS)of biceps and triceps,and synergistic contraction rate(SCR)were significantly lower than those before treatment in both groups,and the levels of cerebral blood flow(CBF)in the thalamus and frontal lobe,fractional anisotropy(FA),norepinephrine(NE),5-hydroxytryptamine(5-TH),and dopamine(DA)were significantly higher than those before treatment.After treatment,the NIHSS score(4.18±1.09 vs.6.89±1.54),traditional Chinese medicine symptom score(5.41±1.08 vs.9.46±1.55),and biceps RMS(μV:9.76±3.51 vs.16.36±3.44),triceps brachii RMS(μV:6.79±1.83 vs.10.61±2.87),and SCR[(28.08±8.73)%

关 键 词：温阳补气针法 肌电生物反馈 脑卒中康复 脑影像结构 表面肌电特征 神经递质 

分 类 号：R246[医药卫生—针灸推拿学]