针药并用治疗卒中恢复期自主神经功能障碍的疗效观察  

Therapeutic observation of acupuncture combined with medication for autonomic dysfunction at the recovery stage of stroke

作　　者：邱思雯 赵海音[1] 韩雪慧 马子霖[1] 李锐 贾世婧 杭明辉 徐浩[5] 王拥军[1,2,5] 鲁望[1] QIU Siwen;ZHAO Haiyin;HAN Xuehui;MA Zilin;LI Rui;JIA Shijing;HANG Minghui;XU Hao;WANG Yongjun;LU Wang(Longhua Hospital,Shanghai University of Traditional Chinese Medicine,Shanghai 200032,China;Shanghai University of Traditional Chinese Medicine,Shanghai 201203,China;Shanghai Jiading District Malu Town Community Health Service Center,Shanghai 201801,China;Dandong Veterans Special Care Hospital of Liaoning Province,Dandong 118000,China;Spine Institute,Shanghai University of Traditional Chinese Medicine,Shanghai 200032,China)

机构地区：[1]上海中医药大学附属龙华医院,上海200032 [2]上海中医药大学,上海201203 [3]上海市嘉定区马陆镇社区卫生服务中心,上海201801 [4]辽宁省丹东市荣军优抚医院,丹东118000 [5]上海中医药大学脊柱病研究所,上海200032

出　　处：《上海针灸杂志》2025年第3期310-316,共7页Shanghai Journal of Acupuncture and Moxibustion

基　　金：上海市卫生健康委员会科研课题(20194Y0045);上海市促进市级医院临床技能与临床创新三年行动计划重大临床研究项目(SHDC2020CR1010A);关键领域优秀博士培育项目(GJ2022009);上海中医药大学产业发展中心医养结合科创项目(602061D)。

摘　　要：目的观察针药并用治疗卒中恢复期自主神经功能障碍的临床疗效,并观察对24 h心率变异性(heart rate variability,HRV)指标的影响。方法将60例卒中恢复期自主神经功能障碍患者随机分为治疗组和对照组,每组30例。对照组采用对症药物治疗,治疗组在对照组治疗基础上采用针刺治疗。观察两组治疗前后临床特征量表(clinical feature scale,CFS)评分、24 h HRV指标[窦性R-R间期标准差(standard deviation of normal-to-normal intervals,SDNN)、窦性R-R间期平均值标准差(standard deviation of the average of normal-to-normal intervals,SDANN)、连续差值的均方根(root mean square of successive differences,RMSSD)、相邻两个窦性R-R间期差值>50 ms的个数所占的百分率(percentage of normal-to-normal intervals differing by more than 50 milliseconds,PNN50)、低频(low frequency,LF)功率、高频(high frequency,HF)功率及LF/HF]的变化,并比较两组临床疗效。结果治疗组总有效率为93.3%,高于对照组的73.3%(P<0.05)。治疗后,两组CFS评分均降低,且治疗组低于对照组,差异有统计学意义(P<0.05)。治疗后,两组SDNN、RMSSD、日间及夜间LF、HF水平较治疗前升高,且治疗组高于对照组,差异有统计学意义(P<0.05);两组SDANN、日间及夜间LF/HF、PNN50水平与治疗前比较差异无统计学意义(P>0.05),组间比较差异无统计学意义(P>0.05)。结论针药并用能够调节卒中恢复期自主神经功能障碍患者的自主神经平衡,有利于患者自主神经功能的恢复。Objective To observe the clinical efficacy of acupuncture combined with medication in treating autonomic dysfunction at the recovery stage of stroke and its effects on 24 h heart rate variability(HRV)indicators.Method Sixty patients with autonomic dysfunction at the recovery stage of stroke were randomly divided into a treatment group and a control group,each consisting of 30 cases.The control group was treated with symptomatic medications,based on which the treatment group was given additional acupuncture intervention.The two groups were observed for post-treatment changes in the clinical feature scale(CFS)score,24 h HRV indicators[standard deviation of normal-to-normal intervals(SDNN),standard deviation of the average of normal-to-normal intervals(SDANN),root mean square of successive differences(RMSSD),percentage of normal-to-normal intervals differing by more than 50 milliseconds(PNN50),low-frequency(LF)power,high-frequency(HF)power,and LF/HF].The clinical efficacy was compared between the two groups.Result The total effective rate was 93.3%in the treatment group,higher than 73.3%in the control group(P<0.05).After the treatment,the CFS score dropped in both groups and was lower in the treatment group than in the control group,and the differences were statistically significant(P<0.05).After the intervention,the SDNN,RMSSD,and diurnal and nocturnal LF and HF levels increased in both groups and were higher in the treatment group than in the control group,and the differences were statistically significant(P<0.05);there were no significant changes in the SDANN,diurnal and nocturnal LF/HF and PNN50 levels in either group(P>0.05),and the between-group differences were statistically insignificant(P>0.05).Conclusion The combined use of acupuncture and medication can regulate autonomic balance in patients with autonomic dysfunction at the recovery stage of stroke,which is beneficial for the recovery of their autonomic function.

关 键 词：针刺疗法 针药并用 卒中 中风后遗症 恢复期 自主神经功能障碍 心率变异性 

分 类 号：R246.6[医药卫生—针灸推拿学]