摘要
目的 观察开窍醒神补虚通络针刺联合重复经颅磁刺激对卒中后偏瘫患者肢体运动功能的影响.方法 将98例卒中后偏瘫患者按照随机数字表法分为2组.对照组49例予重复经颅磁刺激治疗,治疗组49例予开窍醒神补虚通络针刺联合重复经颅磁刺激治疗,2组均连续治疗3个月.评估对比2组临床疗效、中医证候积分、脑血流动力学、脑损伤标志物、肢体运动功能和治疗安全性.结果 治疗后,2组偏枯不用、口角歪斜、肢体无力、面色萎黄评分均显著降低(P＜0.05),且治疗组均低于对照组(P＜0.05).治疗后,2组大脑中动脉、基底动脉、椎动脉血流速度均较本组治疗前增快(P＜0.05),且治疗组均快于对照组(P＜0.05).治疗后,2组脑损伤标志物脑型脂肪酸结合蛋白(B-FABP)、神经元特异性烯醇化酶(NSE)、甘露糖结合凝集素相关丝氨酸蛋白酶3(MASP-3)水平均显著降低(P＜0.05),且治疗组均低于对照组(P＜0.05).治疗后,2组Fugl-Meyer运动功能量表(FMA)评分、Berg平衡量表(BSS)评分、6 min步行距离(6MWD)均显著提高(P＜0.05),且治疗均高于对照组(P＜0.05).治疗组总有效率为91.84％(45/49),不良反应发生率12.24％(6/49),对照组分别为73.47％(36/49)、8.16％(4/49),治疗组总有效率高于对照组(P＜0.05),2组不良反应发生率比较差异无统计学意义(P＞0.05).结论 开窍醒神补虚通络针刺联合重复经颅磁刺激治疗卒中后偏瘫效果显著,可改善患者中医证候,改善脑血流动力学,降低脑损伤标志物水平,提高患者肢体运动功能,安全性良好.
Abstract
Objective To explore the effect of Kaiqiao Xingshen Buxu Tongluo acupuncture combined with repetitive transcranial magnetic stimulation(rTMS)on limb motor function in patients with post-stroke hemiplegia.Methods Ninety-eight patients with post-stroke hemiplegia were recruited in this study,and they were assigned in a 1∶1 ratio to rTMS(control group)or Kaiqiao Xingshen Buxu Tongluo acupuncture plus rTMS(treatment group)by a random number table for 3 months.The clinical efficacy,traditional Chinese medicine(TCM)symptom scores,cerebral hemodynamics,brain injury markers,limb motor function scores,and treatment-emergent adverse events(TEAEs)were evaluated between two groups.Results After treatment,the TCM syndrome scores(incomplete use,angular deviation,limb weakness,and pale complexion)of the both groups were significantly lower than those before treatment(P＜0.05),and which were significantly lower in the treatment group than in the control group(P＜0.05).After treatment,the blood flow velocity of the middle cerebral artery,basilar artery and vertebral artery in both groups were significantly faster than those before treatment(P＜0.05),and which were significantly faster in the treatment group than in the control group(P＜0.05).After treatment,the levels of brain fatty acid binding protein(B-FABP),neuron specific enolase(NSE)and mannose-binding lectin-associated serine protease 3(MASP-3)in the both groups were significantly lower than those before treatment(P＜0.05),which in the treatment group were significantly lower than those in the control group(P＜0.05).After treatment,the scores of Fugl Meyer Motor Function Scale(FMA),Berg Balance Scale(BSS),and 6-minute walking distance(6MWD)in the both groups were significantly higher than those before treatment(P＜0.05),the increases were more common in the treatment group relative to the control group(P＜0.05).The total effective rate of the treatment group was significantly higher than that of the control group(91.84％[45/49]vs 73.47％[36/49],P＜0.05).The incidence of TEAEs in the treatment group and the control group was comparable(12.24％[6/49]vs 8.16％[4/49],P＞0.05).Conclusion The combination of Kaiqiao Xingshen Buxu Tongluo acupuncture and rTMS has a significant effect in the treatment of post-stroke hemiplegia,which can improve patients'TCM syndromes,improve cerebral hemodynamics,reduce the level of brain injury markers,and im-prove patients'limb motor function,it has a good safety.
维普
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