目的 观察不同针灸介入时机对大脑中动脉供血区急性脑梗死神经功能预后的影响。方法 回顾性选取2020年1月—2022年8月收治的116例大脑中动脉供血区急性脑梗死患者的临床资料进行分析，根据针灸介入时机分为两组。两组均进行静脉溶栓及常规药物治疗，观察组61例患者于发病72 h内给予针灸治疗，对照组55例患者于发病2周时给予针灸治疗。检测两组不同时间点侧支循环代偿情况、脑损伤标志物的水平，评估两组不同时间点简易精神状态检查(Mini-mental state examination，MMSE)评分、神经功能评分、Barthel指数(Barthel index，BI)评分、肢体运动功能评分、中医症状评分的差异，统计两组疗效。结果 治疗前，两组侧支循环代偿情况比较，差异无统计学意义(P＞0。05)。治疗4周和随访时，两组患侧大脑前动脉平均血流速度与对侧大脑中动脉平均血流速度的比值(Ratio of the average flow ve-locity of the affected anterior cerebral artery to the average flow velocity of the contralateral middle cerebral artery，iVACA/cVM-CA)较治疗前升高，观察组同时间点较对照组更高(P＜0。05);两组患侧大脑后动脉平均血流速度与对侧大脑中动脉平均血流速度的比值(Ratio of the average flow velocity of the affected posterior cerebral artery to the average flow velocity of the contralateral middle cerebral artery，iVPCA/cVMCA)与治疗前比较，差异无统计学意义(P＞0。05)。治疗前，两组脑损伤标志物比较，差异无统计学意义(P＞0。05)。治疗4周和随访时，两组脑源性神经营养因子(Brain-derived neurotrophic factor，BDNF)较治疗前升高，观察组同时间点较对照组更高(P＜0。05);两组钙结合蛋白β(Calcium binding protein β，S100β)、神经胶质纤维酸性蛋白(Glial fibrillary acid protein，GFAP)较治疗前下降，观察组同时间点较对照组更低(P＜0。05)。治疗前，两组Fugl-Meyer评分、中医症状评分等相关评分比较，差异无统计学意义(P＞0。05)。治疗4周和随访时，两组MMSE评分、BI评分及上肢和下肢Fugl-Meyer评分较治疗前升高，观察组同时间点较对照组更高(P＜0。05);两组美国国立卫生院神经功能缺损(National institutes of health stroke scale，NIHSS)评分、中医症状评分较治疗前下降，观察组同时间点较对照组更低(P＜0。05)。观察组总有效率为88。52％(54/61)高于对照组的72。73％(40/55)，差异有统计学意义(P＜0。05)。结论 发病72h内采用针灸治疗可改善大脑中动脉供血区急性脑梗死脑损伤标志物的表达，改善脑血流，促进神经功能的恢复，有利于疾病的康复。
Effect of Different Acupuncture Intervention Timing on Prognosis of Neurological Function in Acute Cerebral Infarction with Middle Cerebral Artery
Objective To observe the effect of different acupuncture intervention timing on the prognosis of neurological func-tion in acute cerebral infarction with middle cerebral artery.Methods The clinical data of 116 patients with acute cerebral infarc-tion in the middle cerebral artery blood supply area admitted to the hospital from January 2020 to August 2022 were retrospective-ly analyzed,and divided into two groups according to the timing of acupuncture intervention.Both groups received intravenous thrombolysis and conventional drug therapy.Sixty-one patients in the observation group received acupuncture treatment within 72 hours of onset,and fifty-five patients in the control group received acupuncture treatment within 2 weeks of onset.Collateral circulation compensation and brain injury markers of the two groups were detected at different time points.Mini-Mental State Examination(MMSE)score,neurological function score and Barthel index(BI)score,limb motor function score,traditional Chi-nese medicine symptom score were evaluated at different time points in the two groups.Results Before treatment,there was no significant difference in collateral circulation compensation between the two groups(P＞0.05).At 4 weeks of treatment and fol-low-up,the ratio of the average flow velocity of the affected anterior cerebral artery to the affected anterior cerebral artery.Ratio of the average flow velocity of the affected anterior cerebral artery to the affected anterior cerebral artery average flow velocity of the contralateral middle cerebral artery(iVACA/cVMCA)was higher than that before treatment,and the ration of the observation group was higher than that of the control group at the same time point(P＜0.05).The ratio of the average flow velocity of the af-fected posterior cerebral artery to the two groups.Ratio of the average flow velocity of the affected posterior cerebral artery to the two groups the average flow velocity of the contralateral middle cerebral artery(iVPCA/cVMCA)was not significantly different from that before treatment(P＞0.05).Before treatment,there was no significant difference in brain injury markers between the two groups(P＞0.05).At 4 weeks of treatment and follow-up,the levels of brain-derived neurotrophic factor(BDNF)of the two groups were increased compared with those before treatment,and the level of the observation group was higher than that of the control group at the same time point(P＜0.05).The levels of calcium binding protein β(S100 β)and glial fibrillary acid protein(GFAP)in the two groups were decreased compared with those before treatment,and the levels were lower in the observation group than those in the control group at the same time point(P＜0.05).Before treatment,there were no significant differences in Fugl-Meyer score,TCM symptom score or other relevant scores between the two groups(P＞0.05).At 4 weeks of treatment and follow-up,MMSE score,BI score and Fugl-Meyer score of upper and lower limbs in both groups were higher than those before treatment,and the scores of the observation group were higher than those of the control group at the same time point(P＜0.05).The National Institutes of Health Stroke Scale(NIHSS)score and TCM symptom score of the two groups were lower than those be-fore treatment,and the scores of the observation group were lower than those of the control group at the same time point(P＜0.05).The total effective rate of the observation group was 88.52％(54/61),higher than that of the control group[72.73％(40/55)],with statistical difference(P＜0.05).Conclusion Acupuncture treatment within 72 hours of onset can improve the expression of brain injury markers in the middle cerebral artery blood supply area of acute cerebral infarction,improve cerebral blood flow,promote the recovery of neurological function,and contribute to the recovery of the disease.
acupuncturemiddle cerebral artery supply areaacute cerebral infarctionmarkers of brain injurycerebral blood flowneural function
万方数据
维普
