针刺联合康复技术治疗脑卒中早期上肢运动功能障碍的疗效及磁共振弥散张量成像研究-现代医学

针刺联合康复技术治疗脑卒中早期上肢运动功能障碍的疗效及磁共振弥散张量成像研究

单位：东南大学附属中大医院江北院区康复医学科, 江苏南京 210044

分类号：R743.3

出版年·卷·期（页码）：2019·47·第四期（439-442）

摘要：

目的：探讨针刺联合现代康复技术治疗早期缺血性脑卒中上肢运动功能障碍的效果，并采用磁共振弥散张量成像（DTI）分析其对大脑可塑性的影响。方法：将110例缺血性脑卒中早期患者随机分为针刺组和对照组，对照组应用康复治疗8周，针刺组在康复治疗的基础上联合针刺治疗8周；采用简化Fugl-Meyer评定量表上肢部分（UE-FMA）评定两组患者治疗前和治疗后4周、8周时上肢运动功能；在治疗前、治疗结束后对两组患者进行DTI扫描，比较两组治疗前后变化。结果：两组间治疗前UE-FMA评分差异无统计学意义（P>0.05）；治疗后4周、8周两组患者UE-FMA评分较治疗前明显提高（P<0.05），且治疗后8周高于治疗后4周（P<0.05）；治疗后4周、8周，针刺组患者UE-FMA评分均高于对照组（P<0.05）。治疗前两组患者病灶侧大脑脚、内囊后肢、放射冠区FA值差异无统计学意义（P>0.05），治疗后8周两组患者病灶侧放射冠FA值均较治疗前增高（P<0.05），且针刺组高于对照组（P<0.05）。结论：针刺联合现代康复技术治疗早期缺血性脑卒中后上肢运动障碍具有较好的临床效果，可能与针刺联合现代康复技术能更好地促进大脑可塑性变化有关。

Objective:To verify the clinical efficacy of acupuncture combined with modern rehabilitation technique on the upper extremity motor function recovery at early stage of stroke, and to explore brain plasticity with diffusion tensor imaging(DTI) in different therapy. Methods:One hundred and ten cases of ischemic stoke of early stage were randomized into acupuncture group(acupuncture combined with modern rehabilitation technique) and control group. Rehabilitation treatment was performed in the control group for eight weeks, while acupuncture group received acupuncture treatment in addition to rehabilitation treatment for 8 weeks. The scores of all the patients were assessed with upper extremity Fugl-Myer Assessment(UE-FMA) before treatment, 4 weeks and 8 weeks after treatment, and the patients were scanned with DTI to observe the changes before and after treatment. Results:There were no statistical differences in UE-FMA scores between the two groups before treatment, but after treatment of 4 weeks and 8 weeks,the scores of UE-FMA in the two groups were higher than those before the treatment. The UE-FMA scores were higher at the 8th week than those at the 4th week after treatment. The UE-FMA scores of acupuncture group were higher than those of the control group 4 weeks after treatment and 8 weeks after treatment. There was no statistical difference in FA values of the corona radiate section between the two groups before the treatment, but the FA value of the corona radiate section was increased after 8 weeks treatment and was higher than that of the control group. Conclusion:Compared with rehabilitation therapy, acupuncture combined with modern rehabilitation technique can achieve better clinical efficacy, which may be related to the promotion of the repairment of CST in the corona radiate section.

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