靳三针结合镜像疗法对脑卒中上肢功能障碍患者脑功能效应的影响
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摘要
目的探讨靳三针结合镜像疗法对脑卒中上肢功能障碍患者上肢功能的即时疗效。方法选取脑卒中上肢功能障碍患者11例,针刺治疗取穴:患肢对侧颞三针,患侧上肢行肩三针、手三针,人中、百会;留针同时行镜像康复疗法30 min。治疗前后均进行静息态功能磁共振(f MRI)扫描T1加权图像和BOLD脑功能图像。分析局部一致性(Re Ho)和节点中心度(DC)有差异的脑区。结果相比治疗前,Reho值在尾状核、缘上回、前扣带回、内囊前肢、梭状回、枕叶外侧显著增强(体素簇体积>165且P<0.05)。DC在颞上回后坡、颞中回、颞下回、枕颞外侧显著增强(体素簇体积>165且P<0.05)。结论靳三针结合镜像疗法可能促进脑卒中上肢功能障碍患者相关区域的脑功能得到更好地重建。
Objective To investigate the real-time effect of JIN's three-needle combined with mirror therapy on upper limb function in patients with stroke and upper extremity dysfunction. Methods A total of 11 patients with stroke and upper extremity dysfunction were selected. Acupuncture treatment was performed in the following acupoints: three needles in the temple of opposite side of the affected limb,three needles in the shoulder and hand of the upper limbs of the affected side,Renzhong( GV26) and Baihui( GV20). While needling retention,mirror rehabilitation was performed for 30 min. Resting state functional magnetic resonance imaging( f MRI) scans of T1-weighted images and BOLD brain functional images were performed before and after treatment. Brain regions with differences in local consistency( Re Ho) and node centrality( DC) were analyzed. Results Compared with before treatment,Reho values were significantly enhanced in the caudate nucleus,superior temporal anterior cingulate gyrus,anterior cingulate anterior limb,fusiform gyrus,and lateral occipital lobe( voxel clustering volume > 165 and P < 0. 05). The DC was significantly enhanced on the back slope,the middle back,the lower back,and the outer side of the pillow( voxel clustering volume > 165 and P < 0. 05). Conclusion JIN's three-needle combined with mirror therapy may promote better reconstruction of brain function in patients with upper limb dysfunction in stroke.
Objective To investigate the real-time effect of JIN's three-needle combined with mirror therapy on upper limb function in patients with stroke and upper extremity dysfunction. Methods A total of 11 patients with stroke and upper extremity dysfunction were selected. Acupuncture treatment was performed in the following acupoints: three needles in the temple of opposite side of the affected limb,three needles in the shoulder and hand of the upper limbs of the affected side,Renzhong( GV26) and Baihui( GV20). While needling retention,mirror rehabilitation was performed for 30 min. Resting state functional magnetic resonance imaging( f MRI) scans of T1-weighted images and BOLD brain functional images were performed before and after treatment. Brain regions with differences in local consistency( Re Ho) and node centrality( DC) were analyzed. Results Compared with before treatment,Reho values were significantly enhanced in the caudate nucleus,superior temporal anterior cingulate gyrus,anterior cingulate anterior limb,fusiform gyrus,and lateral occipital lobe( voxel clustering volume > 165 and P < 0. 05). The DC was significantly enhanced on the back slope,the middle back,the lower back,and the outer side of the pillow( voxel clustering volume > 165 and P < 0. 05). Conclusion JIN's three-needle combined with mirror therapy may promote better reconstruction of brain function in patients with upper limb dysfunction in stroke.
引文
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[20]王海燕,赵志军,蒋苹,等.镜像疗法对脑卒中偏瘫患者下肢运动功能障碍的康复效果研究[J].贵州医药,2017,41(6):603-604.
[21]刘英媛,孟德勇,周扬.头针联合膝关节控制训练对脑卒中后偏瘫患者步行能力的影响[J].现代中西医结合杂志,2016,25(34):3788-3791.
[22]崔韶阳,许明珠,王曙辉,等.针刺配合镜像疗法对脑梗死偏瘫患者下肢功能障碍的影响[J].上海针灸杂志,2017,36(1):9-13.
[23]阳运秋,唐纯志,崔韶阳,等.针灸结合镜像疗法在脑卒中治疗的临床应用现况[J].时珍国医国药,2018,29(11):2737-2739.
[24]于致顺.头穴基础与临床[M].北京:中国医药科技出版社,1992:64.
[25]骆明军,程玲,徐丽,等.电针刺激水沟、百会穴后对缺血再灌注大鼠脑内小胶质细胞的活化[J].中国临床康复,2006,10(11):180-182.
[26]李雅洁,樊小农,王舒,等.针刺水沟穴治疗脑梗死的参数优化研究[J].中医杂志,2009,50(5):428-431.
[27]李雅洁,樊小农,王舒,等.不同参数针刺水沟穴对脑缺血模型大鼠脑组织病理形态学的影响[J].辽宁中医杂志,2012,39(6):1165-1168.
[28]郁洁,章薇,郭卫军,等.电针人中穴对大脑中动脉阻塞大鼠脑神经细胞凋亡及其相关基因表达的干预[J].中国临床康复,2006,10(31):90-92.
[29]MANDEVILLE JB,MAROTA JJ,AYATA C,et al.MRI mearsurement of the temporal evolution of relative CMRO(2)during rat forepaw stimulation[J].Magn Reson Med,1999,42(5):944-951.
[30]龚洪翰.磁共振成像原理与临床应用[M].南昌:江西科学技术出版社,2006:440-441.
[31]ZANG YF,JIANG TZ,LU YL,et al.Regional homogeneity approach to f MRI data analysis[J].Neuroimage,2004,22(1):394-400.
[32]廖艳辉,唐劲松,王绪轶,等.氯胺酮依赖者脑功能活动的局部一致性改变-静息态功能磁共振成像研究[J].中国药物依赖性杂志,2010,19(5):343-348.
[33]ZUO XN,ROSS E,MAARTEN M,et al.Network centrality in the human functional connectome[J].Cerebral Cortex,2012,22(8):1862-1875.
[34]汪小帆李翔陈关荣.网络科学导论[M].北京:高等教育出版社,2012:158-159.
[2]杨期东.神经病学[M].北京:人民卫生出版社,2002:118.
[3]JORGENSE HS,NAKAYAMA H,RAASCHOU HO,et al.Functional and neurological outcome of stroke and the relation to stroke severity and type,stroke unit treatment,body temperature,age,and other risk factors:the Copenhagen stroke study[J].Top Stroke Rehabil,2000,6(4):1-19.
[4]HARRIS JE,ENG JJ,MILLER WC,et al.A selfadministered graded repetitive arm supplementary program(GRASP)improves arm function during inpatient stroke rehabilitation:a multi-site randomized controlled trial[J].Stroke,2009,40(6):2123-2128.
[5]徐世芬,庄礼兴,贾超,等.“靳三针”对脑卒中偏瘫患者认知功能和日常生活能力的影响:多中心随机对照研究[J].中国针灸,2009,29(9):689-694.
[6]孙焜,沈巍,韩德雄,等.“靳三针”对中风后偏瘫患者肢体运动功能和日常生活活动能力的影响[J].中医杂志,2010,51(6):524-527.
[7]郎建英,庄礼兴,贾超,等.“靳三针”结合康复疗法治疗缺血性中风痉挛性偏瘫的临床疗效观察[J].广州中医药大学学报,2011,28(4):369-373.
[8]RAMACHANDRAN VS,ROGERS-RAMACHANDRAN D,COBB S.Touching the phantom limb[J].Nature,1995,377(6549):489-490.
[9]ALTSCHULER EL.Motor rehabilitation in a stroke patient using a mirror[J].Society for Neuroscience Abstracts,1998,24(1/2):1408.
[10]中华医学会全国第四届脑血管病学术会议.各类脑血管疾病诊断要点[J].中华神经科杂志,1996,29(6):376-381.
[11]国家中医药管理局脑病急症协作组.中风病诊断与疗效评定标准(试行)[J].北京中医药大学学报,1996,19(1):55-56.
[12]周维金,孙启良.瘫痪康复评定手册[M].北京:人民卫生出版社,2006:36-37.
[13]陈清棠.脑卒中患者临床神经功能缺损程度评分标准(1995)[J].中华神经科杂志,1996,29(6):381-383.
[14]MALOUIN F,RICHARDS C,JACKSON P,et al.The Kinesthetic and Visual Imagery Questionnaire(KVIQ)for assessing motor imagery in persons with physical disabilities:a reliability and construct validity study[J].J Neurol Phys Ther,2007,31(1):20-29.
[15]励建安,黄晓琳.康复医学[M].北京:人民卫生出版社,2016:95.
[16]中华医学会神经病学分会中华医学会神经病学分会脑血管病学组.中国急性缺血性脑卒中诊治指南2014[J].中华神经科杂志,2015,48(4):246-257.
[17]CHAO-GAN Y,YU-FENG Z.DPARSF:a MATLAB toolbox for“pipeline”data analysis of resting-state f MRI[J].Front Syst Neurosci,2010,4:13.doi:10.3389/fnsys.2010.00013.
[18]SONG XW,DONG ZY,LONG XY,et al.REST:A toolkit for resting-state functional magnetic resonance imaging data processing[J].PLo S ONE,2011,6(9):e25031.doi:10.1371/journal.pone.0025031.
[19]蒋金鹏,刘洪武,王志双.镜像疗法配合康复训练对脑卒中偏瘫患者上肢运动功能的临床疗效分析[J].中国医学装备,2015,12(9):107-109.
[20]王海燕,赵志军,蒋苹,等.镜像疗法对脑卒中偏瘫患者下肢运动功能障碍的康复效果研究[J].贵州医药,2017,41(6):603-604.
[21]刘英媛,孟德勇,周扬.头针联合膝关节控制训练对脑卒中后偏瘫患者步行能力的影响[J].现代中西医结合杂志,2016,25(34):3788-3791.
[22]崔韶阳,许明珠,王曙辉,等.针刺配合镜像疗法对脑梗死偏瘫患者下肢功能障碍的影响[J].上海针灸杂志,2017,36(1):9-13.
[23]阳运秋,唐纯志,崔韶阳,等.针灸结合镜像疗法在脑卒中治疗的临床应用现况[J].时珍国医国药,2018,29(11):2737-2739.
[24]于致顺.头穴基础与临床[M].北京:中国医药科技出版社,1992:64.
[25]骆明军,程玲,徐丽,等.电针刺激水沟、百会穴后对缺血再灌注大鼠脑内小胶质细胞的活化[J].中国临床康复,2006,10(11):180-182.
[26]李雅洁,樊小农,王舒,等.针刺水沟穴治疗脑梗死的参数优化研究[J].中医杂志,2009,50(5):428-431.
[27]李雅洁,樊小农,王舒,等.不同参数针刺水沟穴对脑缺血模型大鼠脑组织病理形态学的影响[J].辽宁中医杂志,2012,39(6):1165-1168.
[28]郁洁,章薇,郭卫军,等.电针人中穴对大脑中动脉阻塞大鼠脑神经细胞凋亡及其相关基因表达的干预[J].中国临床康复,2006,10(31):90-92.
[29]MANDEVILLE JB,MAROTA JJ,AYATA C,et al.MRI mearsurement of the temporal evolution of relative CMRO(2)during rat forepaw stimulation[J].Magn Reson Med,1999,42(5):944-951.
[30]龚洪翰.磁共振成像原理与临床应用[M].南昌:江西科学技术出版社,2006:440-441.
[31]ZANG YF,JIANG TZ,LU YL,et al.Regional homogeneity approach to f MRI data analysis[J].Neuroimage,2004,22(1):394-400.
[32]廖艳辉,唐劲松,王绪轶,等.氯胺酮依赖者脑功能活动的局部一致性改变-静息态功能磁共振成像研究[J].中国药物依赖性杂志,2010,19(5):343-348.
[33]ZUO XN,ROSS E,MAARTEN M,et al.Network centrality in the human functional connectome[J].Cerebral Cortex,2012,22(8):1862-1875.
[34]汪小帆李翔陈关荣.网络科学导论[M].北京:高等教育出版社,2012:158-159.