针刺穴位联合康复训练治疗急性脑梗死上肢运动功能障碍并功能磁共振研究

目的:观察针刺穴位联合康复训练治疗急性脑梗死上肢运动功能障碍的疗效,并借助功能磁共振探讨对神经功能重塑的影响。方法:选取急性脑梗死上肢运动功能障碍患者60例,随机分为对照组及治疗组,各30例。对照组行常规药物治疗和运动康复训练,治疗组在对照组的基础上给予针刺穴位治疗;均治疗3个月。于治疗前、后,对2组患者行美国国立卫生院脑卒中量表(NIHSS)评分、Fugl-Meyer上肢运动量表(FMA-UE)评分、患肢的食指轻叩试验检查、握力测量及运动任务态的功能磁共振扫描。结果:治疗后,2组的NIHSS评分、FMA-UE评分、患肢食指轻叩试验及握力测量均较治疗前改善(均P<0.01),且治疗组改善程度较对照组明显(均P<0.01)。治疗前,2组患者左手握拳运动可稳定激活对侧初级运动区(M1)及辅助运动区(SMA);治疗后,2组患者左手握拳运动时,对侧M1区及双侧SAM区较治疗前激活增强(P<0.01),且治疗组较对照组激活增强明显(P<0.01)。结论:针刺穴位联合康复训练治疗急性脑梗死上肢运动功能障碍疗效肯定,促进对侧M1及双侧SAM脑区的激活、调节神经功能重塑可能是其机制之一。

An Functional MRI Study of Effects of Acupuncture Combined with Rehabilitation Trainingon Recovery of Upper Limb Motor Function in Ischemic Stroke Patients

To investigate the effects of acupuncture combined with rehabilitation training on the recovery of upper limb motor function in patients with acute ischemic stroke and to study brain function remodeling using functional magnetic resonance imaging (fMRI). Methods: Sixty acute ischemic stroke patients withmotor dysfunction of the upper limbs were randomly divided into the treatment group and control group, with 30patients in each. Patients in both groups were treated with routine drugs and exercise rehabilitation training for 3months, and patients in the treatment group were additionally given acupuncture treatment. All patients were assessed before and after treatment by the NIHSS score, Fugl-Meyer assessment for upper extremity (FMA-UE),index finger tapping test, grip strength measurement, and exercise task-based fMRI scanning. Results: Aftertreatment, the index finger tapping test, hand grip strength, NIHSS score, and FMA-UE score in both groupswere improved compared with those before treatment (all P<0.01), and the degree of improvement in the treatment group was significantly higher than that in the control group (all P<0.01). Before treatment, both groupsshowed activation of the contralateral primary motor region (M1) and supplementary motor area (SMA) duringgripping exercises; after treatment, both groups showed enhanced activation in the contralateral M1 and bilateralSMA (P<0.01) compared to before treatment, and the treatment group showed a greater enhancement than thecontrol group (P<0.01). Conclusion: In acute ischemic stroke patients with upper limb motor dysfunction, acupuncture combined with rehabilitation is an effective treatment that can promote activation of the bilateral SMAand contralateral M1 and remodeling of brain function.