基于ERP探讨头针治疗脑卒中偏瘫即刻效应机制的研究

摘 要：目的：采用事件相关电位（Event-Related Brain Potential, ERP）探讨头针顶颞前斜线中2/5治疗脑卒中的即刻效应机制。方法:选取符合纳入标准的脑卒中患者30例，健康人25例，两组均予头针刺激，均选取右侧顶颞前斜线中2/5。两组分别于针刺前,针刺10 min后进行ERP检测，脑卒中组还需进行肌力评级及神经功能缺损评分。全部试验结束后，从ERP里提取受试者左右手的运动皮层相关电位（（movement-related cortical potentials，MRCPs）。结果：头针刺激10 min后，脑卒中组运动神经功能缺损评分较前降低（P<0.05）；肌力评级较前升高（P<0.05）；针刺前后脑卒中组患侧手MRCPs波幅较前明显下降(P<0.05)。结论：头针治疗脑卒中患者肢体偏瘫的即刻效应明确，其作用机制可能是针刺顶颞前斜线时刺激皮层运动功能区，降低了大脑运动执行策划的能量损耗，激活了受损脑区与运动相关皮层区域的神经元，提高了大脑对运动过程的处理效率，从而促进偏瘫肢体运动功能的即刻改善。并且我们观察到，健侧脑具有代偿性作用，这提示我们临床中进行头针针刺时，进行双侧刺激可能疗效更佳。

Study on Mechanism of Scalp Acupuncture in Immediate Effects of Stroke Hemiplegia Based on ERP

Abstract: This study was aimed to explore the immediate effect mechanism of the middle 2/5 of the vertex-temporal anterior oblique line in the treatment of stroke by scalp acupuncture using event-related brain potential (ERP). A total of 30 stroke cases who met the inclusion criteria and 25 healthy subjects were selected. Patients in both groups were treated by scalp acupuncture, with stimulation on the middle 2/5 of the vertex-temporal anterior oblique line on the right side. ERP was detected before acupuncture and 10 min after acupuncture in both groups. The muscle strength and neurological deficit score of the stroke group were also detected. At the end of the experiment, the movement-related cortical potentials (MRCPs) of both the left and right hand were extracted from the ERP. The results showed that after 10 min scalp acupuncture stimulation, the neurological deficit score of the stroke group was lower than that of the pretreatment (P < 0.05); the muscle strength rating was higher than before (P < 0.05). Before and after acupuncture, the amplitude of MRCPs on the diseased side of the stroke group was significantly decreased compared to before (P < 0.05). It was concluded that the immediate effect of scalp acupuncture treatment of hemiplegia patients with stroke was definite. Its mechanism may be that acupuncture stimulates the motor cortex through the vertex-temporal anterior oblique line, reduces the energy loss of brain motion planning, activates the damaged brain movement related area cortex neurons, improves the processing efficiency of movement in the brain, so as to promote the improvement of hemiplegic limb motor function immediately. And we also observed that the healthy side brain has a compensatory effect, which suggested that in our clinical scalp acupuncture, bilateral stimulation may be more effective.