通督调神针法介入时机对急性脑梗死溶栓后神经功能的影响

目的：评价不同时机介入通督调神针法治疗急性脑梗死溶栓后偏瘫患者神经功能及t-PA、PAI-1、D-D水平的影响。方法：采用倾向性匹配评分均衡组间基线，纳入68例匹配患者，根据溶栓后不同针刺介入时机分成A、B、C、D组。A组（溶栓时即刻介入）17例，B组（溶栓后24小时内介入）17例，C组（溶栓72小时后介入）17例，D组（不进行针刺）17例，四组均接受静脉rt-PA溶栓和常规治疗，A、B、C三组在D组疗法基础上，采用“通督调神”针法，连续治疗2个疗程，共28。四组患者均设置治疗周期为28d，随访至90d。观察各组治疗前后各时间点神经功能、日常生活能力以及残障程度改善情况，检测血清t-PA、PAI-1、D-D水平变化情况。结果：A组、B组、C组NIHSS、BI和mRS、血液流变学的改善情况明显优于D组（P<0.05），其中A组、B组优于C组（P<0.05），A组与B组相比较无明显差异（P>0.05）；针刺时机与患者发病30d神经功能、日常生活能力、残障状态以及90d生活能力和残障状态独立相关（P<0.05）。结论：针刺介入时机是影响脑梗死肢体神经功能、日常生活能力以及患者残障程度的独立因素，溶栓后24小时内介入针刺疗效可能更佳，通督调神针刺能够改善患者神经功能、血液流变学指标、日常生活能力和降低残障率，安全性较高，值得在临床上推广应用。

The Effect of Timing of Tongdu Tiaoshen Acupunture Intervention on Neurological Function Following Thrombolysis in Acute Cerebral Infarction

Objective: To assess the impact of different timing interventions of Tongdu Tiaoshen Acupunture method on neurological function and levels of t-PA, PAI-1, and D-D in patients with hemiplegia following thrombolysis for acute cerebral infarction. Methods: SPSS25.0 software was employed to establish baseline equivalence between groups. A total of 68 matched patients were divided into four groups, A, B, C, and D, according to the timing of acupunture intervention after thrombolysis. Group A (at the time of thrombolysis) consisted of 17 patients, group B (within 24 hours after thrombolysis) consisted of 17 patients, group C (after 72 hours after thrombolysis) consisted of 17 patients, and group D (without acupuncture) consisted of 17 patients. All four groups received intravenous rt-PA thrombolysis and conventional treatment, while groups A, B, and C were treated with Tongdu Tiaoshen Acupunture method, once a day, for 14 days per treatment course, with continuous treatment for two courses. The treatment period was set at 28 days for all four groups, and patients were followed up until 90 days after the onset of the disease. The improvement of neurological function, daily living ability, and degree of disability at each time point before and after treatment were assessed in the four groups, and the changes in serum t-PA, PAI-1, and D-D levels were detected. Results: The improvement of NIHSS, BI, and mRS, as well as blood rheology, in groups A, B, and C were significantly better than those in group D (the control group), with groups A and B being better than group C. There was no significant difference between group A and group B. The timing of acupunture was independently associated with patients'' neurological function, daily living ability, and disability status at 30 days of onset and living ability and disability status at 90 days (P<0.05). Conclusion: The timing of acupuncture intervention is an independent factor affecting the neurological function of the cerebral infarct limbs, daily living ability, and the degree of disability of patients. The efficacy acupuncture intervention within 24 hours following thrombolysis may be superior. and Tongdu Tiaoshen Acupunture can improve neurological function, blood rheology index, daily living ability, and reduce the disability rate in patients with higher safety. These results are worth promoting in clinical application.