Chen Sifang, Han Wei, Sun Shanbin, Zhang Guoqing, Zhang Ling
Department of Rehabilitation, The Second Affiliated Hospital of Anhui University of CM, Hefei 230061, China.
Department of Encephalopathy, The Second Affiliated Hospital of Anhui University of CM, Hefei 230061, China.
Zhongguo Zhen Jiu. 2018 Sep 12;38(9):913-7. doi: 10.13703/j.0255-2930.2018.09.001.
To observe the effects of "" acupuncture on cerebral blood flow in high-risk patients of cerebral ischemic stroke based on arterial spin labeling (ASL) and perfusion-weighted imaging (PWI), and to evaluate the clinical efficacy.
A total of 180 patients with transient ischemic attacks (TIA) / minor ischemic stroke (MIS) were randomly divided into an acupuncture A group, an acupuncture B group and a medication group, 60 cases in each group. The patients in the acupuncture A group were treated with "" acupuncture at Baihui (GV 20), Fengfu (GV 16), Yamen (GV 15), Dazhui (GV 14), Shenzhu (GV 12), Zhiyang (GV 9), Mingmen (GV 4), Yaoyangguan (GV 3) and Jingjiaji (EX-B 2), once a day; the patients in the acupuncture B group were treated with identical acupoints but was given once every other day; the patients in the medication group were treated with oral administration of nimodipine tablets, 30 mg, three times daily. All the three groups were treated for four weeks. ASL and PWI, including relative cerebral blood volume (rCBV), relative cerebral blood flow (rCBF), relative mean transit time (rMTT) and relative time to peak (rTTP), were conducted before and after treatment; the changes of the test indexes were compared before and after treatment. The clinical efficacy of the three groups was compared.
Compared before treatment, the numbers of ASL normal perfusion in the 3 groups were significantly increased after treatment (all <0.01); the number of ASL normal perfusion in the acupuncture A group was higher than that in the acupuncture B group (<0.05), but was not significantly different from that in the medication group (>0.05). Compared before treatment, rCBV and rCBF in the 3 groups were significantly increased after treatment (all <0.01), and rMTT and rTTP were significantly reduced (all <0.01). After treatment, rCBV and rCBF in the acupuncture A group were higher than those in the acupuncture B group (all <0.05); the rMTT and rTTP in the acupuncture A group were lower than those in the acupuncture B group (all <0.05); the differences of PWI parameters after treatment were not statistically significant between the acupuncture A group and medication group (all >0.05). The total effective rate was 88.3% (53/60) in the acupuncture A group, 73.3% (44/60) in the acupuncture B group and 90.0% (54/60) in the medication group; the total effective rate in the acupuncture A group was superior to that in the acupuncture B group (<0.05), but was not significantly different from that in the medication group (>0.05).
"" acupuncture could effectively improve the hypoperfusion of cerebral blood flow in patients with high risk of cerebral ischemic stroke, reduce the incidence of severe CIS; acupuncture for once a day is better than once every other day.
基于动脉自旋标记(ASL)和灌注加权成像(PWI)观察“醒脑开窍”针刺法对脑缺血性中风高危患者脑血流的影响,并评估其临床疗效。
将180例短暂性脑缺血发作(TIA)/轻度缺血性中风(MIS)患者随机分为针刺A组、针刺B组和药物组,每组60例。针刺A组患者采用“醒脑开窍”针刺法针刺百会(GV 20)、风府(GV 16)、哑门(GV 15)、大椎(GV 14)、身柱(GV 12)、至阳(GV 9)、命门(GV 4)、腰阳关(GV 3)和颈夹脊(EX - B 2),每日1次;针刺B组患者针刺相同穴位,但隔日1次;药物组患者口服尼莫地平片,30 mg,每日3次。三组均治疗4周。治疗前后行ASL和PWI检查,包括相对脑血容量(rCBV)、相对脑血流量(rCBF)、相对平均通过时间(rMTT)和相对达峰时间(rTTP);比较治疗前后各检测指标的变化。比较三组的临床疗效。
与治疗前比较,三组治疗后ASL正常灌注例数均显著增加(均P <0.01);针刺A组ASL正常灌注例数高于针刺B组(P <0.05),但与药物组比较差异无统计学意义(P>0.05)。与治疗前比较,三组治疗后rCBV和rCBF均显著增加(均P <0.01),rMTT和rTTP均显著降低(均P <0.01)。治疗后,针刺A组rCBV和rCBF高于针刺B组(均P <0.05);针刺A组rMTT和rTTP低于针刺B组(均P <0.05);针刺A组与药物组治疗后PWI参数差异无统计学意义(均P>0.05)。针刺A组总有效率为88.3%(53/60),针刺B组为73.3%(44/60),药物组为90.0%(54/60);针刺A组总有效率优于针刺B组(P <0.05),但与药物组比较差异无统计学意义(P>0.05)。
“醒脑开窍”针刺法可有效改善脑缺血性中风高危患者脑血流灌注不足,降低重症CIS的发生率;每日针刺1次优于隔日针刺1次。