Li Rui-Yu, Wang Rui-Xian, Xiao Ling-Yong, Zhang Yue-Xin, Pang Zhi-Xi, Wang Qing-Xin, Dai Xiao-Yu
Department of Acupuncture and Moxibustion, First Teaching Hospital of Tianjin University of TCM/National Clinical Medicine Research Center of Chinese Acupuncture and Moxibustion, Tianjin 300193, China.
First Section of Department of Encephalopathy, Beichen District Hospital of TCM, Tianjin University of TCM.
Zhongguo Zhen Jiu. 2021 Mar 12;41(3):257-62. doi: 10.13703/j.0255-2930.20200911-k0001.
To evaluate the clinical efficacy of acupuncture at different timings in acute stage for limb dysfunction in patients with cerebral infarction.
A total of 101 patients with cerebral infarction limb dysfunction were divided into an early exposure group (=51) and a late exposure group (=50) according to the time of first acupuncture treatment during the acute phase. SPSS 25.0 software was used to balance the baseline between the two groups, and 31 pairs of matched patients were included, including 31 cases in the early exposure group and 31 cases in the late exposure group. The two groups were treated with acupuncture at Shuigou (GV 26), Neiguan (PC 6), Sanyinjiao (SP 6), Jiquan (HT 1), Chize (LU 5), Weizhong (BL 40), etc., once a day, and the course of treatment was not limited. In the early exposure group, acupuncture was started after 1 to 3 days of onset; in the late exposure group, acupuncture was started after 11 to 14 days of onset. The modified Rankin scale (mRS) grade was recorded before treatment, 30 and 60 days after onset; Fugl-Meyer assessment (FMA) grade was observed before treatment and 30 days after onset; the effect of acupuncture timing on the patients was analyzed by logistic analysis.
Compared before treatment, the mRS grade at 30 and 60 days after onset in the early exposure group was improved (<0.05), which was superior to the late exposure group (<0.05); compared before treatment, the FMA grade at 30 days after onset in the early exposure group was improved (<0.05), which was superior to the late exposure group (<0.05). The timing of acupuncture was independently correlated with the disability status and the severity of motor dysfunction at 30 days after onset, and the disability status at 60 days after onset (<0.05). Compared with the late exposure group, the possibility of becoming non-disabled at 30 days after onset (=22.882, 95%: 4.034-129.778), normal limb motor dysfunction (=22.320, 95%: 3.454-144.213) and non-disabled at 60 days after onset (=8.650, 95%: 2.437-30.696) in the early exposure group was increased.
The timing of acupuncture is an independent factor affecting the disability status and limb motor dysfunction in patients with cerebral infarction, and the effect of early intervention may be better than late intervention.
评估脑梗死患者急性期不同时机针刺治疗对肢体功能障碍的临床疗效。
将101例脑梗死肢体功能障碍患者根据急性期首次针刺治疗时间分为早期针刺组（n = 51）和晚期针刺组（n = 50）。采用SPSS 25.0软件平衡两组基线，纳入31对匹配患者，其中早期针刺组31例，晚期针刺组31例。两组均针刺水沟（GV 26）、内关（PC 6）、三阴交（SP 6）、极泉（HT 1）、尺泽（LU 5）、委中（BL 40）等穴位，每日1次，疗程不限。早期针刺组于发病1至3天开始针刺；晚期针刺组于发病11至14天开始针刺。记录治疗前、发病30天及60天后的改良Rankin量表（mRS）分级；观察治疗前及发病30天后的Fugl - Meyer评估（FMA）分级；采用logistic分析针刺时机对患者的影响。
与治疗前比较，早期针刺组发病30天及60天后的mRS分级改善（P<0.05），优于晚期针刺组（P<0.05）；与治疗前比较，早期针刺组发病30天后的FMA分级改善（P<0.05），优于晚期针刺组（P<0.05）。针刺时机与发病30天后的残疾状态及运动功能障碍严重程度、发病60天后的残疾状态独立相关（P<0.05）。与晚期针刺组比较，早期针刺组发病30天后变为非残疾（OR = 22.882，95%CI：4.034 - 129.778）、肢体运动功能正常（OR = 22.320，95%CI：3.454 - 144.213）及发病60天后变为非残疾（OR = 8.650，95%CI：2.437 - 30.696）的可能性增加。
针刺时机是影响脑梗死患者残疾状态及肢体运动功能障碍的独立因素，早期干预效果可能优于晚期干预。
