Wu Bangqi, Ding Yi, Peng Maohan, Wang Xuhui, Li Yibing, Cheng Xinyue
First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, 300381, People's Republic of China.
Tianjin University of Traditional Chinese Medicine, Tianjin, 301617, People's Republic of China.
J Multidiscip Healthc. 2023 Feb 21;16:463-474. doi: 10.2147/JMDH.S398202. eCollection 2023.
Limb motor disorders after stroke are very common, and the clinical related factors of improving limb motor function are still unclear. As a part of comprehensive rehabilitation strategy, acupuncture has been widely used in rehabilitation after stroke in China. But more evidence is needed for the influence of acupuncture and some other clinical factors on post-stroke motor disorders.
A retrospective study was conducted using the database of patients with post-stroke motor disorders admitted to the Neurological Rehabilitation Unit of the First Teaching Hospital of Tianjin University of Traditional Chinese Medicine. The included patients were grouped according to whether NIHSS improved or muscle strength improved. The positive logistic regression was used to analyze the influencing factors of possible NIHSS improvement. Combined with the influencing factors of NIHSS improvement and muscle strength improvement, the influencing factors of limb motor function recovery after stroke were obtained.
When analyzing the baseline of the included patients, it was found that patients with NIHSS improvement had earlier acupuncture intervention time (M, (IQR):13.5 (14), OR=0.716, 95% CI [0.591-0.869], p=0.001), more cumulative acupuncture treatment times (M,(IQR):29 (12), OR=0.744, 95% CI [0.608-0.910], p=0.004), and less hypertension history (OR=0.256, 95% CI [0.082-0.801], p=0.019). Smoking history only has positive significance in univariate and multivariate analysis of NIHSS, not muscle strength (OR=0.274, 95% CI [0.097-0.779], p=0.015).
The earlier acupuncture intervention and the more cumulative acupuncture treatment times are, the more beneficial the limb function of stroke patients with motor disorders will be. The previous history of hypertension is the influencing factor of limb motor function not improving in patients with limb motor disorder after a stroke. The effect of smoking history on limb movement function of patients with limb motor disorder after stroke needs further study.
脑卒中后肢体运动障碍非常常见，改善肢体运动功能的临床相关因素仍不明确。作为综合康复策略的一部分，针灸在中国已广泛应用于脑卒中后的康复治疗。但针灸及其他一些临床因素对脑卒中后运动障碍的影响还需要更多证据。
采用天津中医药大学第一附属医院神经康复科收治的脑卒中后运动障碍患者数据库进行回顾性研究。纳入患者根据美国国立卫生研究院卒中量表（NIHSS）是否改善或肌力是否改善进行分组。采用正向逻辑回归分析NIHSS可能改善的影响因素。结合NIHSS改善和肌力改善的影响因素，得出脑卒中后肢体运动功能恢复的影响因素。
在分析纳入患者的基线情况时发现，NIHSS改善的患者针灸干预时间更早（中位数，四分位间距：13.5（14），比值比=0.716，95%可信区间[0.591-0.869]，p=0.001），累积针灸治疗次数更多（中位数，四分位间距：29（12），比值比=0.744，95%可信区间[0.608-0.910]，p=0.004），高血压病史更少（比值比=0.256，95%可信区间[0.082-0.801]，p=0.019）。吸烟史仅在NIHSS的单因素和多因素分析中有阳性意义，对肌力无影响（比值比=0.274，95%可信区间[0.097-0.779]，p=0.015）。
针灸干预越早、累积针灸治疗次数越多，对脑卒中运动障碍患者的肢体功能越有益。既往高血压病史是脑卒中后肢体运动障碍患者肢体运动功能未改善的影响因素。吸烟史对脑卒中后肢体运动障碍患者肢体运动功能的影响有待进一步研究。
