中国神经再生研究(英文版)

中国神经再生研究(英文版) ›› 2016, Vol. 11 ›› Issue (5): 758-764.doi: 10.4103/1673-5374.182702

• 原著:脑损伤修复保护与再生 • 上一篇    下一篇

头穴捻转补法针刺急性缺血性脑卒中偏瘫即刻效应的隐性关联研究

  

  • 收稿日期:2015-12-22 出版日期:2016-05-20 发布日期:2016-05-20
  • 基金资助:

    国家科技部“十一五”支撑计划NO.2006BAI12B02；甘肃中医药大学引进人才科研启动金项目NO:2012-11

Immediate effects of scalp acupuncture with twirling reinforcing manipulation on hemiplegia following acute ischemic stroke: a hidden association study

Xiao-zheng Du1, *, Chun-ling Bao2, Gui-rong Dong2, Xu-ming Yang3, *   

  1. "1 School of Acupuncture and Manipulation, Gansu University of Chinese Medicine, Lanzhou, Gansu Province, China 2 Department of Acupuncture, Yueyang Hospital of Integrated Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China 3 School of Acupuncture and Manipulation, Shanghai University of Traditional Chinese Medicine, Shanghai, China"
  • Received:2015-12-22 Online:2016-05-20 Published:2016-05-20
  • Contact: Xiao-zheng Du, M.D. or Xu-ming Yang, lz-duxiaozheng@163.com or fslbest@126.com.
  • Supported by:

    "This work was supported by a grant from the Supporting Program of the “Eleventh Five-year Plan” for Science & Technology Research of China, Ministry of Science and Technology of China, No. 2006BAI12B02; and a grant from the Scientific Research Fund for Talent Introduction in the Gansu University of Chinese Medicine of China, No. 2012-11."

PDF

441

摘要：

为了进一步发掘出隐含于针刺手法与效应之间数据内部的诸多条件的隐性关联，为针灸临床治疗提供决策依据，我们选择具有针刺即刻效应的急性缺血性脑卒中偏瘫患者30例，纳入后用在百会穴（GV20）至太阳穴（EX-HN5）的连线上接力式刺入3针，用捻转补法行针1 min，间隔10 min 以相应手法行针1次，留针30 min，总共针刺1次，收集治疗前及治疗后即刻变化的神经功能缺损评分、简化Fugl-Meyer量表、偏瘫肢体近端和远端肌力、H反射与M波的最大波幅之比(Hmax/Mmax)、肌张力值以及治疗前急性缺血性脑卒中偏瘫患者的中医证候。通过关联算法和人工神经网络BP算法挖掘得到：头穴捻转补法对急性缺血性脑卒中不同的中医证候患者存在着疗效差异；上肢远端和下肢近端肌力变化值是决定四肢简化Fugl-Meyer评分即刻变化值的主要因素，上肢肌张力变化值与Hmax/Mmax变化值之间存在“正相关”，而下肢肌张力变化值与Hmax/Mmax变化值存在的相关性情况比较复杂，即“正、负相关情况均出现”。采用人工神经网络BP算法进一步发掘发现：当上、下肢肌张力的变化值大于零或小于零时，Hmax/Mmax变化值分别是正值或负值，说明针刺头穴对偏瘫肢体肌张力有双向调节作用。结果显示，捻转补法对急性缺血性脑卒中不同的症状及病期可产生不同的疗效，上肢和下肢近端肌力改善是患者获得运动功能的最重要因素，Hmax/Mmax变化值是反映肌张力的一个重要指标。

orcid: 0000-0002-8995-4710(Xiao-zheng Du), 0000-0002-2880-2609(Xu-ming Yang)

关键词: 神经再生, 中医药, 针刺, 捻转补法, 急性缺血性脑卒中后偏瘫, 即刻效应, 关联算法, 人工神经网络算法, 神经功能缺损评分, 简化Fugl-Meyer量表, H反射与M波的最大波幅之比Hmax/Mmax, 中医证候, 头穴

Abstract:

"Data mining has the potential to provide information for improving clinical acupuncture strategies by uncovering hidden rules between acupuncture manipulation and therapeutic effects in a data set. In this study, we performed acupuncture on 30 patients with hemiplegia due to acute ischemic stroke. All participants were pre-screened to ensure that they exhibited immediate responses to acupuncture. We used a twirling reinforcing acupuncture manipulation at the specific lines between the bilateral Baihui (GV20) and Taiyang (EX-HN5). We collected neurologic deficit score, simplified Fugl-Meyer assessment score, muscle strength of the proximal and distal hemiplegic limbs, ratio of the maximal H-reflex to the maximal M-wave (Hmax/Mmax), muscle tension at baseline and immediately after treatment, and the syndromes of traditional Chinese medicine at baseline. We then conducted data mining using an association algorithm and an artificial neural network backpropagation algorithm. We found that the twirling reinforcing manipulation had no obvious therapeutic difference in traditional Chinese medicine syndromes of “Deficiency and Excess”. The change in the muscle strength of the upper distal and lower proximal limbs was one of the main factors affecting the immediate change in Fugl-Meyer scores. Additionally, we found a positive correlation between the muscle tension change of the upper limb and Hmax/Mmax immediate change, and both positive and negative correlations existed between the muscle tension change of the lower limb and immediate Hmax/Mmax change. Additionally, when the difference value of muscle tension for the upper and lower limbs was > 0 or < 0, the difference value of Hmax/Mmax was correspondingly positive or negative, indicating the scalp acupuncture has a bidirectional effect on muscle tension in hemiplegic limbs. Therefore, acupuncture with twirling reinforcing manipulation has distinct effects on acute ischemic stroke patients with different symptoms or stages of disease. Improved muscle tension in the upper and lower limbs, reflected by the variation in the Hmax/Mmax ratio, is crucial for recovery of motor function from hemiplegia."

Key words: nerve regeneration, traditional Chinese medicine, needling, reinforcing manipulation, hemiplegia due to acute ischemic stroke, immediate effect, association algorithm, artificial neural network algorithm, neurological deficit score, simplified Fugl-Meyer assessment, Hmax/Mmax, traditional Chinese medicine syndromes, scalp acupoints, neural regeneration