开窍定志方与头针联合视觉观察训练对脑卒中后单侧空间忽略的康复效果研究

赵文化; 卢俊英; 赵怀消; 刘银芳; 张晓曼

doi:10.16766/j.cnki.issn.1674-4152.002698

开窍定志方与头针联合视觉观察训练对脑卒中后单侧空间忽略的康复效果研究

doi: 10.16766/j.cnki.issn.1674-4152.002698

1.
河南五建建设集团职工医院内科，河南郑州 450000
2.
郑州市第一人民医院神经内科，河南郑州 450000

基金项目:

河南省医学科技攻关项目 2018020725

详细信息

通讯作者:
赵文化, E-mail: zwhh515@163.com

中图分类号: R743.3R493
计量
- 文章访问数: 114
- HTML全文浏览量: 69
- PDF下载量: 2
- 被引次数: 0
出版历程
- 收稿日期: 2022-03-21
- 网络出版日期: 2022-11-30

Study on the rehabilitation effect of Kaiqiao Dingzhi Prescription and head acupuncture combined with visual observation training on unilateral spatial neglect after stroke

1.
Internal Medicine Department, Staff Hospital of Henan Wujian Construction Group, Zhengzhou, Henan 450000, China

摘要

摘要: 目的观察开窍定志方、头针联合视觉观察训练对脑卒中后单侧空间忽略患者的康复干预效果。方法将河南五建建设集团职工医院2019年1月—2020年6月收治的94例脑卒中单侧空间忽略患者按照随机数字表法分为治疗组(47例)和对照组(47例)。对照组在常规康复训练的基础上给予视觉观察训练，观察组在对照组基础上给予开窍定志方、头针。对比2组各项指标。结果与对照组相比，观察组患者治疗后的直线二等分试验、画钟试验、临摹画图试验、数字删除试验评分均有所降低(均P＜0.05)；运动功能评分量表(FMA)、日常生活能力(ADL)量表、脑卒中专用生活质量量表(SS-QOL)评分均显著升高(均P＜0.05)；治疗2周、4周后，观察组的凯瑟琳-伯哥量表(CBS)评分均显著低于对照组[(16.17±2.32)分vs. (18.24±3.27)分、(12.58±1.83)分vs. (16.06±2.10)分，均P＜0.05]，简易智能状态量表(MMSE)评分均显著高于对照组[(24.16±3.25)分vs. (22.30±3.20)分、(26.51±2.78)分vs. (25.10±1.69)分，均P＜0.05]；观察组治疗后血清中颅脑损伤相关因子S100β蛋白(S100β)、巨噬细胞炎性蛋白1α(MIP-1α)、神经元特异性烯醇化酶(NSE)水平及血小板聚集率、纤维蛋白原、全血高切黏度、全血低切黏度均低于对照组(均P＜0.05)。结论开窍定志方、头针联合视觉观察训练利于控制脑卒中后单侧空间忽略患者的病情，可能与抑制S100β、MIP-1α、NSE等表达、改善血液流变以促进脑功能恢复、提高脑局部血液灌注有关。
- 开窍定志方 /
- 头针 /
- 视觉观察训练 /
- 脑卒中后单侧空间忽略 /
- 临床研究
Abstract: Objective To observe the effect of rehabilitation intervention using Kaiqiao Dingzhi Prescription and head acupuncture combined with visual observation training on patients with unilateral spatial neglect after stroke. Methods A total of 94 patients suffering from stroke and unilateral spatial neglect and admitted to the Staff Hospital of Henan Wujian Construction Group from January 2019 to June 2020 were divided into treatment group (47 cases) and control group (47 cases) by the random-number table method. The patients in the control group underwent visual observation training on the basis of routine rehabilitation training, whereas the patients in the observation group received a combination of Kaiqiao Dingzhi Prescription and head acupuncture. The indicators of the two groups were compared. Results Compared with the control group, the scores of linear bisection test, bell drawing test, copy drawing test and number deletion test in the observation group all decreased after treatment (all P < 0.05). The Fugl-Meyer motor function assessment (FMA), activities of daily living (ADL) and stroke specific quality of life scale (SS-QOL) scores of the observation group significantly increased (all P < 0.05). After 2 and 4 weeks of treatment, the Catherine Bergego scale (CBS) score of the observation group was significantly lower than that of the control group [(16.17±2.32) points vs. (18.24±3.27) points, (12.58±1.83) points vs. (16.06±2.10) points, all P < 0.05]. The mini-mental state examination (MMSE) score of cognitive function was significantly higher than that of the control group [(24.16±3.25) points vs. (22.30±3.20) points, (26.51±2.78) points vs. (25.10±1.69) points, all P < 0.05]. After treatment, the serum S100β, macrophage inflammatory protein-1α (MIP-1α), neuron-specific enolase (NSE) levels, platelet aggregation rate, fibrinogen, whole blood high shear viscosity and whole blood low shear viscosity of the observation group were significantly lower than that of the control group (all P < 0.05). Conclusion Kaiqiao Dingzhi Prescription and head acupuncture combined with visual observation training are beneficial to control unilateral spatial neglect of patients after stroke, which may be related to the inhibited expression of S100β, MIP-1α and NSE, improving hemorheology to promote brain function recovery and improve cerebral blood perfusion.
- Kaiqiao Dingzhi Prescription /
- Head needle /
- Visual observation training /
- Unilateral spatial neglect after stroke /
- Clinical research

HTML全文

图 1 2组脑卒中单侧空间忽略患者MMSE评分比较

Figure 1. Comparison of MMSE score between two groups of patients with unilateral spatial neglect of stroke

下载: 全尺寸图片幻灯片

表 1 2组脑卒中单侧空间忽略患者基线资料比较

Table 1. Comparison of baseline data between two groups of patients with unilateral spatial neglect of stroke

组别	例数	性别(例)		年龄(x ±s，岁)	脑卒中类型(例)		病程(x ±s，d)	文化程度(例)
组别	例数	男性	女性	年龄(x ±s，岁)	脑出血	脑梗死	病程(x ±s，d)	高中以下	高中及以上
观察组	47	27	20	57.42±3.17	17	30	23.15±2.04	21	26
对照组	47	25	22	56.84±4.20	18	29	23.12±2.11	23	24
统计量		0.172^a		0.756^b	0.046^a		0.070^b	0.171^a
P值		0.678		0.452	0.830		0.944	0.679
注：^a为χ²值，^b为t值。

下载: 导出CSV

表 2 2组脑卒中单侧空间忽略患者单侧空间忽略程度评分比较(x ±s，分)

Table 2. Changes in unilateral spatial neglect degree score of patients between two groups of patients with unilateral spatial neglect of stroke (x ±s, score)

组别	例数	直线二等分试验		画钟试验		临摹画图试验		数字删除试验
组别	例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
对照组	47	2.57±0.34	1.24±0.13^a	3.11±0.19	1.03±0.20^a	2.29±0.56	1.72±0.35^a	2.62±0.14	1.75±0.06^a
观察组	47	2.60±0.27	0.76±0.08^ab	3.10±0.22	0.54±0.12^ab	2.32±0.61	0.84±0.14^ab	2.65±0.10	1.10±0.12^ab
t值		0.474	21.558	0.236	14.403	0.248	16.004	1.195	33.214
P值		0.637	＜0.001	0.814	＜0.001	0.804	＜0.001	0.643	0.643
注：与同组治疗前比较，^aP＜0.05；与对照组比较，^bP＜0.05。

下载: 导出CSV

表 3 2组脑卒中单侧空间忽略患者FMA、ADL、SS-QOL评分比较(x ±s，分)

Table 3. Comparison of FMA, ADL and SS-QOL score between two groups of patients with unilateral spatial neglect of stroke (x ±s, score)

组别	例数	FMA		ADL		SS-QOL
组别	例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
对照组	47	53.17±5.35	67.52±6.45^a	36.75±6.22	42.21±5.29^a	60.54±11.12	71.02±12.34^a
观察组	47	52.20±4.78	79.24±8.15^ab	37.04±5.78	47.56±7.70^ab	61.40±10.89	82.58±15.26^ab
t值		0.927	7.731	0.234	3.926	0.379	4.038
P值		0.356	＜0.001	0.851	＜0.001	0.706	＜0.001
注：与同组治疗前比较，^aP＜0.05；与对照组比较，^bP＜0.05。

下载: 导出CSV

表 4 2组脑卒中单侧空间忽略患者治疗前后CBS总分比较(x ±s，分)

Table 4. Comparison of the CBS total score between two groups of patients with unilateral spatial neglect of stroke before and after treatment (x ±s, score)

组别	例数	治疗前	治疗2周	治疗4周	F值	P值
对照组	47	20.34±4.58	18.24±3.27^a	16.06±2.10^ab	19.475	＜0.001
观察组	47	20.30±4.76	16.17±2.32^a	12.58±1.83^ab	13.296	＜0.001
t值		0.042	3.539	8.568
P值		0.967	0.001	＜0.001
注：与同组治疗前比较，^aP＜0.05；与同组治疗2周比较，^bP＜0.05。

下载: 导出CSV

表 5 2组脑卒中单侧空间忽略患者血清中脑损伤相关因子水平比较(x ±s)

Table 5. Comparison of serum levels of brain-injury-related factors between two groups of patients with unilateral spatial neglect after stroke (x ±s)

组别	例数	S100β(μg/L)		MIP-1α(pg/mL)		NSE(ng/L)
组别	例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
对照组	47	0.411±0.102	0.268±0.057^a	90.72±8.36	82.45±4.78^a	21.45±2.35	18.15±2.23^a
观察组	47	0.407±0.100	0.109±0.032^ab	90.66±7.98	74.27±1.96^ab	21.39±2.42	13.20±1.70^ab
t值		0.192	16.676	0.036	10.855	0.122	12.102
P值		0.848	＜0.001	0.972	＜0.001	0.903	＜0.001
注：与同组治疗前比较，^aP＜0.05；与对照组比较，^bP＜0.05。

下载: 导出CSV

表 6 2组脑卒中单侧空间忽略患者血液流变学指标比较(x ±s)

Table 6. Comparison of hemorheological indexes between two groups of patients with unilateral spatial neglect after stroke (x ±s)

组别	例数	血小板聚集率(%)		纤维蛋白原(g/L)		全血高切黏度(mPa/s)		全血低切黏度(mPa/s)
组别	例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
对照组	47	73.11±6.72	62.53±5.28^a	9.26±1.34	6.88±0.53^a	6.79±1.22	5.11±0.67^a	13.11±3.24	10.24±1.85^a
观察组	47	73.47±6.58	51.03±3.25^ab	9.19±1.26	4.08±0.19^ab	6.68±1.31	4.05±0.12^ab	13.07±3.16	7.56±0.34^ab
t值		0.262	12.716	0.261	34.094	0.421	10.676	0.061	9.678
P值		0.794	＜0.001	0.795	＜0.001	0.675	＜0.001	0.952	＜0.001
注：与同组治疗前比较，^aP＜0.05；与对照组比较，^bP＜0.05。

下载: 导出CSV

参考文献(25)

[1]	BERNADETTE C T, ANDREA W, RUUD H K, et al. Patients' experiences of unilateral spatial neglect between stroke onset and discharge from inpatient rehabilitation: A thematic analysis of qualitative interviews[J]. Disabil Rehabil, 2020, 42(11): 1578-1587. doi: 10.1080/09638288.2018.1531150
[2]	李春红, 巴小玲, 刘连生. 延伸护理对高海拔地区脑卒中单侧空间忽略症患者自理能力的影响[J]. 安徽医学, 2017, 38(8): 1074-1076. doi: 10.3969/j.issn.1000-0399.2017.08.035 LI C H, BA X L, LIU L S, et al. Effect of extended nursing on self-care ability of patients with unilateral spatial neglect after stroke in high altitude area[J]. Anhui Med J, 2017, 38(8): 1074-1076. doi: 10.3969/j.issn.1000-0399.2017.08.035
[3]	王玉, 唐巍. 脑卒中后单侧空间忽略的诊疗思路[J]. 安徽中医药大学学报, 2021, 40(1): 1-4. doi: 10.3969/j.issn.2095-7246.2021.01.001 WANG Y, TANG W. Diagnosis and treatment of unilateral spatial neglect after stroke[J]. J Anhui Univ Tradit Chin Med, 2021, 40(1): 1-4. doi: 10.3969/j.issn.2095-7246.2021.01.001
[4]	王萍, 单春雷, 王健. 单侧空间忽略的康复研究进展[J]. 中国康复理论与实践, 2020, 26(1): 59-61. doi: 10.3969/j.issn.1006-9771.2020.01.010 WANG P, SHAN C L, WANG J. Progress in rehabilitation of unilateral spatial neglect[J]. Chin J Rehabil Theory Pract, 2020, 26(1): 59-61. doi: 10.3969/j.issn.1006-9771.2020.01.010
[5]	王振垚, 张虎, 杨洋, 等. 头针结合针刺背俞穴对脑卒中后认知障碍患者临床症状及血清APP、Aβ1-42水平的影响[J]. 中国临床研究, 2019, 32(4): 552-555. doi: 10.13429/j.cnki.cjcr.2019.04.030 WANG Z Y, ZHANG HMYANG Y, et al. Influence of scalp acupuncture combined with needling at Back-shu points on clinical symptoms and serum levels of APP and Aβ1-42 in patients with post-stroke cognitive impairment[J]. Chinese Journal of Clinical Research, 2019, 32(4): 552-555. doi: 10.13429/j.cnki.cjcr.2019.04.030
[6]	李沐涵, 程海波, 李黎, 等. 中药对脑缺血和缺血/再灌注性损伤的保护作用研究[J]. 中国中医急症, 2017, 26(4): 648-651. doi: 10.3969/j.issn.1004-745X.2017.04.027 LI M H, CHENG H B, LI L, et al. Effects of traditional Chinese medicine on cerebral ischemia and ischemia/reperfusion injury[J]. Chin J Tradit Chin Med Emerg, 2017, 26(4): 648-651. doi: 10.3969/j.issn.1004-745X.2017.04.027
[7]	国家中医药管理局脑病急症协作组. 中风病诊断与疗效评定标准(试行)[J]. 北京中医药大学学报, 1996, 19(1): 55-56. doi: 10.3321/j.issn:1006-2157.1996.01.022 National Administration of Traditional Chinese Medicine Encephalopathy Emergency Cooperation Group. Standard of diagnosis and curative effect evaluation of apoplexy (trial)[J]. J Beijing Univ Tradit Chin Med, 1996, 19(1): 55-56. doi: 10.3321/j.issn:1006-2157.1996.01.022
[8]	中华医学会神经病学分会, 中华医学会神经病学分会脑血管病学组. 中国急性缺血性脑卒中诊治指南2018[J]. 中华神经科杂志, 2018, 51(9): 666-682. doi: 10.3760/cma.j.issn.1006-7876.2018.09.004 Neurology branch of Chinese medical association, the Chinese Medical Association of Neurology Branch of Cerebrovascular Epidemiology Group. Chinese guidelines for diagnosis and treatment of acute ischemic stroke 2018[J]. Chinese Journal of Neurology, 2018, 51(9): 666-682. doi: 10.3760/cma.j.issn.1006-7876.2018.09.004
[9]	中华医学会神经病学分会, 中华医学会神经病学分会脑血管病学组. 中国脑出血诊治指南(2019)[J]. 中华神经科杂志, 2019, 52(12): 994-995. doi: 10.3760/cma.j.issn.1006-7876.2019.12.003 Neurology branch of Chinese medical association, the Chinese Medical Association of Neurology Branch of Cerebrovascular Epidemiology Group. Chinese guidelines for diagnosis and treatment of acute intracerebral hemorrhage 2019[J]. Chinese Journal of Neurology, 2019, 52(12): 994-995. doi: 10.3760/cma.j.issn.1006-7876.2019.12.003
[10]	王玉龙. 神经康复学评定方法[M]. 北京: 人民卫生出版社, 2015: 402-403. WANG Y L. Evaluation methods of neurological rehabilitation[M]. Beijing: People' s Medical Publishing House, 2015: 402-403.
[11]	WILLIAMS L S, WEINBERGER M, HARRIS L E, et al. Development of a stroke-specific quality of life scale[J]. Stroke, 1999, 30(7): 1362-1369. doi: 10.1161/01.STR.30.7.1362
[12]	王伊龙, 马建国, 李军涛, 等. 脑卒中生存质量量表中译本信度和效度及敏感度的初步研究[J]. 中华老年心脑血管病杂志, 2003, 5(6): 391-394. doi: 10.3969/j.issn.1009-0126.2003.06.010 WANG Y L, MA J G, LI J T, et al. The study on reliability, validity and responsiveness of the Chinese version of stroke-specific quality of life[J]. Chinese Journal of Geriatric Heart Brain and Vessel Diseases, 2003, 5(6): 391-394. doi: 10.3969/j.issn.1009-0126.2003.06.010
[13]	AZOUVI P, OLIVIER S, DE MONTETY G, et al. Behavioral assessment of unilateral neglect: Study of the psychometric properties of the Catherine Bergego Scale[J]. Arch Phys Med Rehabil, 2003, 84(1): 51-57. doi: 10.1053/apmr.2003.50062
[14]	TSUJIMOTO K, MIZUNO K, KOBAYASHI Y, et al. Right as well as left unilateral spatial neglect influences rehabilitation outcomes and its recovery is important for determining discharge destination in subacute stroke patients[J]. Eur J Phys Rehab Med, 2020, 56(1): 5-13.
[15]	孟庆福, 陈楠, 葛瑶琪, 等. 颈部肌肉振动对脑卒中后偏侧忽略的短期疗效观察[J]. 中华全科医学, 2019, 17(12): 2016-2019. doi: 10.16766/j.cnki.issn.1674-4152.001116 MENG Q F, CHEN N, GE Y Q, et al. Effect of cervical muscle vibration on lateral neglect after stroke[J]. Chin J General Clin, 2019, 17(12): 2016-2019. doi: 10.16766/j.cnki.issn.1674-4152.001116
[16]	陈志芬, 叶俏慧, 逄锦熙, 等. 益髓醒神针联合镜像视觉反馈对脑卒中后单侧空间忽略患者康复的影响[J]. 浙江中西医结合杂志, 2020, 30(8): 642-646. doi: 10.3969/j.issn.1005-4561.2020.08.011 CHEN Z F, YE Q H, PANG J X, et al. Effects of yixinxinshen acupuncture combined with mirror visual feedback on rehabilitation of patients with unilateral spatial neglect after stroke[J]. Zhejiang J Integr Chin Western Med, 2020, 30(8): 642-646. doi: 10.3969/j.issn.1005-4561.2020.08.011
[17]	李永凯, 郭慧. 治神调髓法治疗脑卒中后单侧空间忽略临床研究[J]. 国际中医中药杂志, 2019, 41(7): 683-687. doi: 10.3760/cma.j.issn.1673-4246.2019.07.003 LI Y K, GUO H. Clinical study on the treatment of unilateral spatial neglect after stroke by treating spinal cord injury[J]. Integr J Tradit Chin Med, 2019, 41(7): 683-687. doi: 10.3760/cma.j.issn.1673-4246.2019.07.003
[18]	谭志, 李卓荣, 谭章财, 等. 头皮针刺联合镜像疗法治疗卒中后单侧忽略的临床观察[J]. 广州中医药大学学报, 2020, 37(12): 2359-2364. https://www.cnki.com.cn/Article/CJFDTOTAL-REST202012021.htm TAN Z, LI Z R, TAN Z C, et al. Clinical observation of scalp acupuncture combined with mirror therapy in the treatment of unilateral neglect after stroke[J]. J Guangzhou Univ Tradit Chin Med, 2020, 37(12): 2359-2364. https://www.cnki.com.cn/Article/CJFDTOTAL-REST202012021.htm
[19]	戈蕾, 薛茜, 王振民, 等. 头针疗法联合重复经颅磁刺激对脑卒中后单侧空间忽略康复疗效研究[J]. 辽宁中医药大学学报, 2020, 22(10): 217-220. https://www.cnki.com.cn/Article/CJFDTOTAL-LZXB202010052.htm GE L, XUE Q, WANG Z M, et al. Therapeutic effect of scalp acupuncture combined with repeated transcranial magnetic stimulation on unilateral spatial neglect after stroke[J]. J Liaoning Univ Tradit Chin Med, 2020, 22(10): 217-220. https://www.cnki.com.cn/Article/CJFDTOTAL-LZXB202010052.htm
[20]	马琳, 石树君. 补气活血中药合经皮穴位电刺激治疗脑梗死后单侧空间忽略疗效及对血液流变学指标水平的影响[J]. 现代中西医结合杂志, 2020, 29(4): 399-402. doi: 10.3969/j.issn.1008-8849.2020.04.015 MA L, SHI S J. Unilateral spatial neglect effect and its influence on hemorheology index level in the treatment of cerebral infarction with Traditional Chinese medicine for invigorating Qi and promoting blood circulation combined with electric stimulation of percutaneous acupoint[J]. J Modern Integr Chin Western Med, 2020, 29(4): 399-402. doi: 10.3969/j.issn.1008-8849.2020.04.015
[21]	冯涛, 韩兵, 叶凯华. 标准外伤大骨瓣开颅术联合亚低温对重型颅脑损伤患者术后NIHSS评分及血清S-100β MBP水平的影响[J]. 河北医学, 2018, 24(8): 1325-1328. doi: 10.3969/j.issn.1006-6233.2018.08.025 FENG T, HAN B, YE K H. Effects of standard large trauma craniotomy combined with mild hypothermia on postoperative NIHSS score and serum S-00β and MBP levels in patients after operation with severe craniocerebral injury[J]. Hebei Medicine, 2018, 24(8): 1325-1328. doi: 10.3969/j.issn.1006-6233.2018.08.025
[22]	李宝, 王志军, 邢笑源, 等. 创伤性颅脑损伤患者外周血sTREM-1、MIP-1α水平及与预后的关系[J]. 疑难病杂志, 2019, 18(12): 1221-1224, 1230. doi: 10.3969/j.issn.1671-6450.2019.12.008 LI B, WANG Z J, XING X Y, et al. Relationship between strem-1, MIP-1α and prognosis in peripheral blood of patients with traumatic craniocerebral injury[J]. Chin J Intrac Dis, 2019, 18(12): 1221-1224, 1230. doi: 10.3969/j.issn.1671-6450.2019.12.008
[23]	刘姚, 王建林, 罗丽华, 等. 石菖蒲对颅脑损伤模型大鼠认知功能障碍、血清炎症因子及S100β、NSE蛋白水平的影响[J]. 中医学报, 2020, 35(2): 334-337. https://www.cnki.com.cn/Article/CJFDTOTAL-HNZK202002027.htm LIU Y, WANG J L, LUO L H, et al. Effects of Acorus tatoris on cognitive dysfunction, serum inflammatory factors, S100 β and NSE protein levels in brain injury model rats[J]. J Tradit Chin Med, 2020, 35(2): 334-337. https://www.cnki.com.cn/Article/CJFDTOTAL-HNZK202002027.htm
[24]	李丽丽, 焦富英. 鬼针草总黄酮通过ERK1/2/NF-κB通路减轻局灶性脑缺血大鼠认知功能障碍[J]. 天津医药, 2019, 47(10): 1040-1045. doi: 10.11958/20190667 LI L L, JIAO F Y. Effects of ERK1/2/NF-κB pathway on cognitive dysfunction in focal cerebral ischemia rats[J]. Tianjin Pharm, 2019, 47(10): 1040-1045. doi: 10.11958/20190667
[25]	王天磊, 刘建浩, 郑杨杨, 等. 加味补阳还五汤联合头针对气虚血瘀证脑卒中后单侧空间忽略的疗效观察[J]. 中国实验方剂学杂志, 2018, 24(13): 196-201. https://www.cnki.com.cn/Article/CJFDTOTAL-ZSFX201813032.htm WANG T L, LIU J H, ZHENG Y Y, et al. Effect of Modified Buyang Huwu Decoction combined with Tou on unilateral spatial neglect after stroke with Qi Deficiency and blood stasis syndrome[J]. Chin J Exp formulae, 2018, 24(13): 196-201. https://www.cnki.com.cn/Article/CJFDTOTAL-ZSFX201813032.htm