Objective: To evaluate the clinical efficacy of acupuncture at different timings in acute stage for limb dysfunction in patients with cerebral infarction.
Methods: A total of 101 patients with cerebral infarction limb dysfunction were divided into an early exposure group (n=51) and a late exposure group (n=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 Xingnao Kaiqiao 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.
Results: Compared before treatment, the mRS grade at 30 and 60 days after onset in the early exposure group was improved (P<0.05), which was superior to the late exposure group (P<0.05); compared before treatment, the FMA grade at 30 days after onset in the early exposure group was improved (P<0.05), which was superior to the late exposure group (P<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 (P<0.05). Compared with the late exposure group, the possibility of becoming non-disabled at 30 days after onset (OR=22.882, 95%CI: 4.034-129.778), normal limb motor dysfunction (OR=22.320, 95%CI: 3.454-144.213) and non-disabled at 60 days after onset (OR=8.650, 95%CI: 2.437-30.696) in the early exposure group was increased.
Conclusion: 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.
目的：评价急性期不同时机介入针刺治疗脑梗死肢体功能障碍患者的临床疗效。方法：101例脑梗死肢体功能障碍患者根据急性期内首次接受针刺治疗的时间自然形成早暴露组（51例）和晚暴露组（50例），采用SPSS25.0软件均衡组间基线，纳入31对匹配患者，即早暴露组31例，晚暴露组31例。两组均采用“醒脑开窍”针刺法治疗，穴取水沟、内关、三阴交、极泉、尺泽、委中等，每日1次，不限定疗程。早暴露组于发病1~3 d开始介入针刺治疗；晚暴露组于发病11~14 d开始介入针刺治疗。于治疗前，发病30、60 d观察两组患者改良Rankin量表（mRS）评级；于治疗前、发病30 d观察两组患者Fugl-Meyer运动功能（FMA）分级；采用Logistic回归分析针刺介入时机对患者的影响。结果：早暴露组患者发病30、60 d mRS评级均较治疗前改善（P<0.05），且优于晚暴露组（P<0.05）；早暴露组患者发病30 d FMA分级较治疗前改善（P<0.05），且优于晚暴露组（P<0.05）。针刺时机与患者发病30 d残障状态、肢体运动功能障碍程度以及发病60 d残障状态独立相关（P<0.05）。与晚暴露组比较，早暴露组发病30 d转为非残障状态的可能性增加（OR=22.882，95%CI：4.034~129.778），肢体运动功能障碍转为正常的可能性增加（OR=22.320，95%CI：3.454~144.213），发病60 d转为非残障状态的可能性亦增加（OR=8.650，95%CI：2.437~30.696）。结论：针刺介入时机是影响脑梗死肢体功能障碍患者残障状态及肢体运动功能障碍程度的独立因素，早介入针刺疗效可能优于晚介入针刺。.
Keywords: Fugl-Meyer assessment (FMA); acupuncture; cerebral infarction; intervention timing; modified Rankin scale (mRS); prospective cohort study.