世界中医药

目的:探讨针刺配合康复训练对脑卒中上肢功能障碍患者神经功能特异性烯醇化酶(NSE)、硫化氢(H2S)、神经营养因子(NGF)与脑血管动力学的影响。方法：选取2016年5月至2017年10月空军军医大学唐都医院收治的脑卒中上肢功能障碍患者198例进行回顾性分析。将患者分为针刺配合康复训练治疗观察组100例，单纯依靠康复训练治疗对照组98例。比较与分析2组治疗前后的NSE、H2S、NGF与脑血管动力学等。结果：观察组治疗后NSE（12.36±6.35）μg/L，H2S（52.19±3.77）μmol/L，NGF（152.94±32.67）pg/mL。对照组治疗后NSE（16.28±7.45）μg/L，H2S（36.67±6.95）μmol/L，NGF（129.81±33.02）pg/mL。观察组治疗后颈动脉血流速度平均值（Vmean）（26.45±3.79）cm/s，血流量（Qmean）（18.52±3.32）cm3/s，外周阻力（RV）（82.37±22.39）kPa·s/m，舒张压与临界压差值(DP)（0.45±0.08）kPa.s/m，动态阻力(DR)（32.36±10.08）kPa。对照组治疗后Vmean（19.86±3.73）cm/s，Qmean（14.79±2.72）cm3/s，RV（95.31±30.45）kPa·s/m，DP（0.63±0.14）kPa·s/m，DR（42.37±9.67）kPa。观察组治疗前FMA评分为（38.41±7.52）分，治疗后FMA评分为（54.61±5.34）分，改善值（16.22±6.46）分。MBI指数治疗前为（36.75±6.87），治疗后为（60.33±12.73），改善值为（23.58±9.34）。观察组中医证候积分治疗前（16.52±0.68）和治疗后（4.60±0.22）。对照组中医证候积分治疗前（16.95±0.83）分和治疗后（8.72±0.27）分。结论：针刺配合康复训练能够有效的帮助脑卒中上肢功能障碍患者的恢复神经功能，加速脑血管血流速度，减少压强阻力，从而达到治疗患者上肢及手功能，恢复日常生活活动能力的效果。

English Summary:

To study the therapeutic effects of acupuncture combined with rehabilitation training on neurological function NSE，H2S，NGF and cerebrovascular dynamics in stroke patients with upper limb dysfunction. Methods:In this cohort study，from May 2016 to October 2017，a total of 198 stroke patients with upper limb dysfunction admitted in Tangdu Hospital，The Fourth Military Medical University were randomly divided into two groups in our hospital:100 patients who were treated with acupuncture combined with rehabilitation training were included in the study group，and 98 patients who were treated with rehabilitation training alone were included in the control group. The results of NSE，H2S，NGF，cerebrovascular dynamics and the other results were compared and analyzed before and after treatment in two groups. Results:(1) Neurological function index:in the study group after treatment，NSE was（12.36±6.35）μg/L，H2S was（52.19±3.77）μmol/L，NGF was (152.94±32.67) pg/mL. In the control group after treatment，NSE was (16.28±7.45) μg/L，H2S was (36.67±6.95) μmol/L，NGF was (129.81±33.02) pg/mL. (2) Cerebrovascular dynamics index:in the study group after treatment，Vmean was （26.45±3.79）cm/s，Qmean was（18.52±3.32）cm3/s，RV was（82.37±22.39）kPa·s/m，DP was（0.45±0.08）kPa·s/m，DR was（32.36±10.08）kPa. In the control group after treatment，Vmean was (19.86±3.73)cm/s，Qmean was（14.79±2.72）cm3/s，RV was（95.31±30.45）kPa·s/m，DP was（0.63±0.14）kPa·s/m，DR was (42.37±9.67) kPa. (3) In the study group before the treatment，FMA score was (38.41±7.52)，FMA score was (54.61±5.34) after the treatment，the improvement was (16.22±6.46). MBI index before the treatment was (36.75±6.87)，after the treatment was (60.33±12.73)，the improvement was (23.58±9.34). They were significantly better than the control group. (4) The scores of TCM symptoms in the study group was (16.52±0.68) before treatment and was (4.60±0.22) after treatment. The score of TCM symptom in the study group was (16.95±0.83) before treatment and was (8.72±0.27) after treatment. Conclusion:The acupuncture combined with rehabilitation training can effectively help the recovery of nerve function in stroke patients with upper limb dysfunction，accelerate the blood flow velocity of cerebral vessels，reduce pressure and resistance，and recover the function of upper limbs and hands. And the abilities of daily activities can be recovered.

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