本文關(guān)鍵詞： 皮質(zhì)下腦卒中 偏癱 功能磁共振 針刺 局部一致性　出處：《廣州中醫(yī)藥大學》2017年碩士論文　論文類型：學位論文

【摘要】：目的:利用靜息態(tài)功能磁共振(rsfMRI)觀察臨床針刺組穴對急性或亞急性期皮質(zhì)下梗死后偏癱患者腦功能的影響,探討臨床常用針刺組穴治療缺血性腦卒中后偏癱發(fā)揮作用的可能神經(jīng)機制,以期為針刺治療卒中后偏癱療效提供內(nèi)在可能理論依據(jù)。方法:本研究通過廣州中醫(yī)藥大學第二附屬醫(yī)院廣東省中醫(yī)院倫理委員會批準。(批號:Y2016-013-01)收集2014年7月至2016年12月在廣東省中醫(yī)院住院治療期間符合研究標準的左側(cè)皮質(zhì)下梗死病人共12例,隨機分為經(jīng)穴針刺治療組和非經(jīng)非穴對照組,分別進行10次針刺治療,予治療前后行靜息態(tài)功能磁共振掃描和簡化Fugl-Meyer運動功能評定量表(Simplified Fugl-meyer Motor Function Rating Scale,FMA)、改良巴氏指數(shù)評定表(Modified Barthel Index,MBI)功能評估。通過功能磁共振圖像局部一致性(Regional Homogeneity,ReHo)分析方法觀察組間腦功能變化情況;臨床數(shù)據(jù)分析運用SPSS22.0進行統(tǒng)計,結(jié)果取P0.05認為有統(tǒng)計學意義。結(jié)果:1.臨床行為學統(tǒng)計:治療組與對照組組內(nèi)治療前后對比FMA、FMA上肢、MBI評分均有統(tǒng)計學意義(P0.05);治療組和對照組組間對比FMA、MBI評分無統(tǒng)計學意義(P0.05);2.rsfMRI數(shù)據(jù)分析結(jié)果:基于ReHo分析方法顯示,治療組治療后在左側(cè)額上回內(nèi)側(cè)、左側(cè)額中回、左側(cè)額下回框部及左側(cè)額框區(qū)、左側(cè)頂下小葉、右側(cè)尾狀核ReHo值顯著升高且以患側(cè)腦激活簇增加顯著,在雙側(cè)枕中回及楔回ReHo值降低;對照組治療后在左側(cè)額下回框部及左側(cè)額下回局部腦區(qū)ReHo值升高,在左側(cè)舌回及右側(cè)小腦山坡ReHo值降低。結(jié)論:1.經(jīng)穴針刺較之非經(jīng)非穴針刺對大腦多個腦功能區(qū)有影響且在患側(cè)腦區(qū)表現(xiàn)出顯著激活,推測經(jīng)穴針刺可能是通過對額葉腦區(qū)、頂下小葉及尾狀核等多個節(jié)點的重建和調(diào)控對腦功能重組發(fā)揮作用并且患側(cè)腦區(qū)的激活可能更有利于功能障礙的康復(fù)。2.經(jīng)穴針刺和非經(jīng)非穴針刺都能夠提高患者的運動功能與日常生活能力,但由于樣本量少、觀察周期短等因素尚需要進一步觀察二者的臨床差異性。
[Abstract]:Objective: to observe the effect of acupuncture on cerebral function in patients with hemiplegia after acute or subacute subcortical infarction by resting functional magnetic resonance imaging (fMRI). To explore the possible neural mechanism of acupuncture group in the treatment of hemiplegia after ischemic stroke. Methods: this study was approved by the Ethics Committee of Guangdong Provincial Hospital of traditional Chinese Medicine, second affiliated Hospital of Guangzhou University of traditional Chinese Medicine. (. Batch number: Y2016-013-01) A total of 12 patients with subcortical infarction who met the study criteria during hospitalization in Guangdong Provincial Hospital of traditional Chinese Medicine from July 2014 to December 2016 were collected. They were randomly divided into acupoint acupuncture treatment group and non-meridian non-point control group, which were treated with acupuncture for 10 times respectively. Rest fMRI and simplified Fugl-Meyer motor function assessment scale (Fugl-Meyer) were performed before and after treatment (. Simplified Fugl-meyer Motor Function Rating Scale. Modified Barthel Index. The changes of diencephalon function in group B were observed by regional homogenicity analysis with regional consistency of functional magnetic resonance imaging (fMRI). Clinical data analysis using SPSS22.0 statistics, the results of P0.05 that there was statistical significance. Results: 1. Clinical behavior statistics: the treatment group and control group before and after treatment compared with FMA. The scores of FMA in upper limb were statistically significant (P 0.05). There was no significant difference in FMA-MBI score between the treatment group and the control group (P 0.05). 2. Results of rsfMRI data analysis: based on ReHo analysis, the treatment group showed that the left superior frontal gyrus, left middle frontal gyrus, left inferior frontal gyrus and left frontal box, left inferior parietal lobule after treatment. The ReHo value of the right caudate nucleus increased significantly and the activation cluster of the affected brain increased significantly, but the ReHo value decreased in the bilateral occipital middle gyrus and cuneate gyrus. The ReHo values of the left inferior frontal gyrus and the left inferior frontal gyrus in the control group increased after treatment. The ReHo value of left lingual gyrus and right cerebellar hillside was decreased. Conclusion: 1. Acupuncture at meridian points has effect on multiple brain functional areas compared with non-meridian point acupuncture, and shows significant activation in the affected brain area. It is speculated that acupuncture at the acupoints may be through the frontal lobe brain area. The reconstruction and regulation of several nodes, such as subparietal lobules and caudate nucleus, may play a role in the reconstitution of brain function and the activation of the affected brain area may be more beneficial to the rehabilitation of dysfunction .2.Acupuncture on the meridian and non-meridian acupuncture can both improve the function of the brain. Motor function and daily living ability of patients. However, because of the small sample size and short observation period, it is necessary to further observe the clinical difference between them.
【學位授予單位】：廣州中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R246.6

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