帕金森便秘(parkinson s constipation,PDC)是帕金森病最常见的非运动症状之一,目前其发病机制尚未完全明确,便秘的长期不愈不仅严重影响着帕金森患者的生活质量,还会引发其他疾病的发生,近年来已成为帕金森相关症状研究的热点。“脑-肠轴”作为连接胃肠系统与中枢神经系统的重要调节通路,其功能紊乱与PDC的发病密切相关。基于“脑-肠轴”通路异常,王鹏琴教授提出应以“脑肠同治”作为指导方针,通过“彭氏眼针”结合体针治疗PDC,在“调神通腑”的同时兼顾“滋肾理脾疏肝”,在临床应用中取得了良好的疗效。因此,基于中医理论和现代医学研究对“脑-肠轴”进行系统阐述,并将王鹏琴教授眼体针结合治疗PDC的经验作一总结,以期为临床治疗提供理论依据及诊疗思路。
Objective:To observe the clinical efficacy of body acupuncture combined with FANG’s scalp acupuncture in treating limb dysfunction in the remission stage of stroke and explore the mechanism.Methods:Sixty patients in the remission stage of stroke with limb dysfunction were divided into a control group and a treatment group using the random number table method,with 30 cases in each group.The control group was treated with ordinary acupuncture based on the conventional rehabilitation treatment,and the treatment group was additionally offered FANG’s scalp acupuncture.The interventions were conducted once daily with 10 sessions as 1 course.The Fugl-Meyer assessment(FMA)and Barthel index(BI)scores and serum malondialdehyde(MDA)and superoxide dismutase(SOD)levels were compared after 2 treatment courses,and the clinical efficacy was evaluated.Results:After treatment,the FMA and BI scores increased in both groups(P<0.05)and were higher in the treatment group than in the control group(P<0.05).Both groups showed a decreased MDA level and an increased SOD level after the intervention,all showing statistical significance(P<0.05);there were significant differences between the two groups(P<0.05).Conclusion:Based on the conventional rehabilitation treatment,ordinary acupuncture used alone or in combination with FANG’s scalp acupuncture can lower the oxidative stress level and improve limb function in treating limb dysfunction in the remission stage of stroke;body acupuncture plus FANG’s scalp acupuncture can produce better results.
AI XiaoHU DanLIU JingDU PanpanKANG RongCAI ChaoqunAI KunLIU Xiaoyu
目的:系统评价近10年头体针联合治疗脑卒中后肢体功能障碍的临床疗效。方法:计算机检索CNKI、WanFang Date、VIP、CBM、PubMed、Embase和Cochrane共7个中英文数据库,收集关于头体针联合治疗脑卒中后肢体功能障碍的临床随机对照试验(RCT),检索时间从2013年1月1日至2023年12月1日。采用Cochrane风险偏倚评估工具评价文献质量,运用Rev Man 5.4软件进行数据分析。结果:纳入27项研究,共2218例受试者。Meta分析结果提示,在改善神经功能缺损方面,头体针联合组明显优于单一体针组[MD=-3.07,95%CI(-4.28,-1.86),P<0.001],且优于单一康复组[MD=-3.22,95%CI(-4.18,-2.25),P<0.001]。在改善肢体运动功能方面,头体针联合组明显优于单一体针组[MD=11.15,95%CI(8.00,14.29),P<0.001],且优于单一康复组[MD=7.62,95%CI(1.07,14.17),P=0.02]。在改善日常生活能力方面,治疗组效果较对照组更显著[MD=10.68,95%CI(9.82,11.53),P<0.001]。在提高临床有效率方面,治疗组较对照组更优[OR=5.67,95%CI(4.05,7.94),P<0.001]。结论:进行头体针联合治疗可明显改善脑卒中后肢体功能障碍患者的神经功能缺损、肢体运动功能及日常生活能力,提高其临床疗效,但因纳入文献的质量一般,仍需大样本、多中心、高质量的RCT进行验证。
