老年脑梗死患者早期中医康复介入治疗的临床疗效及机制探讨

Clinical Efficacy and Mechanism Exploration of Early Traditional Chinese Medicine Rehabilitation Interventional Therapy in Elderly Patients with Cerebral Infarction

摘要: 目的：探讨早期中医康复介入治疗(针灸 + 中药 + 推拿 + 传统功法训练)在老年脑梗死患者神经功能、运动功能、中医证候评分及生活质量改善中的临床价值，为优化“时间窗–技术组合–个体化”治疗方案提供依据，并分析其潜在机制。方法：本研究是一项病例对照研究，回顾性地收集2023年1月~2023年12月在我院神经内科住院治疗的急性脑梗死患者相关资料，作为对照组：常规西医治疗 + 基础康复训练(物理治疗(关节活动度训练、步态训练)、作业治疗(ADL训练)，每日1次，每次30分钟，每周5天)；将2024年1月~2024年12月在我院神经内科住院治疗的急性脑梗死患者相关资料，作为观察组：常规西医治疗 + 早期中医康复介入(针灸 + 中药 + 推拿 + 传统功法训练)。采用SPSS 26.0软件统计分析，时间点：基线(T0)、干预1周(T1)、1个月(T2)。组间计量资料组间比较采用独立样本t检验，计数资料比较采用χ²检验，不同康复治疗方案的脑梗死患者各时间节点其NIHSS评分、生活自理能力评估量表Barthel评分、中医证候评分比较采用重复测量方差分析，以P < 0.05为差异具有统计学意义。结果：本研究共纳入80例老年脑梗死患者，对照组与观察组各40例，结果显示，老年脑梗死患者在早期中医康复介入治疗1周、1月后，其生活自理能力评估量表Barthel评分较治疗前(基线)提高，高于基础康复训练治疗对应时间节点得分；老年脑梗死患者在早期中医康复介入治疗1周、1月后，其NIHSS评分、中医证候评分较治疗前(基线)降低，低于基础康复训练治疗对应时间节点得分，差异具有统计学意义(P < 0.05)，两组患者在1个月内卒中复发率、不良反应统计上无差异。结论：本研究根据脑梗死的不同阶段(超早期、急性期、恢复期)动态调整方案，通过整合中药、针灸、推拿及传统功法(如八段锦)，形成多模态的早期中医康复介入治疗体系，其通过多靶点调控炎症、改善血流动力学、促进神经重塑，可降低老年脑梗死患者的NIHSS评分、中医证候评分，提高ADL评分，为老年脑梗死患者提供了一种安全有效的综合治疗方案。

Abstract: Objective: To explore the clinical value of early TCM rehabilitation interventional therapy (acupuncture + Chinese medicine + massage + traditional exercise training) in the improvement of neurological function, motor function, TCM syndrome score and quality of life in elderly patients with cerebral infarction, to provide a basis for optimizing the treatment plan of “time window-technology combination-individuation”, and to analyze its potential mechanism. Methods: This study was a case-control study. Data of patients with acute cerebral infarction who were hospitalized in the Department of Neurology of our hospital from January 2023 to December 2023 were retrospectively collected as control group: Conventional Western medicine treatment + basic rehabilitation training (physical therapy (joint motion training, gait training), occupational therapy (ADL training), once a day, 30 minutes each time, 5 days a week); The relevant data of patients with acute cerebral infarction hospitalized in the Department of Neurology of our hospital from January 2024 to December 2024 were selected as the observation group: conventional Western medicine treatment + early TCM rehabilitation intervention (acupuncture + traditional Chinese medicine + massage + traditional exercise training). SPSS 26.0 software was used for statistical analysis. Time points were baseline (T0), intervention for 1 week (T1), and intervention for 1 month (T2). Independent sample t test was used for inter-group comparison of measurement data, and χ² test was used for comparison of counting data. The NIHSS score, self-care ability assessment scale Barthel score and TCM syndrome score of cerebral infarction patients with different rehabilitation treatment plans at each time node were compared by repeated measure ANOVA, with P < 0.05 being statistically significant. Results: A total of 80 elderly patients with cerebral infarction were included in this study, including 40 in the control group and the observation group respectively. The results showed that after 1 week and 1 month of early TCM rehabilitation interventional treatment, the Barthel score of elderly patients with cerebral infarction was higher than that before treatment (baseline), and higher than that of the corresponding time node of basic rehabilitation training treatment. After 1 week and 1 month of early TCM rehabilitation intervention treatment, the NIHSS score and TCM syndrome score of elderly cerebral infarction patients were lower than before treatment (baseline), and lower than the corresponding time node score of basic rehabilitation training treatment, the difference was statistically significant (P < 0.05), and there was no statistical difference between the two groups in stroke recurrence rate and adverse reactions within 1 month. Conclusion: According to the dynamic adjustment plan of different stages of cerebral infarction (super early stage, acute stage and convalescent stage), this study formed a multi-modal early TCM rehabilitation interventional treatment system by integrating traditional Chinese medicine, acupuncture, massage and traditional exercises (such as Baduanjin). Through multi-target regulation of inflammation, improvement of hemodynamics, and promotion of nerve remodeling, it can reduce the NIHSS score and TCM syndrome score of elderly patients with cerebral infarction, and improve the ADL score, providing a safe and effective comprehensive treatment plan for elderly patients with cerebral infarction.