针刺治疗卒中后认知障碍的研究进展
Efficacy of Acupuncture in Post-Stroke Cognitive Impairment: A Research Overview
DOI: 10.12677/acm.2025.1582311, PDF,   
作者: 纪睿宇：黑龙江中医药大学研究生院，黑龙江 哈尔滨；孔 莹*：黑龙江中医药大学附属第二医院哈南分院针灸十科，黑龙江 哈尔滨
关键词: 脑卒中；认知障碍；针刺；临床研究；实验研究；机制；Stroke； Cognitive Impairment； Acupuncture； Clinical Research； Experimental Research； Mechanism
摘要: 脑卒中后认知障碍(PSCI)作为一种脑卒中并发症，易造成患者多认知域损害，严重影响了脑卒中患者的日常生活。中医认为该病发生于脑、肾等脏腑功能异常情况下，多由痰瘀等病机损伤脑络及年老肾精不足、脑髓空虚而引发。近年来针刺治疗PSCI的临床研究日益增多，通过改善血液循环、兴奋神经组织等，改善患者认知障碍症状，效果显著。针刺疗法的方法众多，为进一步梳理针刺治疗PSCI现状，本文综述PSCI发生的中医病因病机、针刺治疗PSCI的作用机制及不同针刺方法对PSCI的临床疗效进展，对针刺治疗本病作归纳总结，以期为临床治疗提供参考。
Abstract: Post-stroke cognitive impairment (PSCI), a common complication of stroke, frequently results in multi-domain cognitive deficits in patients, significantly impairing their quality of life. According to traditional Chinese medicine (TCM), PSCI arises from the dysfunction of vital organs such as the brain and kidneys. It is often triggered by pathogenic factors like phlegm and blood stasis, which damage cerebral vessels, or by the deficiency of kidney essence and brain marrow due to aging. In recent years, there has been a growing body of clinical research on acupuncture for the treatment of PSCI. By promoting blood circulation and stimulating neural tissues, acupuncture can effectively alleviate cognitive impairment symptoms in patients. Various acupuncture techniques have been developed for this purpose. To comprehensively summarize the current state of acupuncture therapy for PSCI, this article reviews the TCM etiology and pathogenesis of PSCI, the mechanisms underlying acupuncture treatment for PSCI, and the advancements in clinical efficacy of different acupuncture methods for PSCI. Additionally, it provides a synthesis of the treatment strategies for PSCI using acupuncture, aiming to offer a valuable reference for clinical practice.
文章引用：纪睿宇, 孔莹. 针刺治疗卒中后认知障碍的研究进展[J]. 临床医学进展, 2025, 15(8): 880-887. https://doi.org/10.12677/acm.2025.1582311

参考文献

[1] 汪凯, 董强, 郁金泰, 等. 卒中后认知障碍管理专家共识2021 [J]. 中国卒中杂志, 2021, 16(4): 376-389.
[2] 段佩, 杨崇阳, 王焕明. 单纯性脑出血并发认知障碍的危险因素分析[J]. 中国当代医药, 2024, 31(35): 57-61.
[3] 朱崇田, 石娜, 石学敏. 醒脑开窍针法治疗出血性中风介入时机的临床研究[J]. 上海针灸杂志, 2017, 36(11): 1277-1280.
[4] Qin, S., Zhang, Z., Zhao, Y., Liu, J., Qiu, J., Gong, Y., et al. (2022) The Impact of Acupuncture on Neuroplasticity after Ischemic Stroke: A Literature Review and Perspectives. Frontiers in Cellular Neuroscience, 16, Article 817732. [Google Scholar] [CrossRef] [PubMed]
[5] 王佳琦, 杨瑜爱, 陈健, 等. 从任督冲三脉探讨卒中后认知障碍的病机及针刺治疗思路[J]. 环球中医药, 2025(3): 565-569.
[6] 王俊. 中国卒中后认知障碍防治研究专家共识[J]. 中国卒中杂志, 2020, 15(2): 158-166.
[7] 朱才丰, 杨骏, 蔡圣朝, 等. 艾灸督脉治疗血管性轻度认知障碍的随机对照试验[J]. 辽宁中医杂志, 2019, 46(1): 132-135.
[8] Nudo, R.J. (2013) Recovery after Brain Injury: Mechanisms and Principles. Frontiers in Human Neuroscience, 7, Article 887. [Google Scholar] [CrossRef] [PubMed]
[9] 王婧吉, 吴生兵, 王堃, 等. 艾灸督脉组穴对血管性痴呆大鼠学习记忆能力和RAGE、LRP-1表达的影响[J]. 安徽中医药大学学报, 2019, 38(5): 48-52.
[10] 金铁, 丁继, 崔凯, 等. 老年脑出血患者血清lncRNA H19和miR-140-5p表达水平与认知功能障碍的相关性[J]. 心血管康复医学杂志, 2024, 33(5): 620-624.
[11] Hao, L., Zhang, A., Lv, D., Gao, M., Guo, W. and Yao, Z. (2025) Exploring the Link between Iron Dysregulation, Ferroptosis, and Cognitive Dysfunction in Intracerebral Hemorrhage Patients. Journal of Clinical Neuroscience, 135, Article 111194. [Google Scholar] [CrossRef] [PubMed]
[12] Chen, Y., Liang, J., Ouyang, F., Chen, X., Lu, T., Jiang, Z., et al. (2019) Persistence of Gut Microbiota Dysbiosis and Chronic Systemic Inflammation after Cerebral Infarction in Cynomolgus Monkeys. Frontiers in Neurology, 10, Article 661. [Google Scholar] [CrossRef] [PubMed]
[13] Schroer, A.B., Ventura, P.B., Sucharov, J., Misra, R., Chui, M.K.K., Bieri, G., et al. (2023) Platelet Factors Attenuate Inflammation and Rescue Cognition in Ageing. Nature, 620, 1071-1079. [Google Scholar] [CrossRef] [PubMed]
[14] 吕转, 陈玉龙, 王亚敏, 等. 通督醒神针刺调节肠道微生物改善缺血性脑卒中后认知障碍的临床机制研究[J]. 世界科学技术-中医药现代化, 2025, 27(2): 545-555.
[15] Yamagata, K. (2021) Astrocyte‐Induced Synapse Formation and Ischemic Stroke. Journal of Neuroscience Research, 99, 1401-1413. [Google Scholar] [CrossRef] [PubMed]
[16] Zhang, J., Gui, Y., Leng, C., et al. (2023) Electroacupuncture at “Baihui, Yintang and Shuigou” Acupoints Improves Post-Stroke Cognitive Impairment in Mice. In: Advances in Biomedical and Bioinformatics Engineering, IOS Press, 723-732.
[17] Han, Q. and Wang, F. (2023) Electroacupuncture at GB20 Improves Cognitive Ability and Synaptic Plasticity via the CaM-CaMKII-CREB Signaling Pathway Following Cerebral Ischemia-Reperfusion Injury in Rats. Acupuncture in Medicine, 42, 23-31. [Google Scholar] [CrossRef] [PubMed]
[18] Kan, B., Dong, Z., Tang, Z., Zhao, L. and Li, Z. (2023) Acupuncture Improves Synaptic Plasticity of SAMP8 Mice through the RhoA/ROCK Pathway. Current Alzheimer Research, 20, 420-430. [Google Scholar] [CrossRef] [PubMed]
[19] 黄耀忠, 曾祥富, 梁土金, 等. 脑卒中患者急性期脑血管血液动力学变化特征研究[J]. 中国医学工程, 2014, 22(8): 10-11.
[20] 沈海锋, 郭根平, 孙赟, 等. 补阳还五汤加减联合针刺、低频重复经颅磁刺激治疗脑卒中后认知障碍临床研究[J]. 新中医, 2025, 57(1): 17-21.
[21] 王利春, 刘海燕, 王志勇, 等. 针刺对拟血管性痴呆大鼠脑内NO、NOS及血液流变学影响的实验研究[J]. 针刺研究, 2005(4): 195-198.
[22] Han, B., Jiang, W., Liu, H., Wang, J., Zheng, K., Cui, P., et al. (2020) Upregulation of Neuronal PGC-1α Ameliorates Cognitive Impairment Induced by Chronic Cerebral Hypoperfusion. Theranostics, 10, 2832-2848. [Google Scholar] [CrossRef] [PubMed]
[23] Ciancarelli, I., Morone, G., Iosa, M., Cerasa, A., Calabrò, R.S., Iolascon, G., et al. (2022) Influence of Oxidative Stress and Inflammation on Nutritional Status and Neural Plasticity: New Perspectives on Post-Stroke Neurorehabilitative Outcome. Nutrients, 15, Article 108. [Google Scholar] [CrossRef] [PubMed]
[24] Abhinand, C.S., Raju, R., Soumya, S.J., Arya, P.S. and Sudhakaran, P.R. (2016) VEGF-A/VEGFR2 Signaling Network in Endothelial Cells Relevant to Angiogenesis. Journal of Cell Communication and Signaling, 10, 347-354. [Google Scholar] [CrossRef] [PubMed]
[25] 杏亚婷, 王东岩, 周以皓, 等. 针刺调控PI3K/AKT通路治疗缺血性脑卒中研究进展[J]. 针灸临床杂志, 2025, 41(4): 114-118.
[26] 王涵, 袁春星. 脑肠同调针刺法治疗急性脑梗死对患者炎症与氧化应激因子的调节作用[J]. 现代医学与健康研究电子杂志, 2025, 9(5): 114-116.
[27] 张旭龙, 王明威, 谢西梅. 石学敏醒脑开窍针法在脑卒中患者并发症中的临床应用现状[J]. 上海中医药杂志, 2020, 54(4): 106-109.
[28] 陈昊, 杜宇征, 张丽丽, 等. 石学敏院士“调神”思想治疗卒中后认知障碍[J]. 吉林中医药, 2022, 42(2): 125-128.
[29] 徐征华, 李雪艳, 李冰. 醒脑开窍针刺法治疗卒中后认知障碍的效果对心理状况的影响[J]. 中国健康心理学杂志, 2025, 33(5): 752-756.
[30] 肖伟, 余巨明. 针刺内关、百会、四神聪穴对脑卒中后认知障碍及脑网络属性的影响[J]. 现代养生, 2024, 24(19): 1472-1475.
[31] 李瑾希, 张素钊, 冯梦, 等. 头针治疗卒中后认知障碍研究进展[J]. 辽宁中医药大学学报, 2021, 23(1): 159-162.
[32] 吴建丽, 尹洪娜, 王德龙, 等. 头针疗法的起源及发展现状[J]. 广州中医药大学学报, 2019, 36(11): 1783-1787.
[33] 韩盛旺, 曹丹娜, 李晓陵, 等. 头针治疗卒中后认知障碍的多模态fMRI研究进展[J]. 中国中西医结合影像学杂志, 2024, 22(1): 41-44.
[34] 屈尧尧, 高欣. 焦氏头针疗法治疗脑卒中后认知障碍的临床观察[J]. 中国民间疗法, 2023, 31(24): 51-53.
[35] 韦冰心, 刘国成, 曾鉴源. 头针运动针刺法联合认知功能训练治疗脑卒中后认知障碍的临床观察[J]. 广州中医药大学学报, 2023, 40(2): 368-374.
[36] 吕玉兰, 王菊枚, 冯丝丝, 等. 腹针治疗中风病的临床研究进展[J]. 中医临床研究, 2022, 14(6): 9-11.
[37] 张含. 腹针联合认知训练治疗肾精亏虚型脑卒中后轻度认知障碍的临床观察[D]: [硕士学位论文]. 北京: 北京中医药大学, 2022.
[38] 吴世嫦. 腹针疗法联合认知康复训练治疗脑卒中后轻度认知功能障碍临床观察[D]: [硕士学位论文]. 南宁: 广西中医药大学, 2019.
[39] 杜以君, 王永慧, 马艳平, 等. 耳穴埋针联合针刺治疗脑卒中后认知障碍30例[J]. 江西中医药, 2020, 51(5): 57-60.
[40] 陈世宣, 徐青青, 陈珍珍, 等. 耳穴压豆经皮耳迷走神经刺激治疗卒中后认知障碍临床研究[J]. 新中医, 2024, 56(3): 171-175.
[41] 王益言, 王东岩, 李慎微, 等. 电针治疗脑卒中后认知障碍突触可塑性机制研究进展[J]. 针灸临床杂志, 2024, 40(1): 102-106.
[42] 雷晓玲, 杜艳军, 郑婵娟, 等. 电针结合重复经颅磁刺激治疗脑卒中后认知功能障碍[J]. 中医学报, 2021, 36(11): 2455-2458.
[43] Lin, R., Yu, K., Li, X., Tao, J., Lin, Y., Zhao, C., et al. (2016) Electroacupuncture Ameliorates Post-Stroke Learning and Memory through Minimizing Ultrastructural Brain Damage and Inhibiting the Expression of MMP-2 and MMP-9 in Cerebral Ischemia-Reperfusion Injured Rats. Molecular Medicine Reports, 14, 225-233. [Google Scholar] [CrossRef] [PubMed]
[44] 李佳仪, 张妍, 王琨, 等. 通腑醒神汤联合腹针加温针灸对老年脑卒中后认知障碍患者的临床疗效[J]. 中成药, 2024, 46(12): 3997-4001.
[45] 苏适. 补肾益智汤联合头皮针治疗脑卒中后认知障碍肾精亏虚证的临床研究[J]. 实用中西医结合临床, 2024, 24(17): 25-28+36.
[46] 邓新新. 祛痰开窍法联合针刺治疗轻度认知功能障碍的临床观察[D]: [硕士学位论文]. 南昌: 江西中医药大学, 2021.
[47] 唐娅妮, 崔艺敏, 何轶帆, 等. 艾灸热、光、烟作用机制研究进展[J]. 中国中医药信息杂志, 2022, 29(11): 148-151.
[48] 施凤飞, 鲍杰伟, 张衍辉, 等. 针刺联合热敏灸治疗卒中后认知障碍的临床观察[J]. 上海针灸杂志, 2025, 44(1): 64-69.
[49] 赖丽婷, 林润, 彭志华, 等. 针刺联合经颅磁刺激治疗脑卒中后认知障碍的系统评价与Meta分析[J]. 广州中医药大学学报, 2023, 40(7): 1838-1846.
[50] 苏菁菁, 范磊, 李旻瑶, 等. 醒脑开窍针刺法联合重复经颅磁刺激治疗卒中后认知障碍的疗效分析[J]. 时珍国医国药, 2024, 35(15): 3421-3423.

为你推荐