针刺防治脑卒中后常见神经系统并发症的临床研究进展

Clinical Research Progress on Acupuncture for the Prevention and Treatment of Common Neurological Complications after Stroke

摘要: 缺血性脑卒中发病率、致残率居高不下，多数患者经急性期溶栓、取栓等急救治疗后，仍遗留运动、睡眠、情志等多类型神经系统并发症。肢体偏瘫痉挛、失眠、卒中后抑郁常常合并出现，相互影响，形成恶性循环，严重降低患者日常生活能力，也增大卒中复发风险。西医多采用解痉、镇静、抗抑郁药物联合康复、重复经颅磁刺激开展对症干预，但长期用药易出现肝肾负担、药物依赖、停药反弹等问题，单一治疗手段较难实现躯体与情志同步改善。针刺凭借安全微创、多靶点整体调节的优势，已被纳入中风中医康复指南。本文从病理机制、临床针刺方案及作用通路展开综述，梳理醒脑开窍、头针、通督调神等针法应用现状，总结针刺修复神经、调控炎症与脑肠轴的相关研究，为缺血性脑卒中后遗症的针灸规范化临床诊疗提供理论参考。

Abstract: Ischemic stroke has high morbidity and disability rate. Most patients still suffer from various neurological complications including motor, sleep and emotional disorders after emergency treatments such as thrombolysis and thrombectomy in acute phase. Hemiplegia spasm, poststroke insomnia and poststroke depression often co-occur and interact with each other, forming a vicious circle, which seriously impairs patients’ activities of daily living and increases the risk of stroke recurrence. Western medicine mainly adopts antispasmodic, sedative and antidepressant drugs combined with rehabilitation and repetitive transcranial magnetic stimulation for symptomatic treatment. Nevertheless, long-term medication may bring liver kidney burden, drug dependence and drug withdrawal rebound, and single therapy hardly achieves simultaneous improvement of physical and mental conditions. As a minimally invasive and multitarget therapy, acupuncture has been included in the traditional Chinese medicine rehabilitation guidelines for stroke. This review summarizes pathological mechanisms, clinical acupuncture regimens and corresponding action pathways, sorts out the application of Xingnao Kaiqiao acupuncture, scalp acupuncture, Tongdu Tiaoshen acupuncture and other therapies, and concludes relevant studies on acupuncture mediated nerve repair, inflammation regulation and brain-gut axis modulation, so as to provide theoretical reference for standardized acupuncture diagnosis and treatment of ischemic stroke sequelae.