中风后失语头电针治疗的新模式

失语是脑梗死常见的并发症之一，特别是运动性失语，约占卒中后失语的67%。失语症患者因不能与人进行正常交流，对其康复、就业、社交、生存质量、心理都会造成严重影响，导致脑梗死后失语患者的并发症和死亡率明显高于无失语的脑梗死患者。近年来，头针配合言语训练治疗中风后失语取得较好疗效，但因头针的穴位定位，针刺手法及最佳治疗量化指标没有统一的临床标准。尤其是头电针疗法，临床上头部治疗区域的选择、电刺激参数各有不同、导致定位不准确、电针使用不当、治疗效果欠佳等问题，影响头电针的推广与发展。Aphasia was one of common complications of cerebral infarction, especially the motor aphasia occupying 67% of post-stroke aphasia. The recovery, employment, social contact, quality of life and mental health of patients suffering from aphasia were seriously affected due to loss of ability of normal communication, resulting in more complications and mortalities of patients from post-stroke aphasia than those from stoke without aphasia. In recent years, scalp acupuncture in combination with speech training had good efficacies on post-stroke aphasia, while there were no uniform standards on acupoint position and technique of scalp acupuncture as well as quantitative indicators for optimum treatment. Especially, there were various selections of scalp electroacupuncture therapies and treatment zones as well as different parameters of electrical stimulations, resulting in inaccurate positioning, inappropriate use of electro-acupuncture and poor efficacies, etc., which affected promotion and development of scalp electroacupuncture.

正常生理模式下，双侧大脑半球皮质各种功能处于平衡状态，这种平衡状态的维持是通过胼胝体的功能交互抑制来实现的，当一侧大脑损伤时，打破了中枢神经系统的平衡状态，两个半球之间的兴奋不对等，损伤侧半球对对侧半球的抑制减弱甚至消失，从而导致对侧半球语言功能区域兴奋性相对增加，阻碍了语言功能的恢复，甚至使失语进一步加重，诸多相关文献均支持这一观点。头针是以大脑的生理、解剖知识为理论基础，通过刺激相应的“投射区”或“穴区”而调节大脑功能。采用头针电刺激兴奋脑梗侧语言区和头针电刺激抑制非脑梗侧语言区治疗，双侧同时治疗，以期达到激活或抑制脑皮质特定功能区，从而恢复两侧大脑皮质的失衡状态，为头针治疗中风后失语的提供了新的模式。In normal physiological model, various functions of cortexes of both cerebral hemispheres kept in balance which was realized by mutual inhibition of functions of corpus callosums, i.e., when the brain was injured on one hemisphere, the balance of central nervous system was broken so that the excitabilities between two hemispheres were not equal and the suppression from the injured hemisphere to the contralateral hemisphere was weakened or even lost, resulting in relatively increase of excitability of the language function of the contralateral hemisphere, impeding recovery of language function and even further worsening aphasia. Such a standpoint was supported by many related literatures. The scalp acupuncture was based on awareness of physiology and anatomy of the brain to regulate cerebral functions by stimulating corresponding “projection areas” or “acupoint areas”. The scalp acupuncture was used with electrical stimulation to excite the language zone at the hemisphere with cerebral infarction while suppressing treatment of the language zone on the contralateral hemisphere to achieve expected activation and suppression of specific functions of cerebral cortexes, so as to re-balance cerebral cortexes of both sides, providing a new pattern for treatment of post-stroke aphasia with scalp acupuncture.

浙江省“十三五”重点专科丽水市中医院针灸科楼喜强，刘襄，刘春花，林华俭，刘鸿，凌军发表在《中国针灸》杂志的“头针调衡电刺激治疗脑梗死后运动性失语疗效观察”研究报告中，作者通过临床观察比较头针调衡电刺激与常规头针治疗脑梗死亚急性期运动性失语的临床疗效。As reported by Lou Xiqiang, Liu Xiang, Liu Chunhua, Lin Huajian, Liu Hong and Ling Jun in acupuncture department of Lishui Hospital of TCM awarded as one of priority specialities in “the 13th Five-year Plan” in Zhejiang Province, in the clinical study report in the title of “Observation of Efficacy on Post-stroke Motor Aphasia Treated with Electrical Stimulation for Balance by Scalp Acupuncture” (which was published in the Journal of Chinese Acupuncture & Moxibustion), the authors compared the clinical efficacies of electrical stimulation for balance via scalp acupuncture and conventional scalp acupuncture on motor aphasia at subacute stage of stroke by clinical observations.

研究结果表明，在头针基础上采用“调衡电刺激”对机体的虚实状态具有良性的双向调节作用，并能较为准确控制各项刺激参数，模拟补泻手法，从而改善脑循环，激活脑皮质特定功能区域，促进大脑语言功能的重建和恢复，提高针刺疗效，促进头电针的临床推广运用。The results indicated that the “electrical stimulation for balance” basing on scalp acupuncture played a good role in two-way regulation of deficiency and excess of human bodies, and could accurately control various stimulus parameters and simulate reinforcing and reducing manipulations so as to improve cerebral circulation, activate specific functional regions in cortexes, accelerate rebuilding and recovering of cerebral language function, improve efficacy of acupuncture and strengthen the promotion and use of scalp electroacupuncture in clinical practice.

研究结果发表于《中国针灸》2021年第11期。原文链接：https://zgze.cbpt.cnki.net/WKA/WebPublication/paperDigest.aspx?paperID=a6777cc2-4ad2-4e03-88c4-dd125d33c583。 The results were published on Chinese Acupuncture & Moxibustion in No. 11, 2021. The original research paper is available in https://zgze.cbpt.cnki.net/WKA/WebPublication/paperDigest.aspx?paperID=a6777cc2-4ad2-4e03-88c4-dd125d33c583.