針灸輔助治療對亞急性期腦中風患者之療效評估：回溯性研究

Comparison of the efficacy of acupuncture between subacute ischemic and hemorrhagic stroke patients: a retrospective observational study

背景：腦中風有很高的死亡率及致殘率，而針灸在臨床上已被廣泛應用於腦中風患者， 但關於針灸治療的最適目標族群及介入時機與效果則未有定論。
方法：本研究透過長庚醫療體系腦中風登錄資料庫，回溯收集2010、2011 年間於神經內科住院且接受針灸會診的腦中風患者，收集其登錄的腦中風量表（NIHSS）、巴氏量表及其它基本資料，比較其針灸前後神經學損傷的恢復程度及日常生活功能的改善程度，並運用子群分析及多項式線性迴歸找出最適族群及針刺時機的優勢。
結果：共65 位患者納入研究，其中梗塞組54 位、出血組11 位。針刺治療對腦中風患者住院前後之神經學損傷及日常生活自理能力有改善，尤其是梗塞型患者的日常生活功能以巴氏量表評估可進步7.3 分（p=0.003）。針對中等嚴重度的族群而言，在發病後四週內接受針刺治療於神經學損傷之進步幅度中扮演重要的角色，接受針刺者其神經學損傷之NIHSS 分數可減少4.384 分（95% 信賴區間：-8.003 ~ -0.765，p=0.019）。
結論：針刺對中等嚴重度之亞急性期腦中風患者的神經學損傷有幫助，在發病後四週內接受針刺能明顯增加NIHSS 的進步。

Background: Stroke may cause high mortality and disability rate, and acupuncture has been widely used in stroke patient in clinical practice. However, there is still no conclusion in the optimal population and the timing and effect of acupuncture intervention.
Methods: In this study, we applied a retrospective analysis with data collection from stroke patients in Stroke Registry In Chang Gung Healthcare System (SRICHS). Stroke patients who received acupuncture consultation in neurology ward of Linkou Chang Gung Memorial Hospital from Jan, 2010 to Dec, 2011 were enrolled. Clinical profiles including neurologic deficit, activities of daily living and other basic characteristics were analyzed. We compared the NIHSS and Barthel index before and after acupuncture, applied with subgroup analysis, and adjusted by regression method.
Results: Totally 65 stroke patients were enrolled with infarction in 54 and hemorrhage in 11. Acupuncture resulted in improvement of NIHSS and Barthel index. For the infarction patients received acupuncture, the improvement of Barthel index score was 7.3 (p=0.003). In stroke patients with moderate severity, acupuncture within four weeks after stroke onset could improve NIH stroke score as 4.384 (95% CI: -8.003, -0.765, p=0.019).
Conclusion: Acupuncture was effective in subacute ischemic stroke patients with moderate severity. Acupuncture intervention within four weeks after stroke onset may play an important role.