針刺治療急性出血性腦中風的療效:病歷回溯性研究

Effect of Early Acupuncture Intervention On Patient With Acute Hemorrhagic Stroke: A Retrospective Study

目的：探討針灸早期介入對於急性出血性中風的療效。方法：採回顧性研究，資料來源為基隆長庚紀念醫院病歷系統，根據是否接受針灸早期介入(於中風發病後2周內接受針灸治療)，將患者分為兩組；A組，有接受早期針灸治療者；B組，無接受針灸治療者。以Mann-Whitney U test分析有無針灸早期介入，與出血性中風病人的功能量表、殘疾量表和意識狀態的關係，最後以羅吉斯回歸模型來獲知哪些因子與中重度中風患者(NIHSS介於16~42)的神經學功能改善相關。結果：從2020年9月到2022年8月，符合分析條件為63人，A組33人，B組30人。在A組中，中風發病後開始針灸的平均時間為7.12±2.83天。在治療後有統計上顯著差異的項目: GCS(IQR A:B=(11.5-15):(7.75-14), p=0.003)、NIHSS(IQR A:B=(6-20):(9.5-25), p=0.033)和肌力(IQR A:B=(1-4):(1-3), p=0.029)。回歸分析顯示，中重度中風病患，影響NIHSS總分改善至16分以下的狀態的因子，為是否有接受針灸早期介入。結論：相較於無針灸治療，接受早期針灸治療的急性出血性中風患者，其GCS、NIHSS和肌力數值恢復較佳。而對於中重度的中風患者，有接受早期針灸治療，其NIHSS較能改善至16分以下的狀態。

BBACKGROUND: This study aims to investigate the effect of early acupuncture treatment in the acute stage of hemorrhagic stroke. METHODS: This retrospective study collected the data of patients with acute hemorrhagic stroke from the medical records system of Keelung Chang Gung Memorial Hospital. The patients were divided into two groups according to whether or not they received early acupuncture treatment (within 2 weeks of stroke onset): received early acupuncture treatment (group A); no acupuncture treatment (group B). The associations between functional scales, disability scales, and consciousness with treatment response were analyzed using the Mann-Whitney U test, and a regression model was used to determine which factors were associated with an improvement in patients with moderate to severe stroke to National Institutes of Health Stroke Scale (NIHSS) score lower than 16. RESULTS: From September 2020 to August 2022, 63 patients were eligible for this study (group A, N=33; group B, N=30). In the acupuncture group, the mean time to starting acupuncture after stroke onset was 7.12±2.83 days. After treatment, the following factors are statistically significant differences among the two groups: GCS(interquartile range, IQR A:B=(11.5-15):(7.75- 14), p=0.003)、NIHSS(IQR A:B=(6-20):(9.5-25), p=0.033) and muscle power(IQR A:B=(1-4):(1-3), p=0.029). In addition, early acupuncture intervention was associated with functional improvement to an NIHSS score lower than 16 in the patients with moderate and severe stroke (OR = 38.521). CONCLUSIONS: The acute hemorrhagic stroke patients who received early acupuncture treatment had better improvements in GCS, NIHSS, and muscle power compared to those who did not receive acupuncture treatment. For moderate to severe and severe stroke patients, receiving early acupuncture was positively associated with an improvement to NIHSS lower than 16.