针刺及电刺激治疗中风后功能障碍的研究进展

Research progress on acupuncture and electrical stimulation in the treatment of post-stroke functional impairments

摘要:

中风后功能障碍是脑卒中患者最常见的并发症，严重影响患者的生活质量和社会功能。针刺（包括手针和电针）和电刺激技术（包括功能性电刺激、经颅直流电刺激等）作为两类不同的神经调控手段，在中风后功能障碍康复中发挥着各自独特的作用。针刺主要通过经络系统调节神经功能，而电刺激则直接作用于神经肌肉系统或大脑皮质。两者在改善运动、认知、语言和吞咽功能障碍方面均显示出良好疗效。该文从临床证据和机制研究两个维度对针刺及电刺激治疗中风后功能障碍的研究进展进行总结。临床研究表明，针刺联合康复训练可显著改善运动功能，电针已被证实对认知障碍具有治疗效果；而功能性电刺激和经颅直流电刺激在运动康复中表现出剂量依赖性效应。机制研究表明，针刺通过调节神经营养因子、促进神经可塑性及改善脑血流灌注等途径发挥作用；而电刺激则主要通过调节大脑皮质兴奋性、诱导突触可塑性及直接激活运动通路等机制产生效应。当前研究仍面临挑战，需要建立标准化治疗指南并开展高质量多中心临床试验，以进一步优化治疗策略。

Abstract:

Post-stroke functional impairments are the most common complications in stroke patients, which seriously affect their quality of life and social function. Acupuncture (including manual acupuncture and electroacupuncture) and electrical stimulation techniques (including functional electrical stimulation and transcranial direct current stimulation), as two distinct neuromodulation approaches, play unique roles in post-stroke rehabilitation. Acupuncture primarily regulates neural function through the meridian system, while electrical stimulation directly acts on the neuromuscular system or cerebral cortex. Both have shown promising efficacy in improving motor, cognitive, language, and swallowing impairments. This article summarizes the current research progress on acupuncture and electrical stimulation in the treatment of post-stroke functional impairments from two dimensions: clinical evidence and mechanistic studies. Clinical studies have shown that acupuncture combined with rehabilitation training can significantly improve motor function, while electroacupuncture has been proven to have therapeutic effects on cognitive impairments; functional electrical stimulation and transcranial direct current stimulation exhibit dose-dependent effects in motor rehabilitation. Mechanistic studies suggest that acupuncture exerts its effects primarily through regulating neurotrophic factors, promoting neuroplasticity, and improving cerebral blood perfusion; whereas electrical stimulation mainly produces effects by modulating cerebral cortical excitability, inducing synaptic plasticity, and directly activating motor pathways. Current research still faces challenges, necessitating the establishment of standardized treatment guidelines and high-quality multicenter clinical trials to further optimize treatment strategies.