张建忠 齐瑞 李昭缘 卞跃峰 周茜

摘要 针刺被广泛应用于脑卒中后偏瘫的康复治疗，基于功能性磁共振成像（fMRI）技术的研究观察到针刺阳陵泉、外关、足三里等脑卒中康复常用穴后，出现运动皮质重塑、脑区连接改变和神经网络变化等，提示针刺能够通过调节脑皮质活性，促进脑功能重组，影响患者运动功能的恢复。针刺调节脑皮质功能活性受到多种因素影响，患者病灶部位、健侧和患侧的选取以及不同取穴方案均能引起神经影像上的差异。众多研究结果在体现针刺辨证论治的个性化疗法特点的同时，也提示了基于“神经调控”开展针刺治疗的难度。

关键词 脑卒中;偏瘫;针刺;功能性磁共振成像;神经重塑;机制;康复;综述

Research on the Mechanism of Functional Magnetic Resonance on Acupuncture for Hemiplegia after Stroke

ZHANG Jianzhong1，2，QI Rui1，2，LI Zhaoyuan1，2，BIAN Yuefeng1，2，ZHOU Qian1，3

（1 Shanghai University of Traditional Chinese Medicine，Shanghai 201203，China; 2 Yueyang Integrated traditional Chinese and Western Medicine Hospital，Shanghai 200437，China; 3 Longhua Hospital，Shanghai 200030，China）

Abstract Acupuncture is widely used in stroke rehabilitation.Based on the study of functional magnetic resonance imaging（fMRI），we observed that motor cortex remodeling and changes of brain area connectivity and neural networks are observed after stimulating at Yanglingquan（GB34），Waiguan（SJ5），Zusanli（ST36） and other acupoints commonly used for stroke rehabilitation.These researches suggest that acupuncture can participate in the reorganization of brain function by regulating the activity of cerebral cortex and affect the effects of stroke rehabilitation.Acupuncture regulating the functional activity of cerebral cortex could be affected by many factors.The location of focus，the selection of healthy side and the selection of affected side and different acupoint selections can cause differences in neuroimaging.The results of many studies not only reflect the characteristics of personalized acupuncture treatment based on syndrome differentiation，but also indicate the difficulty of applying acupuncture by neural regulations.

Keywords Stroke; Hemiplegia; Acupuncture; fMRI; Neural plasticity; Mechanism; Rehabilitation; Review

中图分类号：R247.9文献标识码：Adoi：10.3969/j.issn.1673-7202.2022.08.022

腦卒中，中医称之为中风，是威胁人类健康的主要疾病之一，具有高发病率、死亡率、复发率和致残率的特点[1]。偏瘫是脑卒中后常见的功能障碍，给患者家庭和社会带来了沉重负担。遵循现代康复“回归家庭，回归社会”的原则，患者在接受运动疗法、物理疗法等康复治疗后，运动功能得到改善。中医针刺疗法在中医辨证论治原则的指导下，在脑卒中后偏瘫患者的康复治疗广泛应用[2]。近年来，随着神经影像研究不断增加，包括针刺在内的康复疗法对脑卒中后患者神经环路的影响不断被揭示，运用功能性磁共振成像（Functional Magnetic Resonance Imaging，fMRI）观察针刺对脑卒中后偏瘫患者皮质的影响研究不断丰富。本研究通过检索PubMed文献库，收集和整理脑卒中患者在针刺后运动皮质激活的相关研究文献并进行总结，为今后以调控脑皮质兴奋性为途径，结合脑功能重塑探索“神经调控”针刺方案，改善脑卒中患者运动功能障碍提供新思路。……