腦中風住院患者合併中醫針灸療效之評估The Study on the Assessment of Therapeutic Effect on Stroke Patients with Integrated Acupuncture and Western Medicine

摘要

針灸在台灣和中國大陸被大量的運用於治療腦中風，來達到肢體功能的進步，健保署也自2006年開辦「腦血管疾病之西醫住院病患中醫輔助醫療試辦計畫」，期待能幫助中風患者生活和神經學功能的進步，以降低後續醫療照護成本。本研究欲評估不同腦中風型態住院患者結合針灸治療在意識、肢體肌力及日常生活功能上的恢復程度的不同。本研究收案對象為台灣南部某醫學中心腦中風住院的病患，收案期從2014年1月至2017年12月，排除住院過程死亡的患者，共收案848人，其中出血型在中醫診斷為中經絡者有92.25%，中臟腑者有7.75%，而梗塞型分別是98.61%及1.39%。中醫平均會診針灸治療次數在出血型是7.83次，高於梗塞型5.66次。分別在第一次治療前與出院前最後一次治療後評估其意識程度、生活能力與四肢肌力。針灸在不同型態中風病患在治療前後效果比較以成對樣本T檢定進行分析。本研究結果顯示，腦中風住院患者在搭配針灸治療後，GCS昏迷指數顯示意識改善程度在出血型顯著高於梗塞型（P<0.0001），四肢徒手肌力測試顯示四肢肌力在出血和梗塞型相似顯著進步程度，巴氏量表顯示生活功能的變化也有相似顯著差異程度，NIHSS量表總分顯示神經學功能的變化在出血型較梗塞型顯著（P<0.0001），針刺治療前後比較皆具統計上的意義。 NIHSS並分出項目意識程度在遵從命令上、右上肢、右下肢、左上肢及左下肢的最佳運動功能上的改善是相似的。出血型和梗塞型腦中風患者住院治療結合中醫針灸治療，都可顯著改善患者的意識狀態、四肢肢體力量和日常生活能力，對於意識狀態的改善程度在出血型更是顯著。

Abstract

Acupuncture is extensively applied to stroke patients to promote limbs function in Taiwan and Mainland China. The auxiliary medical care pilot project has been implemented for several years to improve the prognosis of stroke patients during hospitalization. However, the effectiveness of this pilot project was not  well established. Hence, we conducted a retrospective study to assess the improvement of patients' functional outcomes after receiving acupuncture treatment. This retrospective study collected subjects from stroke registration database of a medical center in southern Taiwan since 1st January 2014 to 31st December 2017. We only enrolled patients with hemorrhagic stroke and ischemic stroke; all of them had received at least one acupuncture treatment. We used Glasgow coma scale (GCS), Barthel Index, manual muscle testing (MMT), and National Institute of Health Stroke Scale (NIHSS) to measure our outcomes. For statistics, all results were analyzed by conducting a paired-sample t test. Overall, we enrolled 848 patients with either hemorrhagic stroke or ischemic stroke in this study. The results show that all outcomes including Glasgow coma scale (GCS), and National Institute of Health Stroke Scale (NIHSS) point to a higher degree of significant improvement (P < 0.0001) for hemorrhage stroke than ischemic stroke after the acupuncture treatment, while Barthel Index and manual muscle testing (MMT) evidence a similar degree of improvement for both types of stroke. Based on this retrospective study, acupuncture as an adjuvant treatment either shows a higher degree of improvement in hemorrhagic stroke patients or similar outcomes in both types of stroke patients.