王雪飞;赵因;王麟鹏;

• 1:首都医科大学附属北京中医医院针灸中心

摘要(Abstract)：

痉挛是脑卒中常见并发症,早期针刺夹脊穴治疗脑卒中后痉挛疗效显著,但其机制尚不明确。通过从兴奋性氨基酸与抑制性氨基酸平衡、γ-氨基丁酸受体环境、神经肽P物质以及离子通道失衡等角度探讨脑卒中后痉挛的发病机制,探寻针刺抗痉挛的可能靶点和作用途径,为脑卒中后痉挛的针刺机制研究提供理论依据,也为临床更好地确定卒中后痉挛针刺介入的时机提供科学依据。

关键词(KeyWords)： 针刺;夹脊穴;脑卒中;痉挛;机制

Abstract:

Keywords:

基金项目(Foundation): 北京市科技计划研发攻关项目(D09050703550902);; 首都医科大学基础-临床合作基金(12JL75项目代码:1000172466)

作者(Author): 王雪飞;赵因;王麟鹏;

Email:

DOI: 10.13463/j.cnki.jlzyy.2015.04.034

参考文献(References)：

• [1]WATKINS C L,LEATHLEY M J,GREGSON J M,et al.Prevalence of spasticity post stroke[J].Clinical Rehabilitation,2002,16(5):515-522.
• [2]刘铭,王海萍,余曙光.针灸治疗中风后偏瘫痉挛状态的研究进展[J].针灸临床杂志,2005,21(7):54-55.
• [3]MARRA G A.D'Aleo G,Di Bella P,bramanti P.Intrathecal baclofen therapy in patients with severe spasticity[J].Acta Neurochir Suppl,2007,97(1):173-180.
• [4]V BALAKRISHNAN M B,funetion of chloride transporters during development of inhibitory neurotransmission in the auditory brainstem[J].J neurosei,2003,23:4134-4145.
• [5]IVANHOE C B,REISTETTER T A.Spasticity:the misunderstood part of the upper motor neuron syndrome[J].American Journal of Physical Medicine&Rehabilitation/Association of Academic Physiatrists,2004,83(10 suppl):S3-S9.
• [6]岳增辉,袁建菱,姜京明.经筋论治脑卒中后痉挛状态及对脑脊液Glu、GABA的影响[J].中国针灸,2004,6(8):50-52.
• [7]杨进廉,宋军,杨金蓉.不同针刺部位对痉挛大鼠模型脑及脊髓内神经递质含量的影响[J].针灸临床杂志,2008,24(2):37-39.
• [8]刘伍立,赵艳玲,章威,等.针刺阳陵泉缓解痉挛状态及对脑脊液γ-氨基丁酸的影响[J],中国针灸,1998,18(9):5-6.
• [9]金荣疆,朱天民,罗荣,等.电针对实验性脑梗死大鼠脑干、脊髓组织GABAB受体影响的研究[J].中国老年学杂志,2008,28(16):1573-1575.
• [10]KAKINOHANA O,HEFFERAN M P,NAKAMURA S,et al.Development of GABA-sensitive spasticity and rigidity in rats after transient spinal cord ischemia:a qualitative and quantitative electrophysiological and histopathological study[J].Neuroscience,2006,141(3):1569-1583.
• [11]GILBERT S L,ZHANG LI,MICHELE L F,et al.Robert L wollmann&bruce T Lahn.Trak1 mutation disrupts GABAA receptor homeostasis in hypertonic mice[J].Nature Genetics,2006,38(2):245-251.
• [12]WEBBER E,LIAN LI,LIH-SHEN CHIN.Hypertonia-Associated protein Trak1 is a novel regulator of Endosome-to-Lysosome trafficking[J].Mol.Biol Taricco M,Adone R,Pagliacci C,Telaro E.Pharmacological interventions for spasticity following spinal cord injury.Cochrane Database Syst Rev,2000,382(2):638-651.
• [13]DONG HONGWEI,WANG LIHUA,ZHANG MIN,et al.Decreased dynorphin A(1-17)in the spinal cord of spastic rats after the compressive injury[J].Brain Research Bulletin,2005,67(3):189-195.
• [14]韩济生.神经科学原理[M].北京:北京医科大学出版社,1999:615-636.
• [15]VAUGHAN C W,INGRAM S L,CONNOR M,et al.How opioids inhibit GABA-mediated neurotransmission[J].Nature,1997,390(6660):611-614.
• [16]董元祥,李云庆.大鼠导水管周围灰质内GABA能神经元与甲硫氨酸-脑啡肽、亮氨酸-脑啡肽、β-内啡肽和强啡肽阳性终末的联系[J].第四军医大学学报,2001,22(20):1825-1827.
• [17]王春琛,杨春艳,王麟鹏,等.早期针刺夹脊穴对MCAO大鼠脊髓β-内啡肽和强啡肽水平的影响[J].中国中医急症,2012,21(2):213,222.
• [18]GOLANOV E V,REIS D J.Neuroprotective electrical stimulation of cerebellar fastigial nucleus attenuates expression of periinfarction depolarizing waves(PIDs)and inhibits cortical spreading depression[J].Brain Research,1999,818(2):304-315.
• [19]LOPAEHIN R M,L C,Gaughan,et al.Effeets of ion Channel bloekade on the distribution of Na,K,Ca and other elements in oxygen-glucose derived CA1 hippocampal neurons[J].Neuroscience,2001,103(4):971-83.
• [20]BOULENGUEZ P,LIABEUF S,BOS R,et al.Down-regulation of the potassium-chloride cotransporter KCC2 contributes to spasticity after spinal cord injury[J].Nature Medicine,2010,16(3):302-307.
• [21]VIEMARI J C,BOS R,BOULENGUEZ P,et al.Chapter 1--importance of chloride homeostasis in the operation of rhythmic motor networks[J].Progress in Brain Research,2011,188(10):34.
• [22]VINAY L,JEAN-XAVIER C.Plasticity of spinal cord locomotor networks and contribution of cation-chloride cotransporters[J].Brain Research Reviews,2008,57(1):103-110.
• [23]ARMSTEAD W E,the role of endothelin antagonists in the management of posttraumatic vasospasm[J].Curr pharm Des,2004,10(18):2185-2192.
• [24]Sipila ST,Schuchmann S,Voipio J,Yamada J,Kaila K.The cation-chloride cotransporter NKCC1 promotes sharp waves in the neonatal rat hippocampus.J Physiol,2006,573(Pt3):765-773.
• [25]CHEN Hai,LUO Jing,KINTNER D B,et al.Na(+)-dependent chloride transporter(NKCC1)-null mice exhibit less gray and white matter damage after focal cerebral ischemia[J].Journal of Cerebral Blood Flow and Metabolism:Official Journal of the International Society of Cerebral Blood Flow and Metabolism,2005,25(1):54-66.
• [26]HUBNER C A,VStein,HERMANS-BORGMEYER 1,et al.Disruption of KCC2 reveals an essential role of K-CI cotransport already in early synaptic inhibition[J].Neuron,2001,30:515-524.
• [27]PALMA E,AMICI M,SOBRERO F,et al.Anomalous levels of Cl-transporters in the hippocampal subiculum from temporal lobe epilepsy patients make GABA excitatory[J].Proceedings of the National Academy of Sciences of the United States of America,2006,103(22):8465-8468.
• [28]祁营洲,傅立新,熊俊,等.针刺治疗中风后痉挛性瘫痪的系统评价[J].中国针灸,2009,29(8):683-688.
• [29]程金莲,王麟鹏,王少松,等.逆针灸治疗对脑卒中偏瘫痉挛状态117例随机对照观察[J].北京中医,2007,26(8):467-469.
• [30]吴萌萌,管莉萍,王麟鹏.卒中后痉挛模型的初步构建及针刺的干预作用[J].北京中医药,2010,29(3):231-233.