【目的】探讨通督调神针法对卒中后癫痫 （post-stroke epilepsy，PSE） 患者的脑血流动力学及氧自由基的效应。 【方法】将 60例PSE患者随机分为治疗组和对照组，每组各30例。2组患者均给予降脂、控压、控糖、抗血小板等基础治疗，对照组同 时给予丙戊酸钠缓释片治疗，治疗组在对照组的基础上给予通督调神针法 （以百会、神庭、水沟、风府、风池等为主穴） 治 疗，1个月为1个疗程，共治疗3个疗程。观察2组患者治疗前后癫痫发作次数、脑电图严重程度和经颅多普勒 （TCD） 检测的 双侧大脑前动脉、大脑中动脉、大脑后动脉收缩期峰值流速 （Vs） 、舒张期末血流速度 （Vd） 等脑血流动力学指标以及外周血 丙二醛 （MDA） 、羟自由基 （OH） 、脂质过氧化物 （LPO） 、超氧化物歧化酶 （SOD） 等氧自由基的变化情况，并评价2组患者的临 床疗效和安全性。 【结果】（1） 疗效方面，治疗3个月后，治疗组的总有效率为93.33% （28/30） ，对照组为73.33% （23/30） ，组 间比较 （χ2 检验） ，治疗组的疗效明显优于对照组 （P＜0.05） 。 （2） 癫痫发作频次方面，治疗后，2组患者的癫痫月平均发作频次 均较治疗前减少 （P＜0.05） ，且治疗组的减少程度明显优于对照组 （P＜0.05） 。 （3） 脑电图严重程度分级方面，治疗后，2组患 者的脑电图严重程度分级情况均较治疗前明显改善 （P＜0.05） ，且治疗组的改善程度明显优于对照组 （P＜0.05） 。 （4） 氧自由基 水平方面，治疗后，2组患者的外周血MDA、OH、LPO水平均较治疗前降低 （P＜0.05） ，外周血SOD水平均较治疗前升高 （P＜0.05） ，且治疗组对外周血MDA、OH、LPO水平的降低幅度及对外周血SOD水平的升高幅度均明显优于对照组 （P＜0.05 或P＜0.01） 。 （5） 脑血流动力学指标方面，治疗后，2组患者的左右侧大脑前动脉、大脑中动脉、大脑后动脉的Vs、Vd值均 较治疗前升高 （P＜0.05） ，且治疗组的升高幅度均明显优于对照组，差异均有统计学意义 （P＜0.05） 。 （6） 安全性方面，治疗过 程中，2组患者均未出现晕针、滞针、出血及皮疹等情况，具有较高的安全性。 【结论】通督调神针法可明显减少PSE发作频 率，改善癫痫脑电图严重程度，其治疗机制可能与降低氧自由基水平、改善脑血流动力学相关。

Abstract：Objective To explore the effect of Tongdu Tiaoshen acupuncture，a needling method for dredging governor vessel and regulating mind，on cerebral hemodynamics and oxygen free radicals in the patients with post- stroke epilepsy （PSE） . Methods A total of 60 patients with PSE were randomly divided into a treatment group and a control group，with 30 cases in each group. Both groups were given basic treatment for lowering lipid level， controlling blood pressure and glucose contents，and counteracting platelet aggregation. Moreover，the control group was treated with Sodium Valproate Sustained-Release Tablets，and the treatment group was treated with Tongdu Tiaoshen acupuncture mainly on the acupoints of Baihui （GV20），Shenting （GV24），Shuigou （GV26），Fengfu （GV16） ，Fengchi （GB20） based on the treatment for the control group. One month constituted a course of treatment，and the treatment for the two groups covered three courses of treatment. The number of epileptic seizures，the severity of electroencephalogram （EEG） ，the peak systolic velocity （Vs） and end diastolic velocity （Vd） of bilateral anterior cerebral arteries，middle cerebral arteries and posterior cerebral arteries detected by transcranial Doppler ultrasonography （TCD） ，and the changes in the peripheral levels of oxygen free radicals such as malondialdehyde （MDA） ，hydroxyl radical （OH） ，lipid peroxide （LPO） and superoxide dismutase （SOD） in the two groups were observed before and after treatment. After treatment，the clinical efficacy and safety of the two groups were evaluated. Results （1） After three months of treatment，the total effective rate of the treatment group was 93.33% （28/30），and that of the control group was 73.33% （23/30） . The intergroup comparison （tested by chi-square test） showed that the efficacy of the treatment group was significantly superior to that of the control group （P＜0.05） . （2） After treatment，the average monthly epileptic seizure frequency in the two groups was decreased when compared with that before treatment （P＜0.05） ，and the decrease in the treatment group was more significant than that in the control group （P＜0.05） . （3） After treatment，the grading of EEG severity in the two groups was significantly improved when compared with that before treatment （P＜0.05） ，and the improvement in the treatment group was significantly superior to that in the control group （P＜0.05） . （4）After treatment，the peripheral levels of oxygen free radicals of MDA，OH and LPO in the two groups were lower than those before treatment （P＜0.05），and the peripheral level of SOD was higher than that before treatment （P＜0.05） . The decrease of MDA，OH and LPO levels and the increase of SOD level in the treatment group were significantly superior to those in the control group （P＜0.05 or P＜0.01） . （5）After treatment， the values of cerebral hemodynamic indicators of Vs and Vd of both left and right anterior cerebral artery，middle cerebral artery and posterior cerebral artery in the two groups were higher than those before treatment （P＜0.05） ，and the increase in the treatment group was significantly superior to that in the control group， the differences being statistically significant （P＜0.05） . （6） During the treatment，there were no fainting，sticking of needle，bleeding and rash occurring during acupuncture in the two groups，which indicated that the therapy had high safety. Conclusion Tongdu Tiaoshen acupuncture can significantly reduce the seizure frequency of PSE and improve the severity of epileptic EEG. Its therapeutic mechanism may be related with the decrease of the oxygen free radical levels and with the improvement of cerebral hemodynamics.

R246.6

广东省中医药局科研项目 （编号：20221038）