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针灸治疗中风后失眠的神经机制及临床研究进展
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Abstract:
针灸治疗中风后失眠(Post-stroke Insomnia, PSI)的神经机制涉及多重病理生理过程：神经递质失衡、关键脑区功能连接异常导致情绪–认知网络失调，神经炎症反应通过NF-κB等通路加剧睡眠–觉醒失衡，下丘脑–垂体–肾上腺素轴(HPA轴)过度激活引发皮质醇分泌节律紊乱，以及默认模式网络(DMN)功能异常干扰静息期认知稳态与觉醒调控。临床研究表明，多种针灸疗法通过多靶点调节发挥显著疗效。通督调神针刺法以督脉穴位为主，总有效率超93%；电针通过调节5-羟色胺(5-HT)与自主神经功能，使匹兹堡睡眠质量指数量表(PSQI)评分显著降低；耳针联合体针可缩短觉醒时间，提升脑血流速度；头针与腕踝针分别通过皮层调控和神经内分泌调节改善睡眠结构，有效率超过90%；穴位埋线和艾灸疗法展现长效优势。这些疗法通过协同调节神经递质、抑制炎症反应、恢复脑网络功能，形成优于药物治疗的综合干预效果，为PSI治疗提供了循证依据。
The neural mechanism of acupuncture for post-stroke insomnia (PSI) involves multiple pathophysiological processes: neurotransmitter imbalance, dysfunctional connectivity of key brain regions leading to dysregulation of emotional-cognitive networks (ECCN), and neuroinflammatory responses exacerbating sleep-wake imbalance through pathways such as the NF-κB pathway, and hypothalamic-pituitary-adrenergic axis (HPA axis) over-activation triggers cortisol secretion rhythm disorders, and abnormalities in the default mode network (DMN) interfere with resting cognitive homeostasis and wakefulness regulation. Clinical studies have shown that a variety of acupuncture therapies have significant therapeutic effects through multi-target regulation. The total effective rate was over 93% for the acupuncture method, which focuses on the acupuncture points of the Duchenwu vein; electroacupuncture can significantly reduce the PSQI score by regulating 5-hydroxytryptamine (5-HT) and autonomic function; auricular acupuncture combined with body acupuncture can shorten the awakening time and increase the cerebral blood flow rate; head acupuncture and carpal and ankle acupuncture can improve the structure of sleep through cortical regulation and neuroendocrine modulation, with an effective rate of over 90%; acupoint thread embedding and moxibustion therapy show long-term advantages. These therapies synergistically regulate neurotransmitters, inhibit inflammation, and restore brain network function, resulting in a comprehensive intervention effect that is superior to that of pharmacological treatment, providing an evidence based basis for the treatment of PSI.
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