【摘要】 目的 分析烟雾病脑梗死术后患儿的临床特点，并观察中医辨证指导下针刺治疗方案对患儿预后的影响。方法 回顾性分析天津市儿童医院2023年7月10日收治的确诊为烟雾病脑梗死术后患儿的诊治过程，采用中医针刺疗法进行治疗，针刺处方：头面部取上星、印堂、头维、顶中线、右侧顶颞前斜线（上1/5段）、顶旁1线、右颞前线、人中、上廉泉、四白、迎香、颧髎、下关、地仓等穴，上肢取极泉、尺泽、内关（快刺不留针）、肩髃、肩髎、曲池、外关、阳溪、后溪、合谷等穴，下肢取委中、委阳（快刺不留针）、髀关、血海、梁丘、足三里、丘墟、三阴交、太冲等穴，每日行针1次，每周连续治疗5 d，治疗2周后观察患儿一般情况，采用Fugl-Meyer运动功能量表（FMA）、Barthel指数（BI）和简易上肢功能检查（STEF）量表评估左上肢运动功能；采用神经生理学技术评估左侧肢体运动神经传导情况。结果 患儿男性8岁，于2023年7月10日入院。(1)主诉：左侧肢体活动不利1个月余。(2)现病史：患儿入院前2年内清醒时出现发作异常，持续约1 min后自行缓解，事后可回忆发作过程，就诊于本院神经内科，诊断为烟雾病，对症治疗后自动出院。出院后于家中发现左侧肢体活动无力，上肢不能抬举，下肢不能行走，就诊于某医院神经外科，诊断为急性脑梗死，行颅脑血管吻合术。术后患儿左侧肢体活动不利，右侧肢体无运动障碍及感觉异常，言语表述不清，为进一步改善患儿肢体运动功能，就诊于本院康复科，初步诊断烟雾病恢复期（左侧偏瘫），根据具体病情调整针刺方案，治疗2周后，患者面纹基本对称，哭笑时嘴角无下垂。治疗4周后，患儿能独立下地行走，但步态偏瘫，左下肢肌张力基本缓解，近端肌力Ⅲ～Ⅳ级，远端肌力Ⅱ～Ⅲ级。治疗6周后，患儿偏瘫步态改善，近端肌力为Ⅳ级，远端肌力为Ⅲ～Ⅳ级，左手能持物数分钟，左手拇指屈指肌力为Ⅲ级，背伸肌力为Ⅱ级，其余四指屈指、背伸肌力为Ⅳ级。近端肌力为Ⅴ级，远端肌力为Ⅳ级。左手腕活动自如，左手指间关节能伸展和握物，左上肢运动功能基本建立，病情趋于稳定。FMA、BI和STEF评分均随治疗时间延长升高，治疗后正中神经、腓神经和胫骨神经的潜伏期和神经传导速度均趋向正常。结论 传统针刺治疗小儿烟雾病脑梗死术后康复疗效显著，可明显改善烟雾病脑梗死术后患儿康复的临床症状。更多还原

【Abstract】 Objective To analyze the clinical characteristics of children with moyamoya disease and the influence of Chinese medicine identification and acupuncture treatment plan on their prognosis. Methods A retrospective analysis was conducted on the diagnosis and treatment of children diagnosed with moyamoya disease who underwent surgery and were treated with acupuncture at Tianjin Children’s Hospital on July 10, 2023. The main acupuncture points were as follows: Points on head and face: shangxing, yintang, touwei, middle line of vertex, anterior oblique line of vertex-temporal(the upper 1/5 section), lateral line 1 of vertex, anterior temporal line, renzhong, shanglianquan, sibai, yingxiang, quanliao, xiaguan, and dicang; Points on upper extremities: jiquan, chize, neiguan(quick stabbing without leaving needles), jianyu, jianliao, quchi, waiguan, yangxi, houxi, hegu; Points on lower extremities: weizhong, weiyang(quick stabbing without leaving needles), biguan, xuehai, liangqiu, zusanli, qiuxu, sanyinjiao, and taichong), the needles were performed once a day, and continuous treatment for 5 days each week, and the general conditions of the children were observed after 2 weeks of treatment, and the Fugl-Meyer assessment(FMA), the Barthel index(BI), and the simple test for evaluating hand function(STEF) were used, to assess left upper limb motor function; neurophysiologic techniques were used to examine motor nerve conduction in the left limb. Results The child was an 8-year-old male admitted to the hospital on July 10, 2023.(1) Complaint: unfavorable movement of the left limb for more than 1 month.(2) History: the child had an abnormal seizure during waking hours 2 years before admission, which lasted for about 1 minute and then resolved on its own, and he could recall the course of the seizure afterward. Attended at the department of neurology of our hospital and diagnosed with moyamoya disease after being discharged from the hospital, the child was found at home to have weakness of the left limbs, unable to lift the upper limbs and unable to walk on the lower limbs. Attended at the department of neurosurgery of a certain hospital and was diagnosed with acute cerebral infarction and underwent cranio-cerebral vascular anastomosis. After the operation, the child’s left limb activity is unfavorable, the right limb has no motor disorder and sensory abnormality, speech expression is unclear, to further improve the motor function of the child’s limbs, the patient was referred to the rehabilitation department of our hospital, the initial diagnosis of moyamoya disease disease recovery(left hemiplegia), according to the specific conditions of the adjustment of the acupuncture program, 2 weeks after the treatment, the patient’s facial lines were basically symmetrical, crying and laughing, the corner of the mouth does not droop. After 4 weeks of treatment, the child was able to walk on the ground independently, but hemiplegic gait, left lower limb muscle tone basically relieved, proximal muscle strength grade Ⅲ-Ⅳ, distal muscle strength gradeⅡ-Ⅲ. After 6 weeks of treatment, the child’s hemiplegic gait was improved, proximal muscle strength was grade Ⅳ, distal muscle strength was grade Ⅲ-Ⅳ, the left hand could hold objects for a few minutes, left thumb flexor strength was gradeⅢ, dorsal extensor strength was gradeⅡ, and the rest of the four fingers flexor and dorsal extensor strength was grade Ⅳ. The proximal muscle strength was gradeⅤand distal muscle strength was grade Ⅳ. The left wrist could move freely, the left interphalangeal joint could extend and hold objects, and the motor function of the left upper limb was basically established, and the condition was stabilized. FMA, BI and STEF scores all increased with the prolongation of the treatment time, and the latency and nerve conduction velocity of the median nerve, peroneal nerve and tibial nerve tended to normal after treatment. Conclusion The efficacy of traditional acupuncture in treating pediatric moyamoya disease after cerebral infarction surgery rehabilitation is remarkable, which can significantly improve the clinical symptoms of children recovering from moyamoya disease.更多还原