针刺治疗脑卒中亚急性期运动障碍:多中心随机对照研究  

Motor dysfunction in stroke of subacute stage treated with acupuncture:multi-central randomized controlled study

作　　者：陈利芳[1] 方剑乔[2] 吴媛媛[2] 马睿杰[1] 徐守宇[1] 沈来华[3] 罗开涛[3] 高峰[3] 包烨华[4] 倪克锋[4] 李丽萍[4] 

机构地区：[1]浙江中医药大学附属第三医院针灸科,杭州310005 [2]浙江中医药大学,杭州310053 [3]嘉兴市中医院 [4]杭州市中医院

出　　处：《中国针灸》2014年第4期313-318,共6页Chinese Acupuncture & Moxibustion

基　　金：浙江省中医药防治重大疾病攻关计划项目:2011ZGG 003;国家中医药管理局重点学科(针灸学)建设经费资助项目:国中医药发[2009]30号

摘　　要：目的:验证针刺治疗缺血性脑卒中亚急性期运动功能障碍的临床疗效。方法:采用多中心随机对照试验,将126例缺血性脑卒中亚急性期患者随机分为针刺组(61例)和常规治疗组(65例),常规治疗组接受西医内科基础治疗和康复训练,针刺组在常规治疗组基础上加用针刺治疗,取穴以上肢伸肌和下肢屈肌上的体穴为主,结合头针顶中线、病灶侧顶颞前斜线和顶颞后斜线。针灸治疗每周5次,共治疗8周。于治疗前、治疗4周后、治疗8周后、治疗结束3个月后随访比较两组运动功能(Fugl-Meyer量表)、美国国立卫生研究院卒中量表(NIHSS量表)、Barthel指数(日常生活能力评定)评分变化情况。结果:治疗4周后、8周后以及随访时,两组患者FuglMeyer量表评分均明显提高(均P<0.01),针刺组在治疗8周后和随访时Fugl-Meyer较常规治疗组提高更明显[68.0(43.0,86.5)vs 52.5(30.3,77.0),77.0(49.5,89.0)vs 63.0(33.0,84.0),均P<0.05];除治疗4周后常规治疗组NIHSS量表评分无明显降低外(P>0.05),两组患者各时间点NIHSS量表评分均较治疗前明显降低(均P<0.01),针刺组治疗8周后、随访时较常规治疗组降低更明显[5.0(3.0,8.0)vs 7.0(3.0,13.8),4.0(1.5,7.0)vs 6.0(2.0,11.7),均P<0.05];两组患者治疗8周后和随访时Barthel指数均较治疗前明显提高(均P<0.05),针刺组随访时较常规治疗组提高更显著[75.0(60.0,87.5)vs 65.0(36.3,87.5),P<0.05]。结论:针刺治疗缺血性脑卒中亚急性期运动功能障碍具有较好的临床疗效。Objective To verify the clinical efficacy of acupuncture on motor dysfunction in ischemic stroke of subacute stage. Methods The multi-central randomized controlled trial was adopted. One hundred and twenty-six cases of ischemic stroke of subacute stage were randomized into an acupuncture group （61 cases） and a conventional treatment group （65 cases）. The basic treatment of western internal medicine and rehabilitation train- ing were applied to the patients of the two groups. In the acupuncture group, acupuncture was supplemented at the body points located on the extensor of the upper limbs and the flexor of the lower limbs. In combination, scalp ac- upuncture was applied to NS5, MS6 and MS6 on the affected side. The treatment was given 5 times a week and to- tally 8 weeks were required. The follow-up observation lasted for 3 months. The scores in Fugl-Meyer scale and NIHSS scale and Barthel index were compared between the two groups before treatment, in 4 and 8 weeks of treatment and the 3-month follow-up observation after treatment separately. Results In 4 and 8 weeks of treatment and the follow- up observation, Fugl-Meyer scale score was improved obviously in the patients of the two groups （all P〈0.01）.In 8 weeks of treatment and the follow-up observation, Fugl-Meyer scale score in the acupuncture groupwas im- proved much apparently as compared with that in the conventional treatment group F68.0 （43.0,86.5） vs 52.5 （30.3, 77.0）, 77.0 （49.5, 89.0） vs 63.0 （33.0, 84.0）, both P〈0. 051. Except that NIHSS scale score was not reduced apparently in 4 weeks of treatment in the conventional treatment group （P^0.05）, the results of NIHSS seale at the other time points were all decreased obviously as compared with those before treatment in the patients of the two groups （all P〈0.01）. In 8 weeks of treatment and the follow-up observation, the results in the acu- puncture group were reduced much apparently as compared with those in the conventional treatment group [5.0 （3.0,8.0）

关 键 词：脑卒中 运动障碍 针刺疗法 随机对照试验 

分 类 号：R246.6[医药卫生—针灸推拿学]