穴位注射对脑卒中下肢痉挛及运动功能的影响  

Effects of acupoint injection on lower limb spasiticity and motor function after stroke

作　　者：丁志清[1] 丁勤能[2] 许光旭[3] 谢财忠[2] 刘蓓蓓[2] 刘燕[2] 郑瑞春[2] DING Zhi-qing DING Qin-neng XIE Cai-zhong LIU Bei-bei LIU Yan ZHENG Rui-chun XU Guang-xu(Nanjing Medical University, Nanjing 210029, China Department of Rehabilitation Medicine, Nanjing General Hospital of Nanjing Military Command, Nanjing 210002, China Department of Rehabilitation Medicine, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China.)

机构地区：[1]南京医科大学,江苏省南京市210029 [2]中国人民解放军南京军区南京总医院康复医学科,江苏省南京市210002 [3]南京医科大学第一附属医院康复医学科,江苏省南京市210029

出　　处：《实用老年医学》2016年第12期1000-1003,共4页Practical Geriatrics

摘　　要：目的探讨穴位注射技术在治疗脑卒中下肢痉挛中的作用及其机制。方法 45例符合纳入标准的脑卒中患者随机分为3组,在常规神经内科治疗和康复训练基础上,3组患者分别增加普通针刺(common acupuncture,CA)、穴位注射生理盐水(acupoint injection of saline solution,AISS)、穴位注射丹参酮ⅡA(acupoint injection of tanshinoneⅡA,AIT)治疗。治疗前及治疗4周后对患者下肢运动功能(FMA)、临床痉挛指数(CSI)、改良Barthel指数(MBI)进行评估,并采用表面肌电分析仪记录膝屈曲、踝背伸最大等长收缩时的积分肌电值(i EMG)和协同收缩率(CR)。结果治疗后,3组患者的FMA、CSI、MBI及膝屈曲、踝背伸的CR较治疗前均有明显改善(P均<0.05),AISS组和AIT组的FMA、CSI及膝屈曲、踝背伸的CR较CA组有显著提高(P<0.05),AISS组和AIT组之间FMA、CSI及膝屈曲、踝背伸的CR差异无统计学意义(P>0.05),3组患者治疗后MBI评分差异无统计学意义(P>0.05)。结论穴位注射技术相较于普通针刺对治疗脑卒中后下肢痉挛有更好的疗效,其可能机制为注射药物对穴位或靶肌肉的长时间持续机械刺激作用以及存在可能的生物反馈效应。Objective To observe the therapeutic effects of acupoint injection（ AI） on lower limb spasticity after stroke by surface electromyography（ s EMG） analysis,and investigate the possible mechanism. Methods Forty-five patients with stroke were randomly divided into three groups. On the basis of neurological routine treatment and rehabilitative training,3 groups were treated with common acupuncture（ CA）,acupoint injection of saline solution（ AISS）or tanshinone ⅡA（ AIT） respectively. Before and after four weeks of training,motor function（ FMA）,clinic spasticity index（ CSI）,modified Barthel index（ MBI） of all subjects were assessed,and the integrated electromyogram（ IEMG） and cocontraction ratio（ CR） during maximum isometric voluntary contraction of the ankle dorsi-flexion and knee-flexion were detected. Results After the treatment,the levels of FMA,CSI,MBI and CR of each group were improved significantly（ P〈0. 05）. FMA,CSI and CR of the groups treated with AISS and AIT were improved significantly compared to group treated with CA（ P〈0. 05）.There was no significant difference between groups treated by AISS and AIT,in FMA,CSI and CR（ P〉0. 05）. There was no significant difference in MBI among three groups（ P〉0. 05）. Conclusions AI has better therapeutic effects than common acupuncture on lower limb spasticity after stroke. The possible mechanism may be that injecting drug has a long time mechanical stimulation on acupoint and target muscle,or has possible biological feedback effects.

关 键 词：穴位注射 痉挛 脑卒中 表面肌电 

分 类 号：R743.3[医药卫生—神经病学与精神病学]