辨证取穴结合电针刺激伸肌对脑卒中后偏瘫患者腕踝关节活动的影响  

Therapeutic Observation of Electroacupuncture at Extensors plus Acupoints Based on Syndrome Differentiation for Wrist-ankle Activity in Post-stroke Hemiplegia

作　　者：吕瑛[1] 石向东 王洁[1] 陈恩卓[1] 张燕[1] 陈春燕[1] 卢苏梅[1] 赵捷 

机构地区：[1]上海交通大学医学院附属同仁医院,上海200336 [2]上海市长宁区华阳社区卫生服务中心,上海200042

出　　处：《上海针灸杂志》2017年第7期776-780,共5页Shanghai Journal of Acupuncture and Moxibustion

基　　金：上海市卫计委中医药专项基金青年项目(2014LQ023A);上海中医药事业发展三年行动计划"杏林新星"人才培养项目(ZY3-RCPY-2-2082)

摘　　要：目的观察辨证取穴结合电针刺激伸肌对脑卒中后偏瘫患者腕踝关节活动的影响。方法将168例脑卒中后偏瘫患者随机分为对照组和治疗组,每组84例。两组均接受西医内科药物治疗,在此基础上对照组采用辨证取穴结合电针治疗,治疗组采用辨证取穴结合电针刺激伸肌治疗。观察两组治疗前后肌电图变化,并比较两组临床疗效。结果治疗组总有效率为95.1%,对照组为91.0%,两组临床疗效比较差异有统计学意义(P<0.05)。治疗后肌电图检查,治疗组桡侧腕伸肌波相与对照组比较,差异具有统计学意义(P<0.05);两组治疗后胫骨前肌波相未见明显差异(P>0.05),但与同组治疗前比较,两组均见显著差异(P<0.05)。两组治疗后H反射检查中M-amp/H-amp比较未见显著差异(P>0.05),但与同组治疗前比较,两组均见显著差异(P<0.01)。结论辨证取穴结合电针刺激伸肌治疗可增加脑卒中后偏瘫患者桡侧腕伸肌和胫骨前肌的运动单位,降低腓肠肌的痉挛程度,临床疗效显著。Objective To observe the effect of electroacupuncture at extensors plus acupoints based on syndrome differentiation on the wrist-ankle activity in post-stroke hemiplegia. Method A total of 168 patients with post-stroke hemiplegia were randomly divided into a control group and a treatment group, 84 cases each. Both groups were prescribed with Western medication, based on which, the control group received electroacupuncture at acupoints based on syndrome differentiation, and the treatment group received electroacupuncture at extensors plus acupoints based on syndrome differentiation. The changes of electromyography （EMG） in the two groups after the intervention were observed, and the clinical efficacies were compared between the two groups.Results The total effective rate was 95.1% in the treatment group versus 91.0% in the control group, and the between-group difference was statistically significant （P〈0.05）. After the intervention, the EMG of extensor carpi radialis in the treatment group was significantly different from that in the control group （P＆lt;0.05）; the between-group difference was statistically insignificant in comparing the EMG of tibialis anterior muscle （P〉0.05）, but the intra-group differences were statistically significant in both groups（P＆lt;0.05）. The value of M-amp/H-amp was changed significantly in both groups after the treatment （P＆lt;0.01）, but the between-group difference was statistically insignificant after the treatment （P〉0.05）.Conclusion Electroacupuncture at extensors plus acupoints based on syndrome differentiation can increase the motor unit of carpi radialis and decrease the spasm of gastrocnemius in post-stroke hemiplegia, and consequently produce a remarkable clinical efficacy.

关 键 词：桡侧腕伸肌 胫骨前肌 电针 中风后遗症 腕踝关节 肌电图 针药并用 伸肌 

分 类 号：R246.6[医药卫生—针灸推拿学]