互动式头针结合PNF技术对缺血性卒中痉挛性偏瘫上肢功能的影响  

Dynamic scalp acupuncture combined with PNF therapy for upper limb motor impairment in ischemic stroke spastic hemiplegia

作　　者：祁丽丽[1] 韩振翔[2] 周一心[2] 陈文华[3] 褚立希 陆静珏[2] 许文杰[2] 王宏林[2] 王智博[2] 凌隽 

机构地区：[1]上海中医药大学附属岳阳中西医结合医院急诊科,上海200437 [2]上海中医药大学附属第七人民医院神经康复科,上海200137 [3]上海交通大学附属第一人民医院康复科 [4]上海中医药大学康复医学院

出　　处：《中国针灸》2018年第3期234-238,共5页Chinese Acupuncture & Moxibustion

基　　金：上海市残联康复系统优秀青年人才项目;上海市中医药领军人才建设项目学术共同体:ZY3-RCPY-1-1001;上海市杏林新星:ZY3-RCPY-2-2077;浦东新区卫计委项目:PW2014B-15;上海市卫计委中发办项目:2014 LQ 030 A;上海市浦东新区中医特色专科(中风特色专科)建设项目:PDZYXK-1-2014001;上海中医药大学附属第七人民医院院级人才项目--中医继承人

摘　　要：目的:在内科基础治疗的基础上,探讨互动式头针治疗、头针后配合本体感觉神经肌肉促进法(proprioceptive neuromuscular facilitation,PNF)康复治疗及单用PNF康复治疗对缺血性脑卒中痉挛性偏瘫患者上肢运动功能的影响。方法:将90例脑卒中痉挛性偏瘫患者随机分为PNF组、互动式头针组与头针组,每组30例,各组均采用内科基础治疗与PNF康复治疗。互动式头针组于头针治疗期间进行肢体PNF康复训练,头针组于头针治疗结束后行PNF康复训练。头针穴取病灶同侧(肢体偏瘫对侧)顶颞前斜线上1/5、中2/5,顶颞后斜线上1/5、中2/5,每日1次,1个月为一疗程,连续干预6个月。于治疗前,治疗2周、1个月、3个月、6个月后记录患者改良Ashworth痉挛量表(MAS)分级、简式Fugl-Meyer运动功能(FMA)评分、Barthel指数(BI)评分。结果:治疗1个月、3个月及6个月后,各组患者上肢MAS分级均较治疗前改善(均P<0.05),且互动式头针组上肢MAS分级优于PNF组与头针组(均P<0.05);治疗1个月、3个月、6个月后,各组患者FMA及BI评分均高于治疗前(均P<0.05),且互动式头针组FMA及治疗3个月、6个月后BI评分均高于PNF组与头针组(均P<0.05)。结论:互动式头针可有效改善缺血性卒中后痉挛性偏瘫患者上肢痉挛状态,改善患者肢体功能,提高患者生活质量,优于头针后采用PNF及单用PNF康复治疗者。Objective On the basic therapy, to assess the clinical effects of dynamic scalp acupuncture, scalp acupuncture combined with proprioceptive neuromuscular facilitation（PNF） therapy and simple PNF therapy for upper limb motor impairment in ischemic post-stroke spastic hemiplegia. Methods A total of 90 cases were randomly assigned into a PNF group, a dynamic scalp acupuncture group and a scalp acupuncture group, 30 cases in each group. Basic therapy and PNF therapy were applied in the three groups. PNF therapy was used during scalp acupuncture in the dynamic scalp acupuncture group. PNF therapy was applied after scalp acupuncture in the scalp acupuncture group. The points were the upper 1/5 and middle 2/5 of Dingnieqianxiexian（MS 6） and Dingniehouxiexian（MS 7） at the lesion side, the hemiparalysis contralateral side. The treatment was given for 6 months, once a day and 1 month as a course. The modified Ashworth scale（MAS）, the Fugl-Meyer motor assessment（FMA） and Barthel index（BI） were observed before treatment and 2 weeks, 1 month, 3 months, and 6 months after treatment. Results The MAS 1 month, 3 months and 6 months after treatment were improved compared with those before treatment in the three groups（ all P〈0.05）, and the MAS results in the dynamic scalp acupuncture group were better than those in the PNF and scalp acupuncture group（all P〈0.05）. The FMA and BI scores 1 month, 3 months and 6 months after treatment were higher than those before treatment（all P〈0.05）. The FMA Scores in the 3 time points and BI scores 3 months and 6 months after treatment in the dynamic scalp acupuncture group were higher than those in the other two groups（all P〈0.05）. Conclusion PNF therapy during scalp acupuncture can relieve the spasmodic condition of patients with upper limb motor impairment in ischemic post-stroke spasmodic hemiplegia, and improve the limb function and life activity, which is better than PNF therapy after scalp acupuncture and simple PNF therapy.

关 键 词：脑卒中 痉挛性偏瘫 互动式头针 本体感觉神经肌肉促进法(PNF) 头针 痉挛量表分级 Fugl-Meyer运动功能评分 Barthel指数评分 

分 类 号：R246.6[医药卫生—针灸推拿学]