基于发育理论的针刺联合康复训练治疗坐位障碍脑瘫RCT研究  

Acupuncture Based on Development Stage Theories plus Rehabilitation Training for Sitting Dysfunction in Cerebral Palsy: A Randomized Controlled Trial

作　　者：张洪[1] 邓鸿 母晓明 艾双春 郭洪科[4] ZHANG Hong;DENG Hong;MU Xiao-ming;AI Shuang-chun;GUO Hong-ke(The Third People＇s Hospital of Mianyang（Sichuan Mental Health Center）,Mianyang 621000,China;Mianyang 404 Hospital,Mi anyang 621000,China;Mianyang Hospital of TCM,Mianyang 621000,China;Mianyang Central Hospital,Mianyang 621000,China)

机构地区：[1]绵阳市第三人民医院(四川省精神卫生中心),绵阳621000 [2]绵阳市404医院,绵阳621000 [3]绵阳市中医院,绵阳621000 [4]绵阳市中心医院,绵阳621000

出　　处：《上海针灸杂志》2018年第8期904-908,共5页Shanghai Journal of Acupuncture and Moxibustion

基　　金：四川省卫计委科研课题(130453)

摘　　要：目的观察基于发育理论的针刺联合康复训练治疗坐位障碍脑瘫的疗效,为按照不同发育阶段给予相应的针刺治疗坐位障碍脑瘫的应用提供依据。方法采用多中心随机对照试验(RCT)的方法,将160例脑瘫患者随机分为治疗组和对照组,每组80例。治疗组采用基于发育理论的针刺疗法配合常规康复训练方案,对照组釆用常规的针刺疗法配合常规康复训练,两组均在治疗前、治疗1个月、治疗2个月,分别用粗大运动功能评估量表中坐位20项和表面肌电图(SEGM)检测患者背阔肌和腹直肌中的RMS(均方根值)平均值和平均功率频率(MPF),并进行疗效比较。结果两组患者治疗后粗大运动功能评估量表GMFM-B区20个项目和表面肌电图中背阔肌和腹直肌的RMS(均方根值)平均值、平均功率频率(MPF)平均值均较治疗前有明显提高(P<0.05);治疗组的疗效明显优于对照组(P<0.05)。说明患者在坐位态下躯干伸肌群的肌肉收缩激活(或募集)速率增快。在运动过程中能动员更多的运动单位参加运动,使得其抗重力伸展和自主活动的能力得到明显增强,坐位平衡能力提高。结论基于发育理论的针刺方案早期治疗脑瘫的临床疗效明显高于对照组,说明按照不同发育阶段给予相应的针刺治疗方案能有效提高脑瘫的运动水平及坐位平衡能力。Objective To observe the therapeutic efficacy of acupuncture based on the development stage theories plus rehabilitation training in treating sitting dysfunction in cerebral palsy, and to provide evidence for using acupuncture to treat cerebral palsy with sitting dysfunction in different development stages. Method By using a multicentered randomized controlled trial（RCT） design, 160 cerebral palsy patients were randomized into a treatment group and a control group, with 80 cases in each group. The treatment group was intervened by acupuncture therapy based on the development stage theories plus rehabilitation training, while the control group was intervened by ordinary acupuncture plus conventional rehabilitation training. Before the treatment, and respectively after 1-month and 2-month treatment, the 20 items of sitting position in the Gross Motor Function Measure（GMFM） and surface electromyogram（SEGM） were adopted to detect the mean value of root mean square（RMS） value and mean power function（MPF） of latissimus dorsi and rectus abdominis, and the therapeutic efficacies were compared. Result After the treatment, the scores of the 20 items in the dimension B of GMFM, and the mean value of RMS and MPF of latissimus dorsi and rectus abdominis in SEGM readings increased significantly in both groups（P0.05）. The therapeutic efficacy of the treatment group was markedly superior to that of the control group（P0.05）. The results indicated that the contraction trigger rate or loading rate of the extensors increased in sitting position and more motor units were able to participate in movement, which allowed the anti-gravity stretch and autonomic activity to be strengthened, so was the balance function in sitting position. Conclusion Compared with the control group, the acupuncture protocol based on the development stage theories can produce a more significant clinical efficacy in treating early-stage cerebral palsy, suggesting that acupuncture based on different stages of development can effectiv

关 键 词：针刺疗法 脑性瘫痪 肌电描记术 表面肌电图 发育理论 

分 类 号：R246.4[医药卫生—针灸推拿学]