基于sEMG评价子午流注巨刺法对卒中后肌痉挛的干预效应  

SEMG-based Evaluation of the Effect of Zi Wu Liu Zhu plus Contralateral Needling on Post-stroke Myospasm

作　　者：樊留博 田瑛 李小军 刘宝华[2] FAN Liu-bo;TIAN Ying;LI Xiao-jun;LIU Bao-hua(Taizhou Hospital Affiliated to Wenzhou Medical University,Taizhou 317000,China;The Second Affiliated Hospital of Wenzhou Medical University,Wenzhou 325035,China)

机构地区：[1]温州医科大学附属台州医院,台州317000 [2]温州医科大学附属第二医院,温州325035

出　　处：《上海针灸杂志》2019年第4期399-403,共5页Shanghai Journal of Acupuncture and Moxibustion

基　　金：浙江省医药卫生科技计划项目(2017KY707;2014KYA224);浙江省台州市科技计划项目(14SF03);温州医科大学高等教育教学改革项目(YBJG201621)

摘　　要：目的观察应用表面肌电图(surface electromyography, sEMG)评价子午流注纳甲法配合巨刺疗法对卒中后痉挛性偏瘫患者疗效的影响。方法将64例卒中后痉挛性偏瘫患者随机分为治疗组和对照组,每组32例。两组患者均采取常规康复治疗,在此基础上对照组采用传统的循经取穴针刺治疗,治疗组采用子午流注纳甲法配合巨刺疗法针刺治疗。两组患者分别于治疗前与治疗4周后采用改良Ashworth分级、临床痉挛指数(CSI)、临床神经功能缺损程度(NDS)、Barthel指数(BI)及表面电极引导和记录肌电信号并对所测得H波、M波最大波幅及H波/M波最大波幅比值(Hmax/Mmax)的变化情况进行分析。结果两组下肢改良Ashworth分级、CSI评分及NDS评分均较治疗前明显下降(P<0.01),治疗组与对照组比较差异有统计学意义(P<0.05)。两组患者BI评分均较治疗前明显提高(P<0.01),治疗组与对照组比较差异有统计学意义(P<0.05)。两组患者治疗后Hmax/Mmax均降低(P<0.05),且治疗组Hmax/Mmax低于对照组(P<0.05)。结论子午流注纳甲法配合巨刺疗法可以降低偏瘫肢体肌张力,改善肢体运动功能,提高日常生活活动能力。Objective To evaluate the efficacy of Zi Wu Liu Zhu Na Jia (midnight-noon ebb-flow method) plus contralateral needling in treating post-stroke hemiplegia patients based on surface electromyography (sEMG). Method Sixty-four patients with post-stroke hemiplegia were randomized into a treatment group and a control group, with 32 cases in each group. The two groups both received rehabilitation. In addition, the control group was given conventional acupuncture treatment by selecting acupoints along meridians, while the treatment group was given Zi Wu Liu Zhu Na Jia plus contralateral needling. Before and after four-week treatment, the two groups were estimated by the modified Ashworth scale (MAS), clinical spasticity index (CSI), clinical neurologic deficit scale (NDS), Barthel index (BI) and sEMG. Changes in the maximum amplitudes of H wave (Hmax) and M wave (Mmax) as well as the Hmax/Mmax were analyzed. Result The lower-limb MAS, CSI and NDS scores declined significantly after the treatment in both groups (P<0.01), and there was a significant difference between the two groups (P<0.05). The BI score increased markedly after the treatment in both groups (P<0.01), and the treatment group was significantly different from the control group (P<0.05). After the intervention, the Hmax/Mmax dropped in both groups(P<0.05), and the Hmax/Mmax was lower in the treatment group than in the control group (P<0.05). Conclusion Zi Wu Liu Zhu Na Jia plus contralateral needling can lower the muscle tension in hemiplegia, and improve the motor function and activities of daily living.

关 键 词：针刺疗法 子午流注纳甲法 巨刺 康复 肌电描记术 偏瘫 肌痉挛 中风后遗症 Ashworth分级 临床痉挛指数 临床神经功能缺损程度 Barthel指数 

分 类 号：R246.6[医药卫生—针灸推拿学]