运动针法联合康复训练治疗脑卒中后上肢痉挛性瘫痪疗效观察  

Therapeutic effect on post-stroke spastic paralysis of upper extremity treated with combination of kinematic-acupuncture therapy and rehabilitation training

作　　者：黄馨云 夏秋芳 朱慧雯 姜淑云 俞艳[1] 朱润佳[1] 陈晓桐 李璟[1] HUANG Xin-yun;XIA Qiu-fang;ZHU Hui-wen;JIANG Shu-yun;YU Yan;ZHU Run-jia;CHEN Xiao-tong;LI Jing(Department of Acupuncture and Moxibustion,Yueyang Integrated Chinese and Western Medicine Hospital Affiliated to Shanghai University of TCM,Shanghai 200437,China;Department of Chinese Medicine Rehabilitation,Shanghai First Rehabilitation Hospital;Institute of Tuina,Yueyang Integrated Chinese and Western Medicine Hospital Affiliated to Shanghai University of TCM)

机构地区：[1]上海中医药大学附属岳阳中西医结合医院针灸科,上海200437 [2]上海市第一康复医院中医康复科 [3]上海中医药大学附属岳阳中西医结合医院推拿研究所

出　　处：《中国针灸》2020年第5期473-478,共6页Chinese Acupuncture & Moxibustion

基　　金：上海市进一步加快中医药事业发展三年行动计划项目:ZY(2018-2020)-FWTX-4008。

摘　　要：目的:比较运动针法联合康复训练与常规针刺联合康复训练治疗脑卒中后上肢痉挛性瘫痪患者的临床疗效。方法:将60例非急性期脑卒中后上肢痉挛性瘫痪患者随机分为观察组(30例)和对照组(30例,脱落1例)。在常规西药及康复训练治疗的基础上,观察组行运动针法,对照组行常规针刺,两组均穴取百会、大椎,患侧T1~T8夹脊穴、天宗、肩贞、肩髃、曲垣等,均每日治疗1次,14d为一疗程,共治疗1个疗程。于治疗前,治疗7、14 d后,比较两组上肢简化Fugl-Meyer(FMA-UE)评分、改良Ashworth量表(MAS)评级和改良Barthel指数评定量表(MBI)评分。结果:治疗7、14 d后,两组FMA-UE评分较治疗前明显升高(P<0.01),且治疗14 d后观察组FMA-UE评分高于对照组(P<0.05)。治疗7、14 d后,两组肩关节、肘关节、腕关节及掌指关节处MAS评级均明显改善(P<0.05);与治疗7 d后比较,两组治疗14 d后肘关节、掌指关节MAS评级明显改善(P<0.05);与对照组比较,治疗14 d后观察组肘关节、掌指关节MAS评级改善更明显(P<0.05)。与治疗前比较,观察组治疗7、14 d后MBI评分升高(P<0.05,P<0.01),对照组治疗14 d后MBI评分升高(P<0.01)。结论:对于非急性期脑卒中后上肢痉挛性瘫痪患者,运动针法联合康复训练能明显改善上肢运动功能、肘关节及掌指关节的肌张力,疗效优于常规针刺联合康复训练,且能提高日常活动能力。Objective To compare the clinical therapeutic effect on post-stroke spastic paralysis of the upper extremity between the combination of kinematic-acupuncture therapy and rehabilitation training and the combined treatment of the conventional acupuncture with rehabilitation training. Methods A total of 60 patients of post-stroke spastic paralysis of the upper extremity at the non-acute stage were randomized into an observation group(30 cases) and a control group(30 cases, 1 case dropped off). On the base of the routine western medication and rehabilitation treatment, the kinematic-acupuncture therapy was added in the observation group and the conventional acupuncture was used in the control group. Baihui(GV 20), Dazhui(GV 14), Jiaji(EX-B 2) from T1 to T8, Tianzong(SI 11), Jianzhen(SI 9), Jianyu(LI 15) and Quyuan(SI 13) were selected in both groups. The treatment was given once daily and the treatment for 14 days was as one course. The one course of treatment was required in this research. Separately, before treatment and in 7 and 14 days of treatment, the score of simplified Fugl-Meyer scale of the upper extremity(FMA-UE), the grade of the modified Ashworth scale(MAS) and the score of the modified Barthel index scale(MBI) were compared between the two groups. Results Compared before treatment, in 7 and 14 days of treatment, FMA-UE score was increased obviously in either group(P<0.01). In 14 days of treatment,FMA-UE score in the observation group was higher than that in the control group(P<0.05). In 7 and 14 days of treatment, MAS grades of shoulder joint, elbow joint, wrist joint and metacarpophalangeal joint were all improved markedly in the two groups(P<0.05). Compared with the grades in 7 days of treatment, MAS grades of elbow joint and metacarpophalangeal joint were improved markedly in 14 days of treatment in the two groups(P<0.05). Compared with the control group, MAS grades of elbow joint and metacarpophalangeal joint were improved more markedly in the observation group in 14 days of treatment(P<0.05). Compa

关 键 词：脑卒中 痉挛性瘫痪 运动针法 针刺疗法 上肢功能 随机对照试验 

分 类 号：R246.6[医药卫生—针灸推拿学]