阴阳平衡透刺法联合康复训练治疗脑卒中偏瘫上肢痉挛疗效观察  

Yin-yang balance penetrating acupuncture combined with rehabilitation training on upper limb spasticity in stroke hemiplegia

作　　者：朱金妹[1] 庄任 何俊[1] 王雪欣 王欢 朱海颖 ZHU Jin-mei;ZHUANG Ren;HE Jun;WANG Xue-xin;WANG Huan;ZHU Hai-ying(Rehabilitation Center,De'an Hospital of Changzhou City,Changzhou 213000,Jiangsu Province,China)

机构地区：[1]常州市德安医院康复中心,江苏常州213000

出　　处：《中国针灸》2020年第7期697-701,共5页Chinese Acupuncture & Moxibustion

基　　金：常州市卫计委青年人才科技项目:QN201827。

摘　　要：目的:比较阴阳平衡透刺法联合康复训练与单纯康复训练治疗脑卒中偏瘫上肢痉挛患者的疗效。方法:将60例脑卒中偏瘫上肢痉挛患者随机分为观察组和对照组,每组30例。在常规西药治疗基础上,对照组采用康复训练治疗;观察组在对照组治疗基础上加用阴阳平衡透刺法,穴取患侧肩髃透臂臑、曲池透少海、阳陵泉透阴陵泉、悬钟透三阴交等。两组均每日治疗1次,5 d为一疗程,疗程间休息2 d,治疗4个疗程。观察两组患者治疗前后改良Ashworth痉挛量表(MAS)评级、患侧上肢表面积分肌电值(i EMG),以及美国国立卫生研究院卒中量表(NIHSS)评分、上肢Fugl-Meyer评定量表(FMA)评分、改良Barthel指数(MBI)评分变化,并比较两组疗效。结果:①治疗后,两组患者MAS评级均降低(P<0.05),观察组0~Ⅰ+级例数多于对照组(P<0.05);两组患侧肱二头肌、肱三头肌、腕屈肌、腕伸肌、指伸肌、拇短展肌最大等长收缩时iEMG值均明显升高(P<0.05),且观察组患侧各肌肉i EMG值升高幅度大于对照组(P<0.05)。②治疗后,两组患者NIHSS评分降低(P<0.05),上肢FMA评分、MBI评分升高(P<0.05),且观察组NIHSS评分降低幅度及上肢FMA评分、MBI评分升高幅度均大于对照组(P<0.05)。③观察组总有效率为93.3%(28/30),高于对照组的70.0%(21/30,P<0.05)。结论:阴阳平衡透刺法联合康复训练治疗脑卒中偏瘫上肢痉挛疗效优于单纯康复训练,可改善上肢痉挛程度,提高患者上肢运动功能和生活自理能力。Objective To compare the therapeutic effect of yin-yang balance penetrating acupuncture combined with rehabilitation training and single rehabilitation training on upper limb spasticity in patients with stroke hemiplegia.Methods A total of 60 patients with upper limb spasticity of stroke hemiplegia were randomized into an observation group and a control group,30 cases in each one.On the basis of conventional western medication,rehabilitation training was adopted in the control group.On the basis of treatment in the control group,yin-yang balance penetrating acupuncture was applied from Jianyu(LI 15)to Binao(LI 14),Quchi(LI 11)to Shaohai(HT 3),Yanglingquan(GB 34)to Yinlingquan(SP 9),Xuanzhong(GB 39)to Sanyinjiao(SP 6),etc.of the affected side in the observation group.The treatment was given once a day,5 days were as one course,with a 2-day interval between two courses,4 courses were required in both groups.The classification of modified Ashworth spasticity scale(MAS),surface integrated electromyogram(iEMG)of affected upper limb and the scores of National Institute of Health stroke scale(NIHSS),Fugl-Meyer assessment(FMA)of upper limb and modified Barthel index(MBI)before and after treatment were observed,the therapeutic effect was evaluated in both groups.Results①After treatment,the MAS classification reduced in both groups(P<0.05),the cases of grade 0 toⅠ+in the observation group were more than those in the control group(P<0.05);iEMG values of the maximum isometric voluntary contraction of affected usculus biceps brachii,musculus triceps brachii,musculus flexor carpi,musculus extensor carpi,extensor digitorum,aductor pollicis brevis were increased in both groups(P<0.05),and the variations of iEMG of above muscles on the affected side in the observation group were larger than those in the control group(P<0.05).②After treatment,the scores of NIHSS were decreased(P<0.05),the scores of FMA,MBI were increased in both groups(P<0.05),and the variations of NIHSS,FMA and MBI scores were larger than those in the contr

关 键 词：脑卒中 上肢痉挛 阴阳平衡透刺法 表面积分肌电 随机对照试验 

分 类 号：R246.6[医药卫生—针灸推拿学]