冲击波疗法结合针刺对脑卒中后上肢痉挛状态的疗效分析  

Effect of Extracorporeal Shock Wave Therapy Combined with Acupuncture on Spasticity of Upper Limb in Stroke Patients

作　　者：张璇 夏文广 陈玉姣 刘磊 ZHANG Xuan;XIA Wen-guang;CHEN Yu-jiao;LIU Lei(Department of Rehabilitation Medicine,Hubei Hospital of Integrated Chinese&Western Medicine,Wuhan 430015,China)

机构地区：[1]湖北省中西医结合医院康复医学科,武汉430015

出　　处：《神经损伤与功能重建》2021年第3期150-153,共4页Neural Injury and Functional Reconstruction

基　　金：重大疑难疾病中西医临床协作试点项目(国中医药办医政发《2018》3号-39)(No.SATCM-20180339)。

摘　　要：目的:观察体外冲击波疗法(ESWT)联合针刺对脑卒中后上肢肌肉痉挛状态的疗效和安全性。方法:伴上肢肌肉痉挛的脑卒中患者70例,随机分为对照组和ESWT组各35例。2组均予常规康复训练方法及针刺治疗,ESWT组增加上肢肱二头肌EWST治疗,每周1次,治疗4周。采用改良Ashworth量表(MAS)、上肢简化的Fugl-Meyer评分(U-FMA)、改良Barthel指数(MBI)及基于卒中病患者报告的临床结局评价量表(PRO)分别于治疗前、治疗4周后对2组患者进行评估,并且应用PRO量表在治疗结束3月时评价远期临床结局疗效。结果:治疗4周后,2组患者MAS、U-FMA、MBI评分及PRO较组内治疗前均有显著改善(P<0.05),ESWT组MAS、U-FMA、MBI评分及PRO评分较对照组明显改善(P<0.05)。治疗结束3月时随访,2组的PRO积分较治疗前均有提高(P<0.05),ESWT组的PRO积分明显高于对照组(P<0.05)。结论:ESWT结合针刺治疗可改善脑卒中后上肢痉挛,有效地提高患者的运动功能和日常生活能力,且有一定远期临床疗效。Objective:To observe the efficacy and safety of extracorporeal shock wave therapy(ESWT)combined with acupuncture in the treatment of upper limb muscle spasm after stroke.Methods:A total of 70 patients with upper limb spastic hemiplegia post-stroke were randomly divided into control group and ESWT group with 35 patients in each.Both groups accepted routine rehabilitation training and acupuncture,and ESWT group additionally received extracorporeal shock wave therapy 1 time a week for 4 weeks.The 2 groups were assessed before and after 4 weeks of treatment with the modified Ashworth Scale(MAS),upper extremity Fugl-Meyer Assessment(U-FMA),modified Barthel Index(MBI),and Patient Reported Outcome(PRO)scores.Three months after treatment,the long-term clinical outcome were evaluated through PRO scores.Results:After4 weeks of treatment,MAS,U-FMA,MBI,and PRO scores in the 2 groups were significantly improved compared to those before treatment(P<0.05),and the scores in the ESWT group were significantly better than those in the control group(P<0.05).At the 3-month follow-up,the PRO score of both groups had significantly improved compared to before treatment(P<0.05),and the PRO score of the ESWT group was significantly higher than that of the control group(P<0.05).Conclusion:ESWT combined with acupuncture can effectively improve motor function and activities of daily living and decrease upper limb spasm after stroke,and it can improve long-term clinical efficacy.

关 键 词：脑卒中 痉挛 冲击波疗法 针刺 

分 类 号：R741[医药卫生—神经病学与精神病学] R741.05[医药卫生—临床医学]