中药熏洗配合巨刺法治疗卒中后痉挛性瘫痪的临床研究及对患者脊髓运动神经元兴奋性的影响  

Clinical efficacy of herbal fumigation combined with the Giant Acupuncture for spastic paralysis after stroke and how to impact on neuronal excitability of spinal cord motor

作　　者：陈文平[1] 李琳 孙益民 刘世杰[1] CHEN Wenping;LI Lin;SUN Yimin;LIU Shijie(Department of Rehabilitation Medicine,Fifth People's Hospital of Hengshui,Hengshui,Hebei 053000)

机构地区：[1]河北省衡水市第五人民医院康复医学科,河北衡水053000

出　　处：《河北中医》2022年第4期660-664,共5页Hebei Journal of Traditional Chinese Medicine

基　　金：衡水市科技计划项目(编号:2019014093Z)。

摘　　要：目的观察中药熏洗配合巨刺法治疗卒中后痉挛性瘫痪的临床疗效及对患者脊髓运动神经元兴奋性的影响。方法选择2019年11月至2021年6月河北省衡水市第五人民医院康复医学科卒中后痉挛性瘫痪患者245例,按照随机数字表法分为治疗组123例和对照组122例。2组均给予常规治疗及康复训练。对照组同时给予患侧常规针刺和痉挛肌低频治疗仪治疗,治疗组在对照组基础上给予中药熏洗配合巨刺法治疗。2组均治疗4周,比较2组临床疗效、中医证候积分、临床痉挛指数(CSI)评分、运动功能Fugel-Meyer评定量表(FMA)评分、改良Barthel指数(MBI)评分、表面肌电信号[H波最大波幅(Hmax)、M波最大波幅(Mmax)、Hmax/Mmax比值]变化。结果治疗期间,治疗组中途退出3例,对照组中途退出8例。治疗组总有效率89.17%(107/120),对照组总有效率78.07%(89/114),治疗组疗效优于对照组(P<0.05)。2组治疗后与本组治疗前比较中医证候各项评分及总分均降低(P<0.05),且治疗组治疗后半身不遂、意识昏蒙、言语謇涩或不语、口舌歪斜评分低于对照组(P<0.05)。2组治疗后与本组治疗前比较CSI评分降低(P<0.05),FMA、MBI评分均升高(P<0.05),且治疗组治疗后CSI评分低于对照组(P<0.05),FMA、MBI评分高于对照组(P<0.05)。2组治疗后与本组治疗前比较Hmax、Mmax、Hmax/Mmax均降低(P<0.05),且治疗组治疗后Hmax、Mmax、Hmax/Mmax均低于对照组(P<0.05)。结论中药熏洗配合巨刺法能够缓解卒中后痉挛性瘫痪患者临床症状,促进运动功能与日常生活活动能力的恢复,可能与抑制脊髓运动神经元兴奋性等因素有关。Objective To observe the clinical efficacy of herbal fumigation combined with the Giant Acupuncture for spastic paralysis after stroke(SPAS)and how to impact on neuronal excitability of spinal cord motor.Methods Totally 245 SPAS patients admitted to the Department of Rehabilitation Medicine,Fifth People's Hospital of Hengshui from November 2019 to June 2021 were randomly divided into the treatment group(n=123)and the control group(n=122);apart from the conventional therapy and rehabilitation training,the control group received routine acupuncture on the diseased side and low-frequency spastic muscle therapeutic apparatus,and the treatment group received herbal fumigation combined with the Giant Acupuncture based on the control group.Treated for 4 weeks,aiming to compare traditional Chinese medicine(TCM)symptom scores,clinical spasticity index(CSI),the Fugl-Meyer assessment(FMA)scale,modified Barthel index(MBI),surface electromyography(sEMG)(H-wave maximum[Hmax],M-wave maximum[Mmax],Hmax/Mmax ratio);the curative effect was assessed.Results During the treatment,3 cases and 8 cases in the treatment group and the control group were sloughed off,respectively.The overall effective rate was higher in the treatment group 89.17%(107/120)compared with the control group 78.07%(89/114),(P<0.05).After treatment,TCM symptom scores in groups were decreased(P<0.05),TCM symptom(half-length-flabbiness,unconscious,poor speech or speechless,tongue skewed)scores were decreased in the treatment group compared with the control group(P<0.05);decreased CSI and increased FMA and MBI were detected in groups after treatment(P<0.05);lower CSI,and higher FMA and MBI were detected in the treatment group than those in the control group(P<0.05);Hmax,Mmax,Hmax/Mmax in groups were decreased(P<0.05),the treatment group was more prevalent(P<0.05).Conclusion For SPAS patients,herbal fumigation combined with the Giant Acupuncture can relieve clinical symptoms and promote the recovery of motor function and activities of daily living by inhibiting the n

关 键 词：中风 中风后遗症 脑性瘫痪 外治法 巨刺 针刺疗法 

分 类 号：R743.3[医药卫生—神经病学与精神病学]