醒脑开窍针刺法加减治疗卒中后足内翻的疗效评价  

Clinical Evaluation of Restoring Consciousness and Opening Orifices Acupuncture inTreatment of Varus after Stroke

作　　者：冯春燕[1,2] 康煜炜 李金波 张春红[3] 牛博真 开佰超[1] 于海龙 杨建[1] 王佐彬[1] 苑丽敏 刘晨思[1] 门杰 FENG Chunyan;KANG Yuwei;LI Jinbo;ZHANG Chunhong;NIU Bozhen;KAI Baichao;YU Hailong;YANG Jian;WANG Zuobin;YAN Limin;LIU Chensi;MEN Jie(The First Teaching Hospital of Tianjin University of Traditional Chinese Medicine,National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion,Tianjin 300193,China;Graduate School,Tianjin University of Traditional Chinese Medicine,Tianjin 301617,China;Bao'an Authentic TCM Therapy Hospital,Shenzhen 518102,Guangdong,China)

机构地区：[1]天津中医药大学第一附属医院,国家中医针灸临床医学研究中心,天津300193 [2]天津中医药大学研究生院,天津301617 [3]深圳市宝安区纯中医治疗医院,广东深圳518102

出　　处：《辽宁中医杂志》2022年第10期177-180,共4页Liaoning Journal of Traditional Chinese Medicine

基　　金：国家中医药管理局国家中医临床研究基地业务建设科研专项(JDZX2015022)。

摘　　要：目的 观察醒脑开窍针刺加减治疗卒中后足内翻对其下肢步行功能、日常生活能力及胫前肌、腓肠肌表面肌电均方根振幅(RMS)的疗效评价。方法 对符合条件的40例脑卒中足内翻病例行醒脑开窍针刺加减治疗3个月,比较治疗前后,Fugl(下肢)、MBI,胫前肌、腓肠肌表面肌电RMS的变化。结果 针刺前后对照,Fugl(下肢)、MBI较针刺治疗前均有显著改善。腓肠肌:被动活动3个月前后有显著性差异,其他均无显著性差异。胫前肌:被动活动时,治疗后肌张力较前显著增加(Z=3.428,P=0.001<0.05),与健侧比较无显著性差异(Z=0.497,P=0.619>0.05);主动活动时,治疗后较前显著增加(Z=3.508,P=0.000<0.05),但仍显著低于健侧(Z=3.79,P=0.000<0.05)。结论 醒脑开窍针刺加减治疗卒中后足内翻,可有效增加患足肌力、肌张力,肌张力增加明显与健侧无显著性差异,肌力较前增加但仍明显低于健侧,提示该针刺法对于改善卒中后足内翻患者肌张力改善优于肌力,对于提高胫前肌肌力更显著,对腓肠肌肌力影响不显。醒脑开窍针刺法加减治疗卒中后足内翻可有效改善患足运动功能、日常活动能力,可能与其较好地协调患足背屈时主动肌、拮抗肌肌张力/肌力相关。但由于病例采集地点局限,病例数较少,建议后期加大样本量,进一步行多中心、大样本、随机对照研究,降低实验误差以更好的指导临床。另外,醒脑开窍针刺法加减治疗卒中后足内翻的相关机制尚待进一步研究。Objective To observe the effect of restoring consciousness and opening orifices acupuncture on walking function, daily life ability and root mean square(RMS) amplitude of tibialis anterior muscle and gastrocnemius muscle.Methods Forty patients with foot varus were treated with restoring consciousness and opening orifices acupuncture for 3 months.The changes of Fugl(lower limb),MBI,tibialis anterior and gastrocnemius surface electromyographyRMSwere compared before and after treatment.Results Before and after acupuncture, Fugl(lower limb) and MBI were significantly improved than those before acupuncture treatment.Gastrocnemius Muscle: There wassignificant difference before and after 3 months passive activity, and there was no significant difference in other activities.Tibialis anterior muscle: The tension of tibialis anterior muscle was significantly increased after treatment(Z=3.428,P=0.001<0.05),but not significantly different from that of contralateral muscle(Z=0.497,P=0.619>0.05).After treatment, it increased significantly(Z=3.508,P=0.000<0.05),but it was still significantly lower than that of the contralateral side(Z=3.79,P=0.000<0.05).Conclusion Restoring consciousness and opening orifices acupuncture can effectively increase muscle strength and muscle tension of the affected foot, and there is no significant difference between the increase of muscle tension and that of the healthy side.It is suggested that acupuncture is better than muscle strength in improving muscular tension of patients with post-stroke foot varusand has more significant effect on tibialis anterior muscle strength than on gastrocnemius muscle strength.The acupuncture therapy of “restoring consciousness and opening orifices” can effectively improve the motor function and daily activity ability of the affected foot after stroke, which may be related to the coordination of the active muscle and the antagonistic muscle tension/muscle strength in the affected foot dorsiflexion.However, due to the limitation of the place where the cases wer

关 键 词：醒脑开窍针刺法加减 卒中后足内翻 疗效评价 表面肌电RMS值 

分 类 号：R246.1[医药卫生—针灸推拿学]