肌电生物反馈联合艾灸治疗脑卒中后上肢肌肉痉挛  

Myoelectric biofeedback combined with moxibustion in the treatment of muscle spasms of the upper extremities after stroke

作　　者：任慧 陈斌[2] 冷军[3] 孟祥志 张思鈺 魏衍旭 李映彩 陈怡婷 REN Hui;CHEN Bin;LENG Jun;MENG Xiangzhi;ZHANG Siyu;WEI Yanxu;LI Yingcai;CHEN Yiting(School of Rehabilitation Medicine,Shandong University of Traditional Chinese Medicine,Ji’nan 250300,China;People’s Hospital Affiliated to Fujian University of Traditional Chinese Medicine,Fuzhou 350000,China;The Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine,Ji’nan 250001,China)

机构地区：[1]山东中医药大学康复医学院,山东济南250300 [2]福建中医药大学附属人民医院,福建福州350000 [3]山东中医药大学第二附属医院,山东济南250001

出　　处：《中国实用神经疾病杂志》2022年第12期1470-1474,共5页Chinese Journal of Practical Nervous Diseases

基　　金：山东省中医药科技发展计划项目(编号:20190247);福建省国家中医临床研究基地专项科研课题(编号:JDZX201915)。

摘　　要：目的评估肌电生物反馈联合艾灸对脑卒中后上肢肌肉痉挛的临床治疗效果。方法选取2020-09—2021-12山东中医药大学第二附属医院收治的75例脑卒中后上肢肌肉痉挛患者为受试对象,随机分为肌电组、艾灸组和联合组各25例,3组均给予常规康复训练。肌电组在常规康复训练的基础上增加肌电生物反馈治疗仪,将电极置于肌肉丰满处,并用胶带固定使其紧贴皮肤,治疗师引导患者根据肌电信号进行肌肉收缩训练,5次/周,连续治疗8周。艾灸组在患侧上肢合谷、外关、内关、大陵、手三里、曲池、尺泽、天泉、肱中等穴位增加艾灸刺激,1次/d,40 min/次,5次/周,连续治疗8周。联合组则是在常规康复训练基础上采用肌电生物反馈治疗仪联合艾灸治疗。治疗前后分别采用改良Ashworth评分量表(MAS)评价上肢痉挛状态,改良Barthel指数(MBI)评价患者日常生活活动功能,简易Fugl-Meyer量表上肢部分(FMA-UE)评价患侧上肢运动能力,观察临床有效率。结果与治疗前相比较,3组患者治疗8周后的MAS评分下降,MBI评分和FMA-UE评分有所提高,差异有统计学意义(P<0.05)。与其他2组相比,联合组各项指标均高于其他2组,疗效更确切,差异有统计学意义(P<0.05)。联合组临床有效率明显高于其他2组,差异有统计学意义(P<0.05)。结论肌电生物反馈联合艾灸治疗脑卒中后上肢肌肉痉挛疗效明确,患者肌张力下降,日常生活活动能力提高,上肢运动功能改善,并且安全、高效、经济、易于接受。Objective To observation of the efficacy of myoelectric biofeedback combined with moxibus-tion to relieve muscle spasm of the upper extremities after stroke.Methods Totally 75 patients with musclespasms of the upper limbs after stroke,admitted to the Second Affiliated Hospital of Shandong University of Tradi-tional Chinese Medicine from September 2020 to December 2021,were enrolled and randomly divided into myo-electric group,moxibustion group and combined group,with 25 cases per group.Patients in all three groups received conventional rehabilitation training.The EMG group added an EMG biofeedback therapy instrument on thebasis of routine rehabilitation training,placed electrodes in muscle fullness,and fixed with tape to the skin,andthe therapist guided the patient to perform muscle contraction training according to the EMG signal,5 times aweek,for eight consecutive weeks.The moxibustion group increased moxibustion stimulation in the upper limbs ofthe affected side,such as Hegu,Waiguan,Neiguan,Daling,Hand Sanli,Quchi,Ruze,Tianquan,and Humerus,once a day,40 min each time,5 times a week,for eight consecutive weeks.The combined group is treated withmyoelectric biofeedback therapy combined with moxibustion on top of conventional rehabilitation.The improvedAshworth score(MAS)was utilized toassess the spasticity of the upper extremitiesbefore and after the treatments,the modified Barthel index(MBI)was utilizedto assess the patient’s ability to perform activities of daily living,the upper limb part(FMA-UE)of the simple Fugl-Meyer scale was utilizedto measure the motor function of theupper limbs on the affected side,and the clinical efficiency after treatmentwas observed.Results Comparisonwith pre-treatment,the MAS score of the three groups decreased,and the MBI score and FMA-UE score were im-proved,and they had a statistically significant difference(P<0.05).Compared with the other two groups,the effi-cacy of the combined group was better thanthe other two groups,and the difference was statistically significant(P<0.05)

关 键 词：脑卒中 偏瘫 肌电生物反馈技术 艾灸 痉挛 中西医结合 

分 类 号：R743.3[医药卫生—神经病学与精神病学]