针刺督脉结合筋膜松解手法治疗脑卒中后上肢痉挛性瘫痪的临床疗效评价  

Clinical Observations on Treatment of Upper Limb Spastic Paralysis after Stroke by Acupuncture at Governor Vessel Combined with Myofascial Release

作　　者：高玉宝[1] 孙晓丽[1] 曹奕[1] 姜天鑫 李飞[1] GAO Yubao;SUN Xiaoli;CAO Yi;JIANG Tianxin;LI Fei(The Second Affiliated Hospital of Anhui University of Chinese Medicine,Hefei 230061,Hefei,China)

机构地区：[1]安徽中医药大学第二附属医院,安徽合肥230061

出　　处：《辽宁中医杂志》2023年第1期167-171,共5页Liaoning Journal of Traditional Chinese Medicine

基　　金：国家自然科学基金项目(81001558);安徽高校自然科学重点项目(KJ2019A0445)。

摘　　要：目的观察针刺督脉结合筋膜松解手法治疗脑卒中后上肢痉挛性瘫痪的临床疗效。方法将60例临床确诊为脑卒中后上肢痉挛性瘫痪的患者,运用随机数字表法分成观察组和对照组两组,每组30例。两组患者均接受调控血压、血糖、血脂等基础治疗,对照组以口服巴氯芬片结合常规中风后康复训练为治疗方法;观察组在此基础上再施以针刺督脉穴位为主的针刺治疗联合筋膜松解手法治疗。在治疗前后,采用改良的Ashworth痉挛状态量表(MAS)、简化Fugl-Meyer上肢运动功能评定量表(FMA-UE)、改良Barthel指数(MBI)分别对两组患者的上肢痉挛程度、上肢功能及自理能力进行评估,根据MAS分级结果对两组进行临床疗效评价,并检测两组血清γ-氨基丁酸(GABA)水平。结果治疗前,两组患者的MAS分级、FMA-UE及MBI评分、血清GABA水平组间比较,差异无统计学意义(P>0.05);与治疗前相比,4周后对照组除MBI评分无明显改善外(P>0.05),FMA评分、MAS分级及血清GABA水平均有改善(P<0.05,P<0.01),而观察组MAS分级、FMA-UE评分、MBI评分及血清GABA水平均有不同程度的改善(P<0.05,P<0.01);与对照组相比,观察组治疗后MAS分级、FMA-UE评分、MBI评分情况及血清GABA水平改善更显著(P<0.05);对比两组的总有效率,观察组66.67%的总有效率明显高于对照组36.67%(P<0.05)。结论针刺督脉结合筋膜松解手法可以有效改善脑卒中后上肢痉挛性瘫痪患者的上肢痉挛程度,改善患者的上肢功能和自理能力,值得临床推广。Objective To observe the clinical effect of acupuncture at the governor vessel combined with myofascial release on upper limb spastic paralysis after stroke.Methods Sixty patients clinically diagnosed as upper limb spastic paralysis after stroke were randomly divided into observation group and control group with 30 cases in each group.Both groups received basic treatment and control of blood pressure,blood glucose,blood lipids and so on.Patients in the control group were treated with baclofen combined with routine rehabilitation training after stroke.On this basis,the observation group was treated with acupuncture at the governor vessel combined with myofascial release.The Modified Ashworth Spasticity Scale(MAS),the simplified Fugl-Meyer upper extremity assessment(FMA-UE)and the modified Barthel index(MBI)were used to evaluate the upper extremity spasticity,function and self-care ability before and after treatment.The clinical efficacy of the two groups was evaluated according to the MAS classification,and the serum levels ofγ-aminobutyric acid(GABA)were detected.Results There was no significant difference in MAS,FMA-UE,MBI or serum GABA levels between the two groups before treatment(P>0.05).After 4 weeks of treatment,compared with those before treatment,the MBI score of the control group had no significant improvement(P>0.05),but the scores of FMA-UE and MAS and serum GABA levels were improved(P<0.05,P<0.01).The scores of MAS,FMA-UE and MBI and serum GABA levels in the observation group were improved in different degrees(P<0.05,P<0.01).Compared with those of the control group,the scores of MAS,FMA-UE and MBI and serum GABA levels in the observation group improved significantly after treatment(P<0.05).The total effective rate of the observation group(66.67%)was significantly higher than that(36.67%)of the control group(P<0.05).Conclusion Acupuncture at the governor vessel combined with myofascial release treatment of upper limb spastic paralysis after stroke can effectively improve the degree of upper limb spast

关 键 词：脑卒中 上肢痉挛性瘫痪 针刺 督脉 筋膜松解手法 

分 类 号：R743.3[医药卫生—神经病学与精神病学]