补土针灸法联合热敏灸治疗脑卒中后肢体痉挛性瘫痪临床研究  

Clinical Study on Earth-Nourishing Acupuncture and Moxibustion Method Combined with Heat-Sensitive Moxibustion for Spastic Paralysis of Limbs After Stroke

作　　者：李佩佩 庄晟坚 盛俊 LI Peipei;ZHUANG Shengjian;SHENG Jun(Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine,Wenzhou Zhejiang 325000,China)

机构地区：[1]温州市中西医结合医院,浙江温州325000

出　　处：《新中医》2024年第4期112-118,共7页New Chinese Medicine

基　　金：浙江省科学技术厅临床应用研究-医卫一般项目(2019GYB02)。

摘　　要：目的:观察补土针灸法联合热敏灸治疗脑卒中后肢体痉挛性瘫痪的临床疗效。方法:选择124例脑卒中后肢体痉挛性瘫痪患者,以随机数字表法分为常规治疗组及针灸联合治疗组各62例。常规治疗组给予西药联合康复训练治疗,针灸联合治疗组在常规治疗组基础上给予补土针灸法联合热敏灸治疗。2组均治疗3个月。比较2组临床疗效、临床痉挛指数(CSI)评分、改良Ashworth量表(MAS)评分、Fugl-Meyer运动功能量表(FMA)评分、脑卒中患者姿势评定量表(PASS)评分、肌电图指标[患侧胫骨前肌和腓肠肌屈伸最大等长收缩时表面肌电图积分肌电值(iEMG)、患肢M波最大波幅(Mmax)和H波最大波幅(Hmax)]、三维步态参数(步频、步速、支撑相、摆动相)及Kelch样环氧氯丙烷相关蛋白-1 (Keap1)/核因子E2相关因子2 (Nrf2)/抗氧化反应元件(ARE)信号通路。结果:治疗后,针灸联合治疗组总有效率96.77%,高于常规治疗组82.26%(P<0.05)。2组CSI、MAS评分均较治疗前降低(P<0.05),针灸联合治疗组CSI、MAS评分均低于常规治疗组(P<0.05)。2组胫骨前肌、腓肠肌iEMG均较治疗前升高(P<0.05),针灸联合治疗组胫骨前肌、腓肠肌i EMG均高于常规治疗组(P<0.05)。2组Mmax、Hmax均较治疗前降低(P<0.05),针灸联合治疗组Mmax、Hmax均低于常规治疗组(P<0.05)。2组步频、步速、支撑相均较治疗前提高(P<0.05),针灸联合治疗组步频、步速、支撑相均高于常规治疗组(P<0.05)。2组摆动相均较治疗前降低(P<0.05),针灸联合治疗组摆动相低于常规治疗组(P<0.05)。2组FMA、PASS评分均较治疗前升高(P<0.05),针灸联合治疗组FMA、PASS评分均高于常规治疗组(P<0.05)。2组Nrf2、ARE水平均较治疗前升高(P<0.05),针灸联合治疗组Nrf2、ARE水平均高于常规治疗组(P<0.05)。2组Keap1水平均较治疗前降低(P<0.05),针灸联合治疗组Keap1水平低于常规治疗组(P<0.05)。结论:补土针灸法联合热敏灸Objective:To observe the clinical effect of Earth-Nourishing Acupuncture and Moxibustion Method combined with heat-sensitive moxibustion on spastic paralysis of limbs after stroke.Methods:A total of 124 cases of patients with spastic paralysis of limbs after stroke were divided into the routine treatment group and the acupuncture and moxibustion group according to the random number table method,with 62 cases in each group.The routine treatment group was treated with western medicine combined with rehabilitation training,the acupuncture and moxibustion group was treated with Earthnourishing Acupuncture and Moxibustion Method combined with heat-sensitive moxibustion based on the treatment of the routine treatment group.Both groups were treated for 3 months.The clinical effects,the scores of Clinical Spasticity Index(CSI),Modified Ashworth Scale(MAS),Fugl-Meyer Assessment(FMA),Postural Assessment Scale for Stroke(PASS),electromyographic indicators[surface electromyographic integral electromyographic values(iEMG)of the affected tibialis anterior muscle and gastrocnemius muscle during maximum isometric contraction,as well as the maximum amplitude of M wave(Mmax)and maximum amplitude of H wave(Hmax)of the affected limb],three-dimensional gait parameters(stride frequency,stride speed,support phase,swing phase),Kelch-like epichlorohydrinrelated protein-1(Keap1)/nuclear factor E2-related factor 2(Nrf2)/and antioxidant response element(ARE)signaling pathway were compared between the two groups.Results:After treatment,the total effective rate was 96.77%in the acupuncture and moxibustion group,higher than that of 82.26%in the routine treatment group(P<0.05).The scores of CSI and MAS in the two groups were decreased when compared with those before treatment(P<0.05),and the scores of CSI and MAS in the acupuncture and moxibustion group were lower than those in the routine treatment group(P<0.05).The iEMG of tibialis anterior muscle and gastrocnemius muscle in the two groups were increased when compared with those before treatm

关 键 词：脑卒中后肢体痉挛性瘫痪 补土针灸法 热敏灸 肌电图 三维步态参数 Keap1/Nrf2/ARE信号通路 

分 类 号：R246.6[医药卫生—针灸推拿学]