针刺联合川平法治疗脑卒中后上肢功能障碍的疗效及电生理特征研究  

Effect and Electrophysiological Characteristics of Acupuncture Combined with RFE in Treatment of Upper Limb Dysfunction after Stroke

作　　者：董春雪 孟庆楠 李卉[1] 苗丽竹 胡斌[1] 柴德君 王宏宇 DONG Chunxue;MENG Qingnan;LI Hui;MIAO Lizhu;HU Bin;CHAI Dejun;WANG Hongyu(The Second Affiliated Hospital of Qiqihar Medical College,Qiqihar 161000,Heilongjiang,China)

机构地区：[1]齐齐哈尔医学院附属第二医院,黑龙江齐齐哈尔161000

出　　处：《中华中医药学刊》2024年第7期197-201,共5页Chinese Archives of Traditional Chinese Medicine

基　　金：黑龙江省省属高校基本科研业务费科研项目(2021-KYYWF-0367)。

摘　　要：目的观察针刺联合川平法治疗脑卒中后上肢功能障碍的疗效及对电生理特征的影响。方法筛选2022年1月—2022年12月,康复科及神经科收治住院的脑卒中后上肢功能障碍患者135例作为研究对象,采用随机数表法分为针刺组、川平组与联合组,每组45例。3组患者均给予常规药物治疗及康复训练。针刺组在常规治疗的基础上给予针刺治疗,川平组在常规治疗的基础上给予川平法(反复促通技术)(Repetitive facilitative exercise, RFE)治疗,联合组在常规治疗的基础上给予针刺联合川平法治疗,均为每日治疗1次,每周连续5 d休息2 d,共治疗8周。分别在治疗前、治疗4周、治疗8周后,比较3组的上肢运动功能[简化Fugl-Meyer评定量表(FMA)],上肢肌张力[改良Ashworth量表(MAS)],手活动功能[Wolf手活动功能测试(WMFT)]及日常生活活动能力[改良Barthel指数(MBI)评分];比较3组的肱二头肌、肱三头肌及腕背伸肌的最大收缩时肌电信号(Electromyography, EMG)界限值,采用生物反馈治疗仪进行测定。结果治疗4周和治疗8周后,3组的简化FMA评分、WMFT评分和MBI评分整体比较差异均有统计学意义(P<0.05),治疗后均较治疗前显著提升(P<0.05),且联合组显著高于针刺组和川平组(P<0.05);3组的改良MAS评分整体比较亦有差异有统计学意义(P<0.05),治疗后均较治疗前显著降低(P<0.05),且联合组显著低于针刺组和川平组(P<0.05)。治疗4周和治疗8周后,3组间肱二头肌、肱三头肌和腕背伸肌的最大收缩时EMG界限值整体比较均有统计学意义(P<0.05),3组的EMG界限值均较治疗前显著提升(P<0.05),且联合组显著高于针刺组和川平组(P<0.05)。结论针刺联合川平法治疗脑卒中后上肢功能障碍,能够有效提高患者上肢及手部主要肌群的最大收缩时EMG界限值,改善患者上肢及手部肌肉的收缩能力,从而显著提升患者的上肢和手部运动功能,缩小上肢肌张力,改善�Objective To observe the effect of acupuncture combined with repetitive facilitative exercise(RFE)on upper limb dysfunction after stroke and its influence on electrophysiological characteristics.Method A total of 135 patients with upper limb dysfunction after stroke admitted to the Department of Encephalopathy from January 2022 to December 2022 were selected as research objects and divided into acupuncture group,RFE group and combined group by random number table method,with 45 cases in each group.All groups were given the conventional drug therapy and rehabilitation training.Besides,the acupuncture group was given the acupuncture therapy on the basis of the conventional treatment,the RFE group was given RFE method on the basis of the conventional treatment,and the combined group was given acupuncture combined with RFE method on the basis of the conventional treatment,once a day,5 consecutive days a week with 2 days off,for a total of 8 weeks.Before and after 4 and 8 weeks of treatment,the upper limb motor function(Fugl-Meyer Assessment,FMA),upper limb muscle tone(Modified Ashworth Scale,MAS),hand motor function(Wolf motor function test,WMFT)and ability of perform activities of daily living(MBI)were compared between the three groups.The maximum contractile electromyography(EMG)limit values of biceps,triceps and extensor wrist dorsum were compared among the three groups and measured by biofeedback therapy instrument.Result After 4 and 8 weeks of treatment,the simplified FMA score,WMFT score and MBI score were significantly different among the three groups by overall comparison(P<0.05),and they were significantly improved after treatment compared with those before treatment(P<0.05),while the scores of the combined group were significantly higher than those of the acupuncture group and RFE group(P<0.05).The modified MAS scores of the three groups were also significantly different by overall comparison(P<0.05),and they were significantly lower after treatment than those before treatment(P<0.05),while the scores of th

关 键 词：川平法 针刺 脑卒中 上肢功能障碍 EMG界限值 

分 类 号：R246.1[医药卫生—针灸推拿学]