针刺联合重复经颅磁刺激治疗缺血性脑卒中后软瘫期上肢功能障碍临床研究  

Clinical Study of Acupuncture Combined with Reptitive Transcranial Magnetic Stimulation for Upper Limb Dysfunction During the Phase of Flaccid Paralysis After Ischemic Stroke

作　　者：张振发 胡晓华[1] 盛敏丽 胡梦云 宋鸿雁 ZHANG Zhenfa;HU Xiaohua;SHENG Minli;HU Mengyun;SONG Hongyan(Hospital of Zhejiang People's Armed Police,Hangzhou Zhejiang 310051,China)

机构地区：[1]武警浙江省总队医院,浙江杭州310051

出　　处：《新中医》2024年第23期118-123,共6页New Chinese Medicine

基　　金：浙江省医药卫生科技计划(2023KY1006)。

摘　　要：目的:观察针刺联合重复经颅磁刺激(rTMS)治疗缺血性脑卒中后软瘫期上肢功能障碍的临床疗效。方法:选取缺血性脑卒中后软瘫期进行上肢功能恢复的患者90例,按随机数字表法分为研究组和对照组各45例。2组均给予基础治疗,对照组在基础治疗同时给予rTMS治疗,研究组在对照组基础上加用针刺治疗,2组均治疗4周。治疗4周后观察临床疗效。治疗前、治疗4周后,比较2组Fugl-Meyer上肢运动功能评分、主动关节活动度以及血清胶质纤维酸性蛋白(GFAP)、髓鞘碱性蛋白(MBP)、γ-氨基丁酸(GABA)、谷氨酸(Glu)。比较2组软瘫持续时间、主动腕背伸率。结果:治疗4周后,研究组总有效率95.56%,高于对照组82.22%(P<0.05)。2组Fugl-Meyer上肢运动功能评分均较治疗前升高(P<0.05),研究组Fugl-Meyer上肢运动功能评分高于对照组(P<0.05)。2组肩关节前屈、外展、后伸,腕关节背伸、掌屈,以及肘关节活动度较治疗前增大(P<0.05),研究组肩关节前屈、外展、后伸,腕关节背伸、掌屈,以及肘关节活动度均大于对照组(P<0.05)。2组血清GFAP、MBP、Glu水平均较治疗前降低(P<0.05),研究组血清GFAP、MBP、Glu水平均低于对照组(P<0.05),2组血清GABA水平均较治疗前升高(P<0.05),研究组血清GABA水平高于对照组(P<0.05)。研究组软瘫持续时间短于对照组(P<0.05)。研究组主动腕背伸率91.11%,高于对照组68.89%(P<0.05)。结论:针刺联合rTMS有助于缺血性脑卒中患者脱离软瘫期,促进肢体主动运动及上肢功能重建,减轻中枢神经损伤。Objective:To observe the clinical effect of acupuncture combined with repetitive transcranial magnetic stimulation in the recovery of upper limb dysfunction during the phase of flaccid paralysis after ischemic stroke.Methods:A total of 90 patients who underwent upper limb function recovery during the phase of flaccid paralysis after ischemic stroke were selected and divided into the study group and the control group by the random number table method,with 45 patients in each group.Both groups received basic treatment;the control group received repetitive transcranial magnetic stimulation in addition to the basic treatment,and the study group was additionally treated with acupuncture based on the treatment of the control group.Both groups were treated for four weeks.After four weeks of treatment,the clinical effects were observed.Before and after four weeks of treatment,the scores of Fugl-Meyer upper limb motor function,active range of motion of the joint,as well as serum levels of glial fibrillary acidic protein(GFAP),myelin basic protein(MBP),γ-aminobutyric acid(GABA),and glutamate(Glu)were compared between two groups.The duration of flaccid paralysis and the rates of active wrist dorsiflexion were compared between the two groups.Results:After four weeks of treatment,the total effective rate in the study group was 95.56%,which was higher than that of 82.22%in the control group(P<0.05).both groups showed an increase in Fugl-Meyer upper limb motor function scores when compared with those before treatment(P<0.05),and the Fugl-Meyer upper limb motor function score in the study group was higher than that in the control group(P<0.05).The range of motion for shoulder flexion,abduction,and extension,wrist dorsiflexion,palmar flexion,and elbow joint in the two groups was increased when compared with that before treatment(P<0.05);the range of motion for shoulder flexion,abduction,and extension,wrist dorsiflexion,palmar flexion,and elbow joint in the study group was biger than that in the control group(P<0.05).The levels o

关 键 词：缺血性脑卒中 软瘫期 上肢功能障碍 针刺 重复经颅磁刺激 中枢神经损伤 主动运动 

分 类 号：R246.1[医药卫生—针灸推拿学]