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分期针刺治疗缺血性脑卒中偏瘫的临床观察

[Clinical observation of the phased acupuncture for ischemic stroke hemiplegia].

作者信息

Chen Yong, Zhou Hai, Jin Tingting, Ye Tianshen, Xie Wenxia

机构信息

Department of Acupuncture and Physiotherapy, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China.

出版信息

Zhongguo Zhen Jiu. 2018 Oct 12;38(10):1027-34. doi: 10.13703/j.0255-2930.2018.10.001.

Abstract

OBJECTIVE

To compare the effect difference among the staged acupuncture combined with conventional rehabilitation, traditional acupuncture combined with conventional rehabilitation, and conventional rehabilitation in the patients with ischemic stroke hemiplegia.

METHODS

A total of 145 patients with ischemic stroke hemiplegia were randomly assigned into an observation group (49 cases), a control group A (49 cases) and a control group B (47 cases). All the patients were received aspirin tablets 100 mg orally, once a day. The staged acupuncture according to Brunnstrom's theory combined with conventional rehabilitation were used in the observation group, at the acupoints in the meridian during the flaccid paralysis phase, at the acupoints in the antagonistic muscle and the tendon of spastic dominant muscle during the spasm stage, and at the acupoints in the meridian and Taixi (KI 3), Guanyuan (CV 4) and Qihai (CV 6) during the sequela stage. Conventional traditional acupuncture at the acupoints in the meridian combined with conventional rehabilitation were applied in the control group A. Simple conventional rehabilitation was used in the control group B. Patients in the observation group and the control group A were received acupuncture and rehabilitation once a day from Monday to Friday, 2 weeks as 1 course; patients in the control group B were received the same rehabilitation as the observation group. The indexes were observed before treatment and at the end of the 2nd, 4th, 6th and 8th weeks of treatment, including National Institutes of Health Stroke Scale (NIHSS), short form Fugl-Meyer motor function assessment (FMA) scale, Fugl-Meyer balance (FM-B) scale, comprehensive spasm scale (CSS) and modified Barthel index (MBI).

RESULTS

Compared with those before treatment, except the MBI score in the control group B after 2 weeks' treatment, the NIHSS, FMA, FM-B and MBI scores were improved in all three groups at the end of the 2nd, 4th, 6th and 8th weeks of treatment (<0.01, <0.05). At the end of the 2nd week of treatment, the NIHSS and CSS scores were lower (<0.05, <0.01), the FMA, FM-B and MBI scores were higher (all <0.05) in the observation group and the control group A than those in the control group B. After 4, 6 and 8 weeks' treatment, the FMA, FM-B and MBI scores were higher (<0.05, <0.01), the NIHSS and CSS scores were lower (all <0.01) in the observation group than those of control group A and control group B; the FMA, FM-B and MBI scores in the control group A were higher than those in the control group B (<0.05, <0.01); the NIHSS and CSS scores in the control group A were lower than those in the control group B (<0.05, <0.01).

CONCLUSION

Staged acupuncture combined with conventional rehabilitation are consistent with the rehabilitation rule of patients with hemiplegia. They can improve motor function and the ability of daily life. They achieve better effect than traditional acupuncture combined with rehabilitation.

摘要

目的

比较分期针刺联合传统康复、传统针刺联合传统康复及单纯传统康复对缺血性脑卒中偏瘫患者的疗效差异。

方法

将145例缺血性脑卒中偏瘫患者随机分为观察组(49例)、对照组A(49例)和对照组B(47例)。所有患者均口服阿司匹林片100mg,每日1次。观察组采用根据Brunnstrom理论的分期针刺联合传统康复,弛缓期针刺经脉穴位,痉挛期针刺拮抗肌及痉挛优势肌肌腱处穴位,后遗症期针刺经脉穴位及太溪(KI3)、关元(CV4)、气海(CV6)。对照组A采用传统针刺经脉穴位联合传统康复。对照组B采用单纯传统康复。观察组和对照组A患者周一至周五每天接受针刺及康复治疗,2周为1个疗程;对照组B患者接受与观察组相同的康复治疗。观察治疗前及治疗第2、4、6、8周结束时的指标,包括美国国立卫生研究院卒中量表(NIHSS)、Fugl-Meyer运动功能简易评估(FMA)量表、Fugl-Meyer平衡(FM-B)量表、综合痉挛量表(CSS)及改良Barthel指数(MBI)。

结果

与治疗前比较,治疗第2、4、6、8周结束时,三组患者的NIHSS、FMA、FM-B及MBI评分均有所改善(<0.01,<0.05),对照组B治疗2周后的MBI评分除外。治疗第2周结束时,观察组和对照组A的NIHSS及CSS评分低于对照组B(<0.05,<0.01),FMA、FM-B及MBI评分高于对照组B(均<0.05)。治疗4、6、8周后,观察组的FMA、FM-B及MBI评分高于对照组A和对照组B(<0.05,<0.01),NIHSS及CSS评分低于对照组A和对照组B(均<0.01);对照组A的FMA、FM-B及MBI评分高于对照组B(<0.05,<0.01);对照组A的NIHSS及CSS评分低于对照组B(<0.05,<0.01)。

结论

分期针刺联合传统康复符合偏瘫患者的康复规律,能改善运动功能及日常生活能力,其疗效优于传统针刺联合康复。

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