针刺联合隔药灸经筋结点法治疗脑卒中后上肢痉挛性瘫痪疗效观察
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摘要
目的观察针刺联合隔药灸经筋结点法治疗脑卒中后上肢痉挛性瘫痪的临床疗效。方法 105例脑卒中后上肢痉挛性瘫痪患者随机分为观察组53例和对照组52例。对照组采用传统针刺治疗,观察组在对照组的基础上采用隔药灸经筋结点法治疗。比较两组治疗前后中医证候、改良Ashworth量表(MAS)、Fugl-Meyer评估法(FMA)、Barthel指数(BI)、健康调查简表(SF-36)评分和肌电图F波波幅、阈值及时限变化,并比较两组临床疗效。结果观察组总有效率为96.2%,显著高于对照组的82.7%(P<0.05)。观察组治疗后中医证候评分、MAS评分显著低于对照组,FMA、BI及SF-36评分显著高于对照组,肌电图F波波幅、阈值及时限变化显著优于对照组(P<0.05)。结论针刺联合隔药灸经筋结点法治疗脑卒中后上肢痉挛性瘫痪疗效确切,对于改善机体痉挛状态,促进肌力及患肢功能恢复,提高患者的生活质量有重要作用。
Objective To observe the clinical efficacy of acupuncture plus herb-partitioned moxibustion at meridian sinew joints in treating post-stroke upper-limb spastic palsy. Method A total of 105 patients with post-stroke upper-limb spastic palsy were randomized into an observation group of 53 cases and a control group of 52 cases. The control group was intervened by ordinary acupuncture, while the observation group was additionally given herbpartitioned moxibustion at meridian sinew joints. The traditional Chinese medicine (TCM) sign and symptom score, Modified Ashworth Scale (MAS) score, Fugl-Meyer Assessment (FMA) score, Barthel Index (BI) score, and 36-item Short-Form Health Survey (SF-36) score of the two groups were compared, as well as the changes in the amplitude, threshold and time limit of F wave on electroencephalogram (EEG). The clinical efficacies were also compared. Result The total effective rate was 96.2% in the observation group, significantly higher than 82.7% in the control group (P<0.05). After the treatment, the TCM sign and symptom score and MAS score in the observation group were significantly lower than those in the control group; the FMA, BI and SF-36 scores in the observation group were markedly higher than those in the control group; and the changes in the amplitude, threshold and time limit of wave F on EEG in the observation group were significantly superior to those in the control group (P<0.05). Conclusion Acupuncture plus herb-partitioned moxibustion at meridian sinew joints can produce valid efficacy in treating post-stroke upper-limb spastic palsy. It can significantly improve the spastic state, promote the recovery of muscle force and function of the affected limb, and enhance the patients' quality of life.
Objective To observe the clinical efficacy of acupuncture plus herb-partitioned moxibustion at meridian sinew joints in treating post-stroke upper-limb spastic palsy. Method A total of 105 patients with post-stroke upper-limb spastic palsy were randomized into an observation group of 53 cases and a control group of 52 cases. The control group was intervened by ordinary acupuncture, while the observation group was additionally given herbpartitioned moxibustion at meridian sinew joints. The traditional Chinese medicine (TCM) sign and symptom score, Modified Ashworth Scale (MAS) score, Fugl-Meyer Assessment (FMA) score, Barthel Index (BI) score, and 36-item Short-Form Health Survey (SF-36) score of the two groups were compared, as well as the changes in the amplitude, threshold and time limit of F wave on electroencephalogram (EEG). The clinical efficacies were also compared. Result The total effective rate was 96.2% in the observation group, significantly higher than 82.7% in the control group (P<0.05). After the treatment, the TCM sign and symptom score and MAS score in the observation group were significantly lower than those in the control group; the FMA, BI and SF-36 scores in the observation group were markedly higher than those in the control group; and the changes in the amplitude, threshold and time limit of wave F on EEG in the observation group were significantly superior to those in the control group (P<0.05). Conclusion Acupuncture plus herb-partitioned moxibustion at meridian sinew joints can produce valid efficacy in treating post-stroke upper-limb spastic palsy. It can significantly improve the spastic state, promote the recovery of muscle force and function of the affected limb, and enhance the patients' quality of life.
引文
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[17]陈小波,周小斌.隔药饼灸治疗脑卒中后肩手综合征33例临床观察[J].江苏中医药,2017,49(11):61-63.
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[19]蔡玉梅,韩海伟,盛国滨.针刺结合隔药灸经筋结点治疗中风后上肢痉挛性瘫痪的临床观察[J].中国中医药科技,2014,21(4):450-452.
[2]Chen A,Akinyemi RO,Hase Y,et al.Frontal white matter hyperintensities,clasmatodendrosis and gliovascular abnormalities in ageing and post-stroke dementia[J].Brain,2016,139(Pt1):242-258.
[3]王锋,佟媛媛,王文熠,等.醒脑开窍针刺法结合筋骨三针疗法治疗中风后上肢痉挛性瘫痪的临床观察[J].天津中医药,2015,32(9):546-548.
[4]肖洪波,朱宗俊,陈瑞全,等.任务导向性训练联合肉毒素对脑卒中后上肢痉挛患者功能恢复的影响[J].中国临床保健杂志,2015,18(1):12-14.
[5]王晓伟,余小柱.恢刺结合麦粒灸对脑卒中上肢痉挛性偏瘫患者屈肌表面肌电及双上肢F波的影响[J].中医学报,2017,32(12):2558-2561.
[6]赵冬娣,李有武,袁涛.平衡针刺法结合中药熏蒸治疗脑卒中后痉挛性瘫痪25例临床观察[J].江苏中医药,2014,46(8):57-59.
[7]沈力,袁红玲,吴剑林.针刺经筋结点结合康复疗法治疗中风后痉挛性瘫痪40例临床观察[J].甘肃中医药大学学报,2017,34(1):66-69.
[8]陈琳,徐守宇.大秦艽汤联合早期综合康复治疗脑卒中后上肢痉挛性瘫痪临床观察[J].新中医,2018,50(7):68-71.
[9]潘喻珍,俞红五,朱艳,等.针刺联合应象刺血治疗脑卒中后上肢痉挛性瘫痪临床观察[J].安徽中医药大学学报,2018,37(1):46-49.
[10]陈芬芬.针灸配合康复训练治疗中风后上肢痉挛性瘫痪的临床研究[J].世界最新医学信息文摘,2017,17(76):114,116.
[11]张玲,张岚.针灸配合康复训练治疗中风后上肢痉挛性瘫痪疗效观察[J].现代中西医结合杂志,2015,24(13):1406-1408.
[12]任媛媛,赵卫峰,朱秀莲.不同频率电针治疗脑卒中后上肢痉挛性瘫痪疗效观察[J].陕西中医,2014,35(10):1404-1405.
[13]李肖荷,甘君学.恢刺经筋结点治疗中风后痉挛性偏瘫的疗效观察[J].中西医结合心脑血管病杂志,2017,15(7):858-860.
[14]邸鸿雁,韩淑凯.表里两经推拿法对脑卒中后上肢痉挛状态的影响[J].中西医结合心脑血管病杂志,2016,14(7):690-692.
[15]李超,时国臣.滞针法配合运动针刺经筋结点治疗中风后痉挛性瘫痪的临床研究[J].山东中医杂志,2016,35(7):623-625.
[16]贺小卉,张少明.针刺结合推拿治疗中风后痉挛性瘫痪的疗效观察[J].辽宁中医杂志,2017,44(6):1283-1285.
[17]陈小波,周小斌.隔药饼灸治疗脑卒中后肩手综合征33例临床观察[J].江苏中医药,2017,49(11):61-63.
[18]刘宝国,张国芳,王丽.芒针结合隔药灸治疗背肌筋膜炎临床研究[J].实用中西医结合临床,2014,14(4):18-19.
[19]蔡玉梅,韩海伟,盛国滨.针刺结合隔药灸经筋结点治疗中风后上肢痉挛性瘫痪的临床观察[J].中国中医药科技,2014,21(4):450-452.