头针联合任务导向型训练对软瘫期卒中患者体感诱发电位及功能恢复的影响
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摘要
目的观察头针联合任务导向型训练对软瘫期卒中患者体感诱发电位(SEP)及功能恢复的影响。方法68例脑卒中软瘫期患者,随机分为对照组和治疗组,每组34例。对照组常规给予任务导向型训练,治疗组在对照组基础上给予头针治疗。比较两组治疗前后简式Fugl-Meyer评测法(FMA)、Barthel指数(BI)、简易精神状态量表(MMSE)、中风专用生活质量量表(SS-QOL)评分和体感诱发电位(SEP)变化,并比较两组临床疗效。结果治疗组总有效率为94.1%,高于对照组的76.5%(P<0.05)。两组治疗后FMA、BI、MMSE、SS-QOL评分较同组治疗前升高(P<0.01),治疗组治疗后的FMA、BI、MMSE、SS-QOL评分高于对照组(P<0.01)。两组治疗后患侧SEP的N_(20)波幅均较同组治疗前增高,潜伏期缩短(P<0.01,P<0.05);治疗组治疗后患侧SEP的N_(20)波幅与潜伏期优于对照组(P<0.01)。结论头针联合任务导向型训练可有效改善卒中软瘫期患者的SEP、运动功能、日常生活能力、认知功能及生活质量。
Objective To observe the effect of scalp acupuncture plus task-oriented approach on somatosensory evoked potential(SEP) and function recovery in patients with cerebral stroke in flaccid paralysis stage. Method Sixty-eight patients with cerebral stroke in flaccid paralysis stage were randomized into a control group and a treatment group, with 34 cases in each group. The control group was given routine task-oriented approach, and the treatment group was additionally given scalp acupuncture. Changes in Fugl-Meyer Assessment(FMA), Barthel Index(BI),Mini-Mental State Examination(MMSE), Stroke-Specific Quality of Life Scale(SS-QOL) and SEP after treatment were compared, and the clinical efficacies of the two groups were also compared. Result The total effective rate was94.1% in the treatment group, higher than 76.5% in the control group(P<0.05). After treatment, the scores of FMA, BI,MMSE and SS-QOL increased significantly in both groups(P<0.01), and the scores in the treatment group were higher than those in the control group(P<0.01). In both groups, the amplitude of N_(20) in SEP of the affected side increased and its latency was shortened after treatment(P<0.01, P<0.05); the amplitude and latency of N_(20) in SEP of the affected side were better in the treatment group than in the control group after intervention(P<0.01). Conclusion Scalp acupuncture plus task-oriented approach can effectively improve the SEP, motor function, activities of daily living, cognition and quality of life in patients with cerebral stroke in flaccid paralysis stage.
Objective To observe the effect of scalp acupuncture plus task-oriented approach on somatosensory evoked potential(SEP) and function recovery in patients with cerebral stroke in flaccid paralysis stage. Method Sixty-eight patients with cerebral stroke in flaccid paralysis stage were randomized into a control group and a treatment group, with 34 cases in each group. The control group was given routine task-oriented approach, and the treatment group was additionally given scalp acupuncture. Changes in Fugl-Meyer Assessment(FMA), Barthel Index(BI),Mini-Mental State Examination(MMSE), Stroke-Specific Quality of Life Scale(SS-QOL) and SEP after treatment were compared, and the clinical efficacies of the two groups were also compared. Result The total effective rate was94.1% in the treatment group, higher than 76.5% in the control group(P<0.05). After treatment, the scores of FMA, BI,MMSE and SS-QOL increased significantly in both groups(P<0.01), and the scores in the treatment group were higher than those in the control group(P<0.01). In both groups, the amplitude of N_(20) in SEP of the affected side increased and its latency was shortened after treatment(P<0.01, P<0.05); the amplitude and latency of N_(20) in SEP of the affected side were better in the treatment group than in the control group after intervention(P<0.01). Conclusion Scalp acupuncture plus task-oriented approach can effectively improve the SEP, motor function, activities of daily living, cognition and quality of life in patients with cerebral stroke in flaccid paralysis stage.
引文
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[17]崔韶阳,许明珠,王曙辉,等.针刺配合镜像疗法对脑梗死偏瘫患者下肢功能障碍的影响[J].上海针灸杂志,2017,36(1):9-13.
[18]王红斌,彭小平,徐健,等.针灸联合康复训练对脑卒中偏瘫患者肢体运动功能及日常生活能力的影响[J].陕西中医,2015,36(7):914-916.
[19]刘英媛,孟德勇,周扬,等.头针联合任务导向性训练治疗小脑卒中平衡功能障碍疗效观察[J].现代中西医结合杂志,2016,25(29):3241-3243.
[20]邓红卫,魏巍,杨云,等.头针联合平衡训练治疗脑卒中后平衡功能障碍的临床疗效观察[J].中国康复,2017,32(1):39-40.
[21]Meyer S,Karttunen AH,Thijs V,et al.How do somatosensory deficits in the arm and hand relate to upper limb impairment,activity,and participation problems after stroke?A systematic review[J].Phys Ther2014,94(9):1220-1231.
[22]Haupt WF,Chopan G,Sobesky J,et al.Prognostic value of somatosensory evoked potentials,neuron-specific enolase,and S100 for short-term outcome in ischemic stroke[J].J Neurophysiol,2016,115(3):1273-1278.
[2]李英华,阴炳侠,关丽梅,等.温通针法结合康复训练治疗急性脑卒中软瘫期疗效观察[J].中国临床医生杂志,2015,43(7):91-92.
[3]陈创,唐朝正,王桂丽,等.经颅直流电刺激结合任务导向性训练对慢性期脑卒中患者上肢及手功能障碍的影响[J].中国康复,2017,32(3):202-204.
[4]金荣见.针刺手三阴经穴与手阳明经穴改善脑卒中软瘫期手指屈伸功能障碍的疗效对比[J].中国中医急症,2014,23(1):111-112.
[5]中华神经科学会,中华神经外科学会.各类脑血管疾病诊断要点[J].中华神经科杂志,1996,29(6):379-380.
[6]国家中医药管理局脑病急症协作组.中风病诊断与疗效评定标准(试行)[J].北京中医药大学学报,1996,19(1):55-56.
[7]全国第四届脑血管病学术会议.脑卒中患者临床神经功能缺损程度评分标准(1995)[J].中华神经科杂志,1996,29(6):381-383.
[8]Sun C,Song B,Jiang C,et al.Effect of antiplatelet pretreatment on safety and efficacy outcomes in acute ischemic stroke patients after intravenous thrombolysis:a systematic review and meta-analysis[J].Expert Rev Neurother,2019,19(4):349-358.
[9]Medlinskiene K,Fay M,Petty D.Uptake of Oral Anticoagulants for Stroke Prevention in Patients with Atrial Fibrillation in a Single Clinical Commissioning Group in England Without Restrictions to Their Use[J].Clin Drug Investig,2019,39(4):401-405.
[10]Kiper P,Turolla A.Updates and comments on:Influence of transcutaneous electrical nerve stimulation on spasticity,balance,and walking speed in stroke patients:A systematic review and meta-analysis[J].J Rehabil Med,2019,51(4):317-318.
[11]Jung GU,Moon TH,Park GW,et al.Use of augmented reality-based training with EMG-triggered functional electric stimulation in stroke rehabilitation[J].J Phys Ther Sci,2013,25(2):147-151.
[12]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.
[13]Lee KH,Kim JH,Choi DH,et al.Effect of task-specific training on functional recovery and corticospinal tract plasticity after stroke[J].Restor Neurol Neurosci,2013,31(6):773-785.
[14]Klamroth-Marganska V,Blanco J,Campen K,et al.Three-dimensional,task-specific robot therapy of the arm after stroke:a multicentre,parallel-group randomised trial[J].Lancet Neurol,2014,13(2):159-166.
[15]秦思,朱天民.针刺结合康复技术治疗脑卒中肢体偏瘫的临床研究进展[J].中国康复医学杂志,2015,30(3):310-312.
[16]杨爱国,闫新华,赵然.针刺结合Bobath疗法治疗脑卒中偏瘫患者核心肌群运动功能障碍临床观察[J].上海针灸杂志,2015,34(2):105-108.
[17]崔韶阳,许明珠,王曙辉,等.针刺配合镜像疗法对脑梗死偏瘫患者下肢功能障碍的影响[J].上海针灸杂志,2017,36(1):9-13.
[18]王红斌,彭小平,徐健,等.针灸联合康复训练对脑卒中偏瘫患者肢体运动功能及日常生活能力的影响[J].陕西中医,2015,36(7):914-916.
[19]刘英媛,孟德勇,周扬,等.头针联合任务导向性训练治疗小脑卒中平衡功能障碍疗效观察[J].现代中西医结合杂志,2016,25(29):3241-3243.
[20]邓红卫,魏巍,杨云,等.头针联合平衡训练治疗脑卒中后平衡功能障碍的临床疗效观察[J].中国康复,2017,32(1):39-40.
[21]Meyer S,Karttunen AH,Thijs V,et al.How do somatosensory deficits in the arm and hand relate to upper limb impairment,activity,and participation problems after stroke?A systematic review[J].Phys Ther2014,94(9):1220-1231.
[22]Haupt WF,Chopan G,Sobesky J,et al.Prognostic value of somatosensory evoked potentials,neuron-specific enolase,and S100 for short-term outcome in ischemic stroke[J].J Neurophysiol,2016,115(3):1273-1278.