董氏奇穴治疗中风后遗症的临床研究
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摘要
背景
中风病是常见的中老年疾病,我国每年中风病发病率约为200万,死亡率约150万人,并随着人口老龄化的增长,其发病率和死亡率还会逐年增高,因此防治中风病仍是现今医学界工作的重心。随着现代医学的发展,中风病病人在急性期得到有效的救治,绝大多数神志可恢复,但一般都有不同程度的后遗症,如偏瘫、偏身感觉障碍、偏盲等三偏症状及言语障碍、吞咽障碍、认知障碍、日常活动能力障碍以及大小便障碍等,其中约15%的存活病人需要照看,严重影响了患者的生活质量,给社会和家庭带来了沉重的负担。因此,中风病后遗症的治疗是当今一项极具挑战的任务,但目前国际上尚缺乏有针对性的治疗措施。而针灸对中风后遗症的治疗已经积累了数千年的经验,有一定的特点和优势。
临床上,考虑中风恢复期有效的治法,可以促进中风患者的康复,减少中风后遗症的发生,减轻神经缺损的程度,从而提高其生活质量,故在整个中风病治疗中占据重要地位。但是,中风恢复期是指中风发病1个月至半年以内,病程比较长,长期使用十四经穴,容易出现穴位耐受性的问题,导致穴位效应差；而董氏奇穴,有别于十四正经的独特的针灸体系,自成一派,现被广泛用于内、外、妇、儿、五官等科疾病中,遂笔者在西医常规治疗的基础上,尝试结合董氏奇穴治疗中风后遗症,取得良好的效果。经查阅相关文献,发现董氏奇穴虽然在临床上已经开始应用,但是对中风后遗症的具体疗效,它与常规针灸疗法孰优孰劣,还未见相关报道。
综上,本研究通过中国脑卒中临床神经功能缺损程度评分量表(CSS)、日常生活活动能力等评价指标,观察董氏奇穴对中风后遗症患者的治疗效果,并与常规针刺疗法比较,为董氏奇穴的进一步推广,提供临床证据；为中风后遗症的治疗,提供一种有效的治疗手段。
目的
探讨董氏奇穴治疗中风后遗症的临床疗效,并与常规针刺的疗效作比较,为中风后遗症的治疗提供新的方法,以供临床医生参考。
方法
(1)病例来源和分组
60例中风后遗症患者均于2011年11月-2012年11月,在南方医院针灸科门诊、神经内科住院部收治。根据随机数字表法将60例病例随机分为治疗组和对照组,每组各30例。
(2)盲法
实行单盲法,盲患者。同时实行结果评估者、操作者、统计者三分离。
(3)诊断标准
中医诊断标准根据国家中医药管理局脑病急症协作组颁布的《中风病诊断与疗效评定诊断(试行)》；西医诊断标准参照中华神经科学会、中华神经外科学会于1996年提出的《各类脑血管病诊断要点》诊断为脑卒中病者。
(4)纳入标准
①符合上文诊断标准,男女不限；②经头颅CT或MRI确诊；③生命体征平稳,意识清楚,配合并坚持治疗者；④发病时间有1-6个月的患者,上、下肢肌力在Ⅰ～Ⅲ级；⑤自愿接受本疗法,并签订知情同意书的患者。
(5)排除标准
①符合上文诊断标准,并经头颅CT或MRI确诊,但无明显中风后遗症症状的患者；②病情危重或急性期病情尚未稳定,伴有意识障碍或严重的认知功能障碍者；或伴有完全性失语和感觉性失语者,或伴有中风后抑郁者；③合并有严重的心、肺、肝、肾疾病,糖尿病,或有严重出血倾向；④年龄≥70岁,或≤40岁者；⑤病程>6月者；⑥用改良的Ashworth痉挛量表评定痉挛在1级以上(不包括1级)者；⑦惧怕针刺者；⑧服用与本病治疗无关药物者。
(6)中止试验标准
试验过程中病情恶化,出现严重的并发症,或出现严重的不良反应,均应中止试验,已超过1/2疗程者,计入疗效统计；因不良反应中止试验者,计入不良反应病例统计。
(7)治疗方法
1.基础治疗
采用西医常规治疗。脑出血病人给予调整血压,维持水、电解质及酸碱平衡,防治感染等。脑梗死病人给予抗血小板聚集、降脂、营养神经、改善脑循环等治疗。
2.董氏奇穴疗法
取穴：以健侧灵骨、大白、中九里,双侧肾关(天皇副穴)为主穴。舌强不语配商丘、正会；肩痛配对侧侧三里、六完；中风手拘挛配对侧重子、重仙。以上穴位可依据患者病情及体位酌情增减。
操作：大白向同侧灵骨齐刺0.5-1寸；灵骨向同侧重仙齐刺1.5-2寸；中九里直刺1-2寸后,左右各旁开1寸向其齐刺；肾关向后肾经方向刺1-2寸。得气后留针30min,每5min行针1次；同时嘱患者主动或被动活动患肢。
3.常规针刺治疗
取穴：以水沟或百会,双侧内关,患侧极泉、尺泽、委中、足三里、三阴交为主穴。口角歪斜者配颊车、地仓；言语蹇涩配哑门、廉泉、通里；患侧经筋屈曲拘挛,肘部者配曲泽,腕部配大陵,膝部配曲泉,踝部配太溪。以上穴位可依据患者病情及体位酌情增减。
操作：水沟用雀啄术,百会、内关用捻转泻法,持续运针1-3分钟；三阴交、足三里用提插补法；刺极泉时,在原穴位置下2寸心经上取穴,避开腋毛,直刺进针,用提插泻法,以患者上肢有麻胀和抽动感为度；尺泽、委中直刺,提插泻法,使肢体有抽动感；诸穴留针30min,每5min行针1次。
两组患者均接受基础治疗,治疗组配合董氏奇穴,对照组配合常规针刺,每组患者每日治疗1次,10次为1疗程。疗程之间休息2天,连续3个疗程后观察临床疗效。
(8)观察方法
1.主要指标
①临床疗效：观察周期结束后,临床疗效的观察。按照国家中医药管理局脑病急症协作组颁发“中风病诊断与疗效评定标准”的“病类诊断标准”记录两组治疗前评分和治疗后评分,计算百分数折算值[病类疗前评分与疗后评分百分数折算法=(治疗前评分-治疗后评分)/治疗前评分],再参照“中风病疗效评定标准”(基本恢复：≥81%,6分以下；显著进步：≥56%,<81%；进步：≥36%,<56%；稍进步；≥11%,<36%；无变化；<11%；恶化(包括死亡)：负值。)评定临床疗效。
②观察神经功能缺损改善情况。采用脑卒中临床神经功能缺损程度评分量表(CSS)进行评价。
2.次要指标：
①观察日常生活活动能力的改善情况。采用改良Barthel指数(MBI)进行评定。
②治疗过程中不良反应的观察。
上述指标均在治疗开始前和疗程结束(或试验中止)时,由专人在不知道患者分组的情况下,各测量1次。
(9)数据处理
所得数据由专人整理后,用SPSS13.0for Windows软件包进行统计学处理。用X±SD表示计量数据；正态分布的计量数据治疗前后的比较采用配对t检验,组间比较采用两独立样本t检验；计数资料采用卡方检验和校正卡方检验；非正态分布的计量资料和等级资料采用秩和检验等非参数检验。若P<-0.05则认为差异有统计学意义。
结果
(1)病例中断与脱落情况
60例患者无1例中断与脱落。两组患者在性别、年龄、病程、病性、病位、病情严重程度和证型的资料比较方面,差异无统计学意义(P>0.05),可认为两组患者具有可比性(P>0.05)。
(2)两组患者临床疗效比较
治疗组基本痊愈1例,显著进步2例,进步7例,稍进步15例,无变化5例,恶化0例,总有效率达83.3%；对照组基本痊愈0例,显著进步4例,进步9例,稍进步14例,无变化3例,恶化0例,总有效率达90.0%；两组临床疗效经Mann-Whitney U检验,Z=-0.890,P=0.373,差异无统计学意义,即两组疗效相当。
(3)两组患者神经功能缺损改善的比较
组内比较,经Wilcoxon符号检验,两组患者面瘫(Z治疗组=-3.051,P治疗组=0.002；Z对照组=-4.264,P<0.001)、言语(Z治疗组=-3.140,P治疗组=0.002；Z对照组=-3.025,P对照组=0.002)、上肢肌力(Z治疗组=-4.378,P治疗组<0.001；Z对照组=-4.069,P对照组<0.001)、手肌力(Z治疗组=-4.195,P治疗组<0.001；Z对照组=-4.110,P对照组<0.001)、下肢肌力(Z治疗组=-4.099,P治疗组<0.001；Z对照组=-3.775,P对照组<0.001)和步行能力(Z治疗组=-4.565,P治疗组<0.001；Z对照组=-4.358,P对照组<0.001)因子分治疗前后比较均有显著差异(P<0.05),即治疗后两组患者上述因子分均低于治疗前；而意识和水平凝视因子分治疗前后比较均无统计学差异(P>0.05)。经配对样本t检验,两组患者CSS总分治疗前后比较均有显著差异(t治疗组=8.635,P治疗组<0.001；t对照组=8.686,P对照组<0.001),即治疗后两组患者CSS总分较治疗前降低。
组间比较,经Mann-Whitney U检验,治疗前后面瘫因子分差值(Z=-2.197,P=0.028)有显著差异(P<0.05),对照组面瘫因子改善情况高于治疗组；而水平凝视、言语、上肢肌力、手肌力、下肢肌力和步行能力因子分均无统计学差异(P>0.05),即两组上述各CSS因子分分值相当。经两独立样本t检验,两组患者CSS治疗前总分、治疗后总分和治疗前后总分差值均无统计学差异(P>0.05),即治疗后两组患者神经功能缺损改善程度相当。
(4)两组患者日常生活能力提高的比较
组内比较,经Wilcoxon检验,两组患者进食(Z治疗组=-3.890,P治疗组<0.001；Z对照组=-3.695,P对照组<0.001)、穿衣(Z治疗组=-4.089,P治疗组<0.001；Z对照组=-4.455,P对照组<0.001)、如厕(Z治疗组=-4.257,P治疗组<0.001；Z对照组=-4.195,P对照组<0.001)、个人卫生(Z治疗组=-3.779,P治疗组<0.001；Z对照组=-4.064,P对照组<0.001)、自己洗澡(Z治疗组=-3.981,P治疗组<0.001；Z对照组=-4.271,P对照组<0.001)、椅/床转移(Z治疗组=-4.498,P治疗组<0.001；Z对照组=-4.391,P对照组<0.001)、行走/坐椅子(Z治疗组=-4.384,P治疗组<0.001；Z对照组=-4.317,P对照组<0.001)和上楼梯(Z治疗组：=-3.873,P治疗组<0.001；Z对照组=-4.179,P对照组<0.001)因子分治疗前后比较均有显著差异(P<0.05),即治疗后两组患者上述因子分均低于治疗前；而大便控制和膀胱控制因子分治疗前后均无统计学差异(P>0.05)。经配对样本t检验,两组患者MBI总分治疗前后比较均有显著差异(t治疗组=-9.713,P治疗组<0.001；t对照组=-11.86,P对照组<0.001),即治疗后两组患者MBI总分均较治疗前降低。
组间比较,经Mann-Whitney U检验,两组患者治疗前、治疗后大便控制、膀胱控制、进食、穿衣、如厕、个人卫生、自己洗澡、椅/床转移、行走／坐椅子和上楼梯因子分,以及上述因子治疗前后差值均无统计学差异(P>0.05),即两组各MBI因子分分值相当。经两独立样本t检验,两组患者MBI治疗前总分、治疗后总分和治疗前后总分差值无统计学差异(P>0.05),即治疗后两组患者日常生活能力提高程度相当。
(5)不良反应
两组患者在试验过程中未出现针刺后不良反应。结论
本研究初步表明,不管是临床疗效、神经功能缺损的改善,还是日常生活能力的比较,董氏奇穴的临床疗效与常规针刺相当。临床上,为避免中风患者病程长,长期使用十四经穴,董氏奇穴是一个很好的替换疗法,值得推广。
Background
Stroke is a common disease in elder people. The incidence of stroke is about2,000,000in our country every year, and its mortality goes to approximately1,500,000. The incidence and mortality of stroke rise year by year due to the increasing aging of population, therefore the prevention and cure of stroke still remain the key point of modern medicine. Most of the apoplectic patients who get effective medical attention during acute phase can regain consciousness with the development of modern medicine, yet most of them shows varying degrees of apoplectic sequelae such as hemiplegic paralysis, hemidysesthesia, hemianopsia, gatism and disorder in speaking, swallowing, cognition and ADL. About15%of the survivers require nursing, which seriously aggravates their living quality and brings great burden to their families and the society. Searching the cure for apoplectic sequelae is a challenging task and so far we are still destitute of pertinent therapeutic measures internationally. However, there are certain advantages and distinguishing features in acupuncture since the experience of curing apoplectic sequelae by acupuncture has been accumulated for thousands of years in China.
Clinically, receiving effective treatment during recovery phase can accelerate the patient's recovery, reduce the occurrence of apoplectic sequelae, abate neurologic defect and ameliorate his/her living quality, therefore it plays a important role in the whole treatment of stroke. However, the recovery phase of stroke refers to the one to six months after the incidence, which indicates the course of disease is prolonged. Tolerance to acupoints may occur after long-term treatment using acupoints of fourteen meridians, therefore leads to low effect of acupoints. The Dong's Extra Acupoints School, a unique system which differs from the traditional acupoints of fourteen meridians, is now wildly used in departments of medicine, surgery, gynecology, pediatrics, ophthalmology and otorhinolaryngology. I attempted to integrate Dong's Extra Acupoints treatment into the whole conventional treatments based on western medicine and have achieved good results. After consulting relevant documents, I found out that although Dong's Extra Acupoints treatment has been used in clinic, there's neither related reports about the specific effect of the treatment of apoplectic sequelae nor judgment between Dong's Extra Acupoints treatment and the conventional needling treatment.
From the above, this research provides clinical evidence for further popularization of Dong's Extra Acupoints School through observing the results of Dong's Extra Acupoints treatment for apoplectic sequelae, evaluated by CSS and ADL standard, and comparing with regular needling treatment; it offers an effective treatment for apoplectic sequelae.
Objective
To discuss the clinical effect of Dong's Extra Acupoints treatment for apoplectic sequelae and compare with the effect of conventional needling treatment. To offer new methods of curing apoplectic sequelae for clinicians'reference.
Methods
(1)Source of Cases and Dividing Groups
All60apoplectic sequelae patients were hospitalized in the out-patient department of acupuncture and moxibustion and the in-patient department of neurology from November2011to November2012. Randomly divided the patients into the therapeutic group and the control group.
(2)Blinding Method
Evaluate the results by blinding method. The patients are blinded and the evaluator, the operator and the counters are all separated.
(3)Diagnostic Criteria
The diagnostic criteria of TCM follows The Diagnosis of Stroke and the Evaluation of Curative Effect (Trial) issued by the Acute Brain Disease Group of the State Administration of TCM. The diagnostic criteria of western medicine follows The Main Points of Diagnosing Cerebrovascular Diseases issued by the Chinese Society of Neurology and the Chinese Society of Neurosurgery in1996.
(4)Inclusion Criteria
①Patients who meet the diagnostic criteria above, male or female;ヾiagnosed by cranial CT or MRI;③with stable vital signs, clear consciousness, coordination and persistence with treatment;④the onset of stroke was1to6months ago and the strength of upper and lower limbs was between level Ⅰ to level Ⅲ;⑤receive the treatment willingly and has signed the informed consents.
(5)Exclusion Criteria
①Patients who meet the diagnostic criteria above and diagnosed by cranial CT or MRI without apparent apoplectic sequelae syndrome;②in a critical condition or an unstable acute phase with consciousness disorder and severe cognitive disorder, complete and sensory aphasia, or post-stroke depression;③with coexistence of severe diabetes and diseases of heart, lungs, liver and kidneys or severe bleeding tendency;④aabove70years old or below50years old;⑤with a course longer than6months;⑥with paralysis which has been evaluated above Grade1(apart from Grade1) by Modified Ashworth Scale;﹚ho feel fear of needling;⑦who takes unrelated medicine.
(6)Exterior and Drop-out Criteria
①Cases which are found unqualified after inclusion;②Patients with low degree of compliance; occurrence of severe adverse events, complications or special physiological changes that are unsuited for the treatment;③Patients who fail to reach1/2of the course of treatment.
(7)Suspension Criteria
Experiment should be suspended as soon as the patient's condition gets worse or severe complications and adverse reactions appear. The results of patients who have reached1/2of the treatment will be taken into account as curative effect, and the results of patients in suspended experiments due to adverse reactions will be taken as adverse reactions cases.
(8)Therapeutic Method
1.Basic Treatment
Regular treatments of western medicine were adopted. Hematencephalon patients were given treatments of controlling cerebral edema, adjusting blood pressure, maintaining the fluid, electrolyte and acid-base balance and preventing infections. Cerebral infarction patients were given treatments of anti-freezing, thrombolysis, defibrinating, anti-platelet aggregation, lipid-lowering, nourishing nerves and ameliorating cerebral circulation.
2.Dong's Extra Acupoints Treatment
Acupoints selection:Take Linggu(PA1), Dabai(PA2), Zhongjiuli(TH53) on the healthy side and Shenguan(LE44, deputy acupoints of Tihuang) on both sides as main acupoints. Add Shangqiu(SP5) and Zhenghui when the patient has aphasia with stiff tongue and pair with Cesanli(LE48) and Liuwan(DT292) on the opposite side for shoulder aching.When dealing patients with hand spasm, Zhongxian(PA4) and Zhongzi(PA3) on the opposite side should be added. Acupoints above can be added or decreased according to condition and body position of the patient.
Operating:Triply puncture0.5-1cun from Dabai(PA2) to Linggu(PAl) on the same side; triply puncture1.5-2cun from Linggu(PAl) to Zhongxian(PA4) on the same side; after perpendicularly puncturing1-2cun on Zhongjiuli(TH53), translate to left and right side for1cun and triply puncture it; puncture back1-2cun from Shenguan(LE44) towards kidney meridian. Retain the needle for30minutes after the arrival of Qi and manipulate it every5minutes. Admonish the patient to exercise the limb mitiatively or passively.
3. Regular Needling Treatment
Acupoints selection:Take Shuigou(GV26) and Baihui(GV20), Neiguan(P6) on both sides, Jiquan(H1), Chize(L5), Weizhong(B40), Zusanli(S36) and Sanyinjiao(SP6) as main acupoints. Jiache(S6) and Dicang(S4) should be added if the patient has a drooping angle of the mouth. Add Yamen(GV15), Lianquan(CV23) and Tongli(H5) for sluggish speaking. When aponeurotic system on the affected side paralyses spastically, add Quze(P3) for elbow, Daling(P7) for wrist, Ququan(LR8) for knee and Taixi(K3) for ankle. Acupoints above can be added or decreased according to condition and body position of the patient.
Operating:Birdpeck Shuigou(GV26), puncture Baihui(GV20) and Neiguan(P6) using reducing method by twirling needle for1-3minutes. Puncture Zusanli(S36) and Sanyinjiao(SP6) using reinforcing method by lifting and thrusting needle. Select the point2cuns below the original acupoint of Jiquan(H1) on the heart meridian, then avoid armpit hair and perpendicularly insert the needle using reducing method by lifting and thrusting needle to the degree when the patient feels numbness, swelling and twitching in upper limbs. Perpendicularly puncture Chize(L5) and Weizhong(B40) using reducing method by lifting and thrusting needle until the patient feels twitching in the limbs. Retain the needles of all acupoints for30minutes and manipulate them every5minutes.
Both of the groups of patients received basic treatment, while the therapeutic group was treated with Dong's Extra Acupoints Treatment and patients of the control group received regular needling treatment. Each group of patients were treated once a day for10days as one curing course. Patients rested for2days between courses and the clinical curative effect was observed after3continuous courses.
(9)Observing Methods
1. Major Index
①Clinical curative effect:The observation of the clinical curative effect after the observation cycle. Record the scores of two groups before treatment and after treatment according to The Diagnosis of Stroke and the Evaluation of Curative Effect (Trial) and The Diagnostic Criteria of Diseases issued by the Acute Brain Disease Group of the State Administration of TCM. Calculate the percentage of converted value [The percentage of converted value before and after treatment=(Scores before treatment-Scores after treatment)/Scores before treatment] and evaluate according to The Curative Effect Evaluation Criteria of Stroke (Basically recovered:≥81%, below6points. Outstandingly improved:≥56%,<81%.Improved:≥36%,<56%. Slightly improved:≥11%,<36%. Without changes:<11%. Aggravated(including death):negative value).
②Observe the improvement of neurologic defect and evaluate by CSS.
2. Secondary Index
①Observe the improvement of ADL and evaluate by MBI.
②Observe the adverse reactions during treatment.
The indexes above are measured once before treatment and once after treatment by a special person who doesn't know which group the patients are in.
(10)Data Processing
The data are analyzed using the SPSS13.0for Windows software package after being sorted out by special staff. Measurement data are shown in±D. The normally distributed measurement data of pre-treatment and post-treatment are analyzed by paired t test, and comparison between groups is analyzed by2independent samples t test.Enumeration data is analyzed using Chi-square test and corrected Chi-square test. Measurement and level data that are not normally distributed are analyzed by nonparametric tests such as rank-sum test. The difference will be considered significant if P≤0.05.
Results
(1)The Exterior and Drop-out Cases
None of the60cases was exterior or dropped-out. The differences such as gender, age, course of disease, character of disease, position of disease, severity and syndromes between two groups are not significant(P>0.05), therefore the two groups of patients can be considered as comparable.
(2)Comparison of Curative Effect between Two Groups
The therapeutic group:1basically recovered,2outstandingly improved,7improved,15slightly improved,5without changes and0aggravated. Total effectivity rate goes to83.3%.
The control group:0basically recovered,4outstandingly improved,9improved,14slightly improved,3without changes and0aggravated.Total effectivity rate goes to90.0%.
The curative effect of two groups was analyzed by Mann-Whitney U test, and Z=-0.890, P=0.373. The difference was not significant, which shows the curative effect of two groups are equivalent.
(3)Comparison of Improvement of Neurological Defect between Two Groups
Compared in group and analyzed by Wilcoxon sign test, the factor scores of facioplegia (Ztherapeutic=-3.051, Ptherapeutic=0.002; Zcontrol=-4.264, Pcontrol<0.001), speaking (Ztherapeutic=-3.140, Ptherapeutic=0.002; Zcontrol=-3.025, Pcontrol=0.002), strength of upper limbs(Ztherapeutic=-4.378, Ptherapeutic<0.001; Zcontrol=-4.069, Pcontrol<0.001), strength of hands(Ztherapeutic=-4.195, Ptherapeutic<0.001; Zcontrol=-4.110, Pcontrol<0.001), strength of lower limbs(Ztherapeutic=-4.099, Ptherapeutic<0.001; Zcontrol=-3.775, Pcontrol<0.001) and walking ability(Ztherapeutic=-4.565, Ptherapeutic<0.001; Zcontrol=-4.358, Pcontrol<0.001) of two groups of patients showed significant differences before and after treatment(P<0.05), indicates the post-treatment factor scores above are lower than pre-treatment factor scores between two groups. The factor scores of consciousness and horizontal gaze before and after treatment showed no significant differences(P>0.05). Analyzed by paired sample t test, the total scores of CSS before and after treatment revealed significant differences between two groups(ttherapeutic=8.635, Ptherapeutic<0.001; tcontrol=8.686,Pcontrol<0.001), which means the total scores of CSS after treatment were lower than the total scores before treatment.
Compared between two groups and analyzed by Mann-Whitney U test, the difference of facioplegia factor scores before and after treatment(Z=-2.197, P=0.028) showed significant differences(P<0.05). The facioplegia factor of the control group was higher than the therapeutic group. However, the horizontal gaze, speaking, strength of upper limbs, strength of hands strength of lower limbs and walking ability factor scores showed no significant differences(P>0.05), indicating the equivalence of the CSS factor scores above between two groups. After analysis by two independent samples t test, the total score of CSS before treatment, total score after treatment and total difference before and after treatment between two groups showed no significant differences(P>0.05), indicating the equivalent improvement of neurological defect of the patients from two groups.
(4)Comparison of Improvement of ADL between Two Groups
Compared in group and analyzed by Wilcoxon sign test, the factor scores of ingress (Ztherapeutic=-3.890, Ptherapeutic<0.001; Zcontrol=-3.695, Pcontrol<0.001), dressing up (Ztherapeutic=-4.089, Ptherapeutic<0.001; Zcontrol=-4.455, Pcontrol<0.001), toileting (Ztherapeutic=-4.257, Ptherapeutic<0.001; Zcontrol=-4.195, Pcontrol<0.001), personal hygiene (Ztherapeutic=-3.779, Ptherapeutic<0.001; Zcontrol=-4.064, Pcontrol<0.001), taking a shower individually(Ztherapeutic=-3.981, Ptherapeutic<0.001; Zcontrol=-4.271, Pcontrol<0.001), transferring between a bed and a chair(Ztherapeutic=-4.498, Ptherapeutic<0.001; Zcontrol=-4.391, Pcontrol<0.001), walking and sitting on a chair (Ztherapeutic=-4.384, Ptherapeutic<0.001; Zcontrol=-4.317, Pcontrol<0.001) and going up stairs(Ztherapeutic=-3.873, Ptherapeutic<0.001; Zcontrol=-4.179, Pcontrol<0.001) of two groups of patients showed significant differences before and after treatment(P<0.05), indicates the post-treatment factor scores above are lower than pre-treatment factor scores between two groups. The factor scores of defecation control and urination control before and after treatment showed no significant differences(P>0.05). Analyzed by paired sample t test, the total scores of MBI before and after treatment revealed significant differences between two groups(ttherapeutic=-9.713, Ptherapeutic<0.001; tcontrol=-11.86,Pcontrol<0.001), which means the total scores of MBI after treatment were lower than those before treatment.
Compared between two groups and analyzed by Mann-Whitney U test, the pre-and post-treatment factor scores of defecation control, urination control, ingress, dressing up, toileting, personal hygiene, taking a shower individually, transferring between bed and chair, walking/sitting on a chair, going up stairs and the difference of the pre-and post-treatment factors above showed no significant differences(P>0.05), indicating the MBI scores of two groups were almost the same. After analysis by two independent samples t test, the total score before treatment of MBI, total score after treatment and total difference before and after treatment between two groups showed no significant differences(P>0.05), indicating the equivalent improvement of ADL of the patients from two groups.
(5)Adverse Reactions
No post-needling adverse reactions occurred during treatments.
Conclusion
Results of the research suggest that the clinical curative effect of Dong's Extra Acupoints Treatment is equivalent to that of regular needling treatment considering either the improvement of neurological defect or the enhancement of ADL. Clinically, in order to avoid long-term treatment using acupoints of fourteen meridians, we can adopt Dong's Extra Acupoints Treatment as a form of alternative therapy which worth popularizing.
中风病是常见的中老年疾病,我国每年中风病发病率约为200万,死亡率约150万人,并随着人口老龄化的增长,其发病率和死亡率还会逐年增高,因此防治中风病仍是现今医学界工作的重心。随着现代医学的发展,中风病病人在急性期得到有效的救治,绝大多数神志可恢复,但一般都有不同程度的后遗症,如偏瘫、偏身感觉障碍、偏盲等三偏症状及言语障碍、吞咽障碍、认知障碍、日常活动能力障碍以及大小便障碍等,其中约15%的存活病人需要照看,严重影响了患者的生活质量,给社会和家庭带来了沉重的负担。因此,中风病后遗症的治疗是当今一项极具挑战的任务,但目前国际上尚缺乏有针对性的治疗措施。而针灸对中风后遗症的治疗已经积累了数千年的经验,有一定的特点和优势。
临床上,考虑中风恢复期有效的治法,可以促进中风患者的康复,减少中风后遗症的发生,减轻神经缺损的程度,从而提高其生活质量,故在整个中风病治疗中占据重要地位。但是,中风恢复期是指中风发病1个月至半年以内,病程比较长,长期使用十四经穴,容易出现穴位耐受性的问题,导致穴位效应差；而董氏奇穴,有别于十四正经的独特的针灸体系,自成一派,现被广泛用于内、外、妇、儿、五官等科疾病中,遂笔者在西医常规治疗的基础上,尝试结合董氏奇穴治疗中风后遗症,取得良好的效果。经查阅相关文献,发现董氏奇穴虽然在临床上已经开始应用,但是对中风后遗症的具体疗效,它与常规针灸疗法孰优孰劣,还未见相关报道。
综上,本研究通过中国脑卒中临床神经功能缺损程度评分量表(CSS)、日常生活活动能力等评价指标,观察董氏奇穴对中风后遗症患者的治疗效果,并与常规针刺疗法比较,为董氏奇穴的进一步推广,提供临床证据；为中风后遗症的治疗,提供一种有效的治疗手段。
目的
探讨董氏奇穴治疗中风后遗症的临床疗效,并与常规针刺的疗效作比较,为中风后遗症的治疗提供新的方法,以供临床医生参考。
方法
(1)病例来源和分组
60例中风后遗症患者均于2011年11月-2012年11月,在南方医院针灸科门诊、神经内科住院部收治。根据随机数字表法将60例病例随机分为治疗组和对照组,每组各30例。
(2)盲法
实行单盲法,盲患者。同时实行结果评估者、操作者、统计者三分离。
(3)诊断标准
中医诊断标准根据国家中医药管理局脑病急症协作组颁布的《中风病诊断与疗效评定诊断(试行)》；西医诊断标准参照中华神经科学会、中华神经外科学会于1996年提出的《各类脑血管病诊断要点》诊断为脑卒中病者。
(4)纳入标准
①符合上文诊断标准,男女不限；②经头颅CT或MRI确诊；③生命体征平稳,意识清楚,配合并坚持治疗者；④发病时间有1-6个月的患者,上、下肢肌力在Ⅰ～Ⅲ级；⑤自愿接受本疗法,并签订知情同意书的患者。
(5)排除标准
①符合上文诊断标准,并经头颅CT或MRI确诊,但无明显中风后遗症症状的患者；②病情危重或急性期病情尚未稳定,伴有意识障碍或严重的认知功能障碍者；或伴有完全性失语和感觉性失语者,或伴有中风后抑郁者；③合并有严重的心、肺、肝、肾疾病,糖尿病,或有严重出血倾向；④年龄≥70岁,或≤40岁者；⑤病程>6月者；⑥用改良的Ashworth痉挛量表评定痉挛在1级以上(不包括1级)者；⑦惧怕针刺者；⑧服用与本病治疗无关药物者。
(6)中止试验标准
试验过程中病情恶化,出现严重的并发症,或出现严重的不良反应,均应中止试验,已超过1/2疗程者,计入疗效统计；因不良反应中止试验者,计入不良反应病例统计。
(7)治疗方法
1.基础治疗
采用西医常规治疗。脑出血病人给予调整血压,维持水、电解质及酸碱平衡,防治感染等。脑梗死病人给予抗血小板聚集、降脂、营养神经、改善脑循环等治疗。
2.董氏奇穴疗法
取穴：以健侧灵骨、大白、中九里,双侧肾关(天皇副穴)为主穴。舌强不语配商丘、正会；肩痛配对侧侧三里、六完；中风手拘挛配对侧重子、重仙。以上穴位可依据患者病情及体位酌情增减。
操作：大白向同侧灵骨齐刺0.5-1寸；灵骨向同侧重仙齐刺1.5-2寸；中九里直刺1-2寸后,左右各旁开1寸向其齐刺；肾关向后肾经方向刺1-2寸。得气后留针30min,每5min行针1次；同时嘱患者主动或被动活动患肢。
3.常规针刺治疗
取穴：以水沟或百会,双侧内关,患侧极泉、尺泽、委中、足三里、三阴交为主穴。口角歪斜者配颊车、地仓；言语蹇涩配哑门、廉泉、通里；患侧经筋屈曲拘挛,肘部者配曲泽,腕部配大陵,膝部配曲泉,踝部配太溪。以上穴位可依据患者病情及体位酌情增减。
操作：水沟用雀啄术,百会、内关用捻转泻法,持续运针1-3分钟；三阴交、足三里用提插补法；刺极泉时,在原穴位置下2寸心经上取穴,避开腋毛,直刺进针,用提插泻法,以患者上肢有麻胀和抽动感为度；尺泽、委中直刺,提插泻法,使肢体有抽动感；诸穴留针30min,每5min行针1次。
两组患者均接受基础治疗,治疗组配合董氏奇穴,对照组配合常规针刺,每组患者每日治疗1次,10次为1疗程。疗程之间休息2天,连续3个疗程后观察临床疗效。
(8)观察方法
1.主要指标
①临床疗效：观察周期结束后,临床疗效的观察。按照国家中医药管理局脑病急症协作组颁发“中风病诊断与疗效评定标准”的“病类诊断标准”记录两组治疗前评分和治疗后评分,计算百分数折算值[病类疗前评分与疗后评分百分数折算法=(治疗前评分-治疗后评分)/治疗前评分],再参照“中风病疗效评定标准”(基本恢复：≥81%,6分以下；显著进步：≥56%,<81%；进步：≥36%,<56%；稍进步；≥11%,<36%；无变化；<11%；恶化(包括死亡)：负值。)评定临床疗效。
②观察神经功能缺损改善情况。采用脑卒中临床神经功能缺损程度评分量表(CSS)进行评价。
2.次要指标：
①观察日常生活活动能力的改善情况。采用改良Barthel指数(MBI)进行评定。
②治疗过程中不良反应的观察。
上述指标均在治疗开始前和疗程结束(或试验中止)时,由专人在不知道患者分组的情况下,各测量1次。
(9)数据处理
所得数据由专人整理后,用SPSS13.0for Windows软件包进行统计学处理。用X±SD表示计量数据；正态分布的计量数据治疗前后的比较采用配对t检验,组间比较采用两独立样本t检验；计数资料采用卡方检验和校正卡方检验；非正态分布的计量资料和等级资料采用秩和检验等非参数检验。若P<-0.05则认为差异有统计学意义。
结果
(1)病例中断与脱落情况
60例患者无1例中断与脱落。两组患者在性别、年龄、病程、病性、病位、病情严重程度和证型的资料比较方面,差异无统计学意义(P>0.05),可认为两组患者具有可比性(P>0.05)。
(2)两组患者临床疗效比较
治疗组基本痊愈1例,显著进步2例,进步7例,稍进步15例,无变化5例,恶化0例,总有效率达83.3%；对照组基本痊愈0例,显著进步4例,进步9例,稍进步14例,无变化3例,恶化0例,总有效率达90.0%；两组临床疗效经Mann-Whitney U检验,Z=-0.890,P=0.373,差异无统计学意义,即两组疗效相当。
(3)两组患者神经功能缺损改善的比较
组内比较,经Wilcoxon符号检验,两组患者面瘫(Z治疗组=-3.051,P治疗组=0.002；Z对照组=-4.264,P<0.001)、言语(Z治疗组=-3.140,P治疗组=0.002；Z对照组=-3.025,P对照组=0.002)、上肢肌力(Z治疗组=-4.378,P治疗组<0.001；Z对照组=-4.069,P对照组<0.001)、手肌力(Z治疗组=-4.195,P治疗组<0.001；Z对照组=-4.110,P对照组<0.001)、下肢肌力(Z治疗组=-4.099,P治疗组<0.001；Z对照组=-3.775,P对照组<0.001)和步行能力(Z治疗组=-4.565,P治疗组<0.001；Z对照组=-4.358,P对照组<0.001)因子分治疗前后比较均有显著差异(P<0.05),即治疗后两组患者上述因子分均低于治疗前；而意识和水平凝视因子分治疗前后比较均无统计学差异(P>0.05)。经配对样本t检验,两组患者CSS总分治疗前后比较均有显著差异(t治疗组=8.635,P治疗组<0.001；t对照组=8.686,P对照组<0.001),即治疗后两组患者CSS总分较治疗前降低。
组间比较,经Mann-Whitney U检验,治疗前后面瘫因子分差值(Z=-2.197,P=0.028)有显著差异(P<0.05),对照组面瘫因子改善情况高于治疗组；而水平凝视、言语、上肢肌力、手肌力、下肢肌力和步行能力因子分均无统计学差异(P>0.05),即两组上述各CSS因子分分值相当。经两独立样本t检验,两组患者CSS治疗前总分、治疗后总分和治疗前后总分差值均无统计学差异(P>0.05),即治疗后两组患者神经功能缺损改善程度相当。
(4)两组患者日常生活能力提高的比较
组内比较,经Wilcoxon检验,两组患者进食(Z治疗组=-3.890,P治疗组<0.001；Z对照组=-3.695,P对照组<0.001)、穿衣(Z治疗组=-4.089,P治疗组<0.001；Z对照组=-4.455,P对照组<0.001)、如厕(Z治疗组=-4.257,P治疗组<0.001；Z对照组=-4.195,P对照组<0.001)、个人卫生(Z治疗组=-3.779,P治疗组<0.001；Z对照组=-4.064,P对照组<0.001)、自己洗澡(Z治疗组=-3.981,P治疗组<0.001；Z对照组=-4.271,P对照组<0.001)、椅/床转移(Z治疗组=-4.498,P治疗组<0.001；Z对照组=-4.391,P对照组<0.001)、行走/坐椅子(Z治疗组=-4.384,P治疗组<0.001；Z对照组=-4.317,P对照组<0.001)和上楼梯(Z治疗组：=-3.873,P治疗组<0.001；Z对照组=-4.179,P对照组<0.001)因子分治疗前后比较均有显著差异(P<0.05),即治疗后两组患者上述因子分均低于治疗前；而大便控制和膀胱控制因子分治疗前后均无统计学差异(P>0.05)。经配对样本t检验,两组患者MBI总分治疗前后比较均有显著差异(t治疗组=-9.713,P治疗组<0.001；t对照组=-11.86,P对照组<0.001),即治疗后两组患者MBI总分均较治疗前降低。
组间比较,经Mann-Whitney U检验,两组患者治疗前、治疗后大便控制、膀胱控制、进食、穿衣、如厕、个人卫生、自己洗澡、椅/床转移、行走／坐椅子和上楼梯因子分,以及上述因子治疗前后差值均无统计学差异(P>0.05),即两组各MBI因子分分值相当。经两独立样本t检验,两组患者MBI治疗前总分、治疗后总分和治疗前后总分差值无统计学差异(P>0.05),即治疗后两组患者日常生活能力提高程度相当。
(5)不良反应
两组患者在试验过程中未出现针刺后不良反应。结论
本研究初步表明,不管是临床疗效、神经功能缺损的改善,还是日常生活能力的比较,董氏奇穴的临床疗效与常规针刺相当。临床上,为避免中风患者病程长,长期使用十四经穴,董氏奇穴是一个很好的替换疗法,值得推广。
Background
Stroke is a common disease in elder people. The incidence of stroke is about2,000,000in our country every year, and its mortality goes to approximately1,500,000. The incidence and mortality of stroke rise year by year due to the increasing aging of population, therefore the prevention and cure of stroke still remain the key point of modern medicine. Most of the apoplectic patients who get effective medical attention during acute phase can regain consciousness with the development of modern medicine, yet most of them shows varying degrees of apoplectic sequelae such as hemiplegic paralysis, hemidysesthesia, hemianopsia, gatism and disorder in speaking, swallowing, cognition and ADL. About15%of the survivers require nursing, which seriously aggravates their living quality and brings great burden to their families and the society. Searching the cure for apoplectic sequelae is a challenging task and so far we are still destitute of pertinent therapeutic measures internationally. However, there are certain advantages and distinguishing features in acupuncture since the experience of curing apoplectic sequelae by acupuncture has been accumulated for thousands of years in China.
Clinically, receiving effective treatment during recovery phase can accelerate the patient's recovery, reduce the occurrence of apoplectic sequelae, abate neurologic defect and ameliorate his/her living quality, therefore it plays a important role in the whole treatment of stroke. However, the recovery phase of stroke refers to the one to six months after the incidence, which indicates the course of disease is prolonged. Tolerance to acupoints may occur after long-term treatment using acupoints of fourteen meridians, therefore leads to low effect of acupoints. The Dong's Extra Acupoints School, a unique system which differs from the traditional acupoints of fourteen meridians, is now wildly used in departments of medicine, surgery, gynecology, pediatrics, ophthalmology and otorhinolaryngology. I attempted to integrate Dong's Extra Acupoints treatment into the whole conventional treatments based on western medicine and have achieved good results. After consulting relevant documents, I found out that although Dong's Extra Acupoints treatment has been used in clinic, there's neither related reports about the specific effect of the treatment of apoplectic sequelae nor judgment between Dong's Extra Acupoints treatment and the conventional needling treatment.
From the above, this research provides clinical evidence for further popularization of Dong's Extra Acupoints School through observing the results of Dong's Extra Acupoints treatment for apoplectic sequelae, evaluated by CSS and ADL standard, and comparing with regular needling treatment; it offers an effective treatment for apoplectic sequelae.
Objective
To discuss the clinical effect of Dong's Extra Acupoints treatment for apoplectic sequelae and compare with the effect of conventional needling treatment. To offer new methods of curing apoplectic sequelae for clinicians'reference.
Methods
(1)Source of Cases and Dividing Groups
All60apoplectic sequelae patients were hospitalized in the out-patient department of acupuncture and moxibustion and the in-patient department of neurology from November2011to November2012. Randomly divided the patients into the therapeutic group and the control group.
(2)Blinding Method
Evaluate the results by blinding method. The patients are blinded and the evaluator, the operator and the counters are all separated.
(3)Diagnostic Criteria
The diagnostic criteria of TCM follows The Diagnosis of Stroke and the Evaluation of Curative Effect (Trial) issued by the Acute Brain Disease Group of the State Administration of TCM. The diagnostic criteria of western medicine follows The Main Points of Diagnosing Cerebrovascular Diseases issued by the Chinese Society of Neurology and the Chinese Society of Neurosurgery in1996.
(4)Inclusion Criteria
①Patients who meet the diagnostic criteria above, male or female;ヾiagnosed by cranial CT or MRI;③with stable vital signs, clear consciousness, coordination and persistence with treatment;④the onset of stroke was1to6months ago and the strength of upper and lower limbs was between level Ⅰ to level Ⅲ;⑤receive the treatment willingly and has signed the informed consents.
(5)Exclusion Criteria
①Patients who meet the diagnostic criteria above and diagnosed by cranial CT or MRI without apparent apoplectic sequelae syndrome;②in a critical condition or an unstable acute phase with consciousness disorder and severe cognitive disorder, complete and sensory aphasia, or post-stroke depression;③with coexistence of severe diabetes and diseases of heart, lungs, liver and kidneys or severe bleeding tendency;④aabove70years old or below50years old;⑤with a course longer than6months;⑥with paralysis which has been evaluated above Grade1(apart from Grade1) by Modified Ashworth Scale;﹚ho feel fear of needling;⑦who takes unrelated medicine.
(6)Exterior and Drop-out Criteria
①Cases which are found unqualified after inclusion;②Patients with low degree of compliance; occurrence of severe adverse events, complications or special physiological changes that are unsuited for the treatment;③Patients who fail to reach1/2of the course of treatment.
(7)Suspension Criteria
Experiment should be suspended as soon as the patient's condition gets worse or severe complications and adverse reactions appear. The results of patients who have reached1/2of the treatment will be taken into account as curative effect, and the results of patients in suspended experiments due to adverse reactions will be taken as adverse reactions cases.
(8)Therapeutic Method
1.Basic Treatment
Regular treatments of western medicine were adopted. Hematencephalon patients were given treatments of controlling cerebral edema, adjusting blood pressure, maintaining the fluid, electrolyte and acid-base balance and preventing infections. Cerebral infarction patients were given treatments of anti-freezing, thrombolysis, defibrinating, anti-platelet aggregation, lipid-lowering, nourishing nerves and ameliorating cerebral circulation.
2.Dong's Extra Acupoints Treatment
Acupoints selection:Take Linggu(PA1), Dabai(PA2), Zhongjiuli(TH53) on the healthy side and Shenguan(LE44, deputy acupoints of Tihuang) on both sides as main acupoints. Add Shangqiu(SP5) and Zhenghui when the patient has aphasia with stiff tongue and pair with Cesanli(LE48) and Liuwan(DT292) on the opposite side for shoulder aching.When dealing patients with hand spasm, Zhongxian(PA4) and Zhongzi(PA3) on the opposite side should be added. Acupoints above can be added or decreased according to condition and body position of the patient.
Operating:Triply puncture0.5-1cun from Dabai(PA2) to Linggu(PAl) on the same side; triply puncture1.5-2cun from Linggu(PAl) to Zhongxian(PA4) on the same side; after perpendicularly puncturing1-2cun on Zhongjiuli(TH53), translate to left and right side for1cun and triply puncture it; puncture back1-2cun from Shenguan(LE44) towards kidney meridian. Retain the needle for30minutes after the arrival of Qi and manipulate it every5minutes. Admonish the patient to exercise the limb mitiatively or passively.
3. Regular Needling Treatment
Acupoints selection:Take Shuigou(GV26) and Baihui(GV20), Neiguan(P6) on both sides, Jiquan(H1), Chize(L5), Weizhong(B40), Zusanli(S36) and Sanyinjiao(SP6) as main acupoints. Jiache(S6) and Dicang(S4) should be added if the patient has a drooping angle of the mouth. Add Yamen(GV15), Lianquan(CV23) and Tongli(H5) for sluggish speaking. When aponeurotic system on the affected side paralyses spastically, add Quze(P3) for elbow, Daling(P7) for wrist, Ququan(LR8) for knee and Taixi(K3) for ankle. Acupoints above can be added or decreased according to condition and body position of the patient.
Operating:Birdpeck Shuigou(GV26), puncture Baihui(GV20) and Neiguan(P6) using reducing method by twirling needle for1-3minutes. Puncture Zusanli(S36) and Sanyinjiao(SP6) using reinforcing method by lifting and thrusting needle. Select the point2cuns below the original acupoint of Jiquan(H1) on the heart meridian, then avoid armpit hair and perpendicularly insert the needle using reducing method by lifting and thrusting needle to the degree when the patient feels numbness, swelling and twitching in upper limbs. Perpendicularly puncture Chize(L5) and Weizhong(B40) using reducing method by lifting and thrusting needle until the patient feels twitching in the limbs. Retain the needles of all acupoints for30minutes and manipulate them every5minutes.
Both of the groups of patients received basic treatment, while the therapeutic group was treated with Dong's Extra Acupoints Treatment and patients of the control group received regular needling treatment. Each group of patients were treated once a day for10days as one curing course. Patients rested for2days between courses and the clinical curative effect was observed after3continuous courses.
(9)Observing Methods
1. Major Index
①Clinical curative effect:The observation of the clinical curative effect after the observation cycle. Record the scores of two groups before treatment and after treatment according to The Diagnosis of Stroke and the Evaluation of Curative Effect (Trial) and The Diagnostic Criteria of Diseases issued by the Acute Brain Disease Group of the State Administration of TCM. Calculate the percentage of converted value [The percentage of converted value before and after treatment=(Scores before treatment-Scores after treatment)/Scores before treatment] and evaluate according to The Curative Effect Evaluation Criteria of Stroke (Basically recovered:≥81%, below6points. Outstandingly improved:≥56%,<81%.Improved:≥36%,<56%. Slightly improved:≥11%,<36%. Without changes:<11%. Aggravated(including death):negative value).
②Observe the improvement of neurologic defect and evaluate by CSS.
2. Secondary Index
①Observe the improvement of ADL and evaluate by MBI.
②Observe the adverse reactions during treatment.
The indexes above are measured once before treatment and once after treatment by a special person who doesn't know which group the patients are in.
(10)Data Processing
The data are analyzed using the SPSS13.0for Windows software package after being sorted out by special staff. Measurement data are shown in±D. The normally distributed measurement data of pre-treatment and post-treatment are analyzed by paired t test, and comparison between groups is analyzed by2independent samples t test.Enumeration data is analyzed using Chi-square test and corrected Chi-square test. Measurement and level data that are not normally distributed are analyzed by nonparametric tests such as rank-sum test. The difference will be considered significant if P≤0.05.
Results
(1)The Exterior and Drop-out Cases
None of the60cases was exterior or dropped-out. The differences such as gender, age, course of disease, character of disease, position of disease, severity and syndromes between two groups are not significant(P>0.05), therefore the two groups of patients can be considered as comparable.
(2)Comparison of Curative Effect between Two Groups
The therapeutic group:1basically recovered,2outstandingly improved,7improved,15slightly improved,5without changes and0aggravated. Total effectivity rate goes to83.3%.
The control group:0basically recovered,4outstandingly improved,9improved,14slightly improved,3without changes and0aggravated.Total effectivity rate goes to90.0%.
The curative effect of two groups was analyzed by Mann-Whitney U test, and Z=-0.890, P=0.373. The difference was not significant, which shows the curative effect of two groups are equivalent.
(3)Comparison of Improvement of Neurological Defect between Two Groups
Compared in group and analyzed by Wilcoxon sign test, the factor scores of facioplegia (Ztherapeutic=-3.051, Ptherapeutic=0.002; Zcontrol=-4.264, Pcontrol<0.001), speaking (Ztherapeutic=-3.140, Ptherapeutic=0.002; Zcontrol=-3.025, Pcontrol=0.002), strength of upper limbs(Ztherapeutic=-4.378, Ptherapeutic<0.001; Zcontrol=-4.069, Pcontrol<0.001), strength of hands(Ztherapeutic=-4.195, Ptherapeutic<0.001; Zcontrol=-4.110, Pcontrol<0.001), strength of lower limbs(Ztherapeutic=-4.099, Ptherapeutic<0.001; Zcontrol=-3.775, Pcontrol<0.001) and walking ability(Ztherapeutic=-4.565, Ptherapeutic<0.001; Zcontrol=-4.358, Pcontrol<0.001) of two groups of patients showed significant differences before and after treatment(P<0.05), indicates the post-treatment factor scores above are lower than pre-treatment factor scores between two groups. The factor scores of consciousness and horizontal gaze before and after treatment showed no significant differences(P>0.05). Analyzed by paired sample t test, the total scores of CSS before and after treatment revealed significant differences between two groups(ttherapeutic=8.635, Ptherapeutic<0.001; tcontrol=8.686,Pcontrol<0.001), which means the total scores of CSS after treatment were lower than the total scores before treatment.
Compared between two groups and analyzed by Mann-Whitney U test, the difference of facioplegia factor scores before and after treatment(Z=-2.197, P=0.028) showed significant differences(P<0.05). The facioplegia factor of the control group was higher than the therapeutic group. However, the horizontal gaze, speaking, strength of upper limbs, strength of hands strength of lower limbs and walking ability factor scores showed no significant differences(P>0.05), indicating the equivalence of the CSS factor scores above between two groups. After analysis by two independent samples t test, the total score of CSS before treatment, total score after treatment and total difference before and after treatment between two groups showed no significant differences(P>0.05), indicating the equivalent improvement of neurological defect of the patients from two groups.
(4)Comparison of Improvement of ADL between Two Groups
Compared in group and analyzed by Wilcoxon sign test, the factor scores of ingress (Ztherapeutic=-3.890, Ptherapeutic<0.001; Zcontrol=-3.695, Pcontrol<0.001), dressing up (Ztherapeutic=-4.089, Ptherapeutic<0.001; Zcontrol=-4.455, Pcontrol<0.001), toileting (Ztherapeutic=-4.257, Ptherapeutic<0.001; Zcontrol=-4.195, Pcontrol<0.001), personal hygiene (Ztherapeutic=-3.779, Ptherapeutic<0.001; Zcontrol=-4.064, Pcontrol<0.001), taking a shower individually(Ztherapeutic=-3.981, Ptherapeutic<0.001; Zcontrol=-4.271, Pcontrol<0.001), transferring between a bed and a chair(Ztherapeutic=-4.498, Ptherapeutic<0.001; Zcontrol=-4.391, Pcontrol<0.001), walking and sitting on a chair (Ztherapeutic=-4.384, Ptherapeutic<0.001; Zcontrol=-4.317, Pcontrol<0.001) and going up stairs(Ztherapeutic=-3.873, Ptherapeutic<0.001; Zcontrol=-4.179, Pcontrol<0.001) of two groups of patients showed significant differences before and after treatment(P<0.05), indicates the post-treatment factor scores above are lower than pre-treatment factor scores between two groups. The factor scores of defecation control and urination control before and after treatment showed no significant differences(P>0.05). Analyzed by paired sample t test, the total scores of MBI before and after treatment revealed significant differences between two groups(ttherapeutic=-9.713, Ptherapeutic<0.001; tcontrol=-11.86,Pcontrol<0.001), which means the total scores of MBI after treatment were lower than those before treatment.
Compared between two groups and analyzed by Mann-Whitney U test, the pre-and post-treatment factor scores of defecation control, urination control, ingress, dressing up, toileting, personal hygiene, taking a shower individually, transferring between bed and chair, walking/sitting on a chair, going up stairs and the difference of the pre-and post-treatment factors above showed no significant differences(P>0.05), indicating the MBI scores of two groups were almost the same. After analysis by two independent samples t test, the total score before treatment of MBI, total score after treatment and total difference before and after treatment between two groups showed no significant differences(P>0.05), indicating the equivalent improvement of ADL of the patients from two groups.
(5)Adverse Reactions
No post-needling adverse reactions occurred during treatments.
Conclusion
Results of the research suggest that the clinical curative effect of Dong's Extra Acupoints Treatment is equivalent to that of regular needling treatment considering either the improvement of neurological defect or the enhancement of ADL. Clinically, in order to avoid long-term treatment using acupoints of fourteen meridians, we can adopt Dong's Extra Acupoints Treatment as a form of alternative therapy which worth popularizing.
引文
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