“靳三针”联合运动整复疗法治疗中风后痉挛性偏瘫临床观察
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摘要
目的:探讨"靳三针"联合运动整复疗法对中风后痉挛性偏瘫患者的临床疗效。方法:选择2016年6月—2018年12月在医院收治的脑卒中痉挛性偏瘫患者90例,随机分为两组,"靳三针"联合运动整复疗法组(治疗组)和对照组,每组各45例。治疗组在常规的药物治疗和康复训练的基础上给予"靳三针"联合运动整复疗法治疗,对照组仅仅给予常规的药物治疗和康复训练,每天治疗1次,1周治疗4次,前后共治疗2周。观察并比较两组患者治疗前、治疗1周后、治疗2周后的改良Ashworth痉挛量表(MAS)分级、四肢简化Fugl-Meyer评分(FMA)、功能综合评定量表评分(FCA)、临床神经功能缺损程度评分(NDS),同时记录并比较治疗2周后两组患者的临床有效率。结果:治疗2周后,治疗组临床有效率为93.3%,对照组临床有效率为77.8%,两组比较,差异有显著性(P<0.05),治疗1周后,治疗组和对照组的各指标均较治疗前明显改善(P<0.05),同时,治疗组在改善各项指标方面明显优于对照组(P<0.05),治疗2周后,治疗组和对照组的各指标均较治疗前和治疗7 d后明显改善(P<0.05),同时,治疗组在改善各项指标方面明显优于对照组(P<0.05)。结论:"靳三针"联合运动整复疗法治疗中风后痉挛性偏瘫能改善患者痉挛指数及神经缺损症状,疗效优于常规的药物治疗和康复训练,且操作简便,值得在临床上推广运用。
Objective:To observe the therapeutic effect of Jin's three-needle combined with physical exercise reduction therapy for post-stroke spastic hemiplegia. Methods:Totally 90 patients were randomized into the Jin's three-needle combined with physical exercise reduction therapy group(the treatment group)and control group,with 45 in each. The patients in the control group were treated with conventional medication and rehabilitation training and the patients in the treatment group were treated with Jin's threeneedle combined with physical exercise reduction therapy on the basis of conventional medication and rehabilitation training,with a course of 2 weeks. Modified Ashworth scales(MAS)of Grading,Fugl-Meyer assessment(FMA),the functional comprehensive assessment(FCA),neurological deficit score(NDS)were recorded before and after 7-day and 14-day treatment. At the same time,the total effective rate of the two groups were recorded and compared after 2 weeks of treatment. Results:The total effective rate of the Jin's three-needle combined with physical exercise reduction therapy group and control group was 93.3%,and 77.8% respectively,with the difference showing statistically significant(P<0.01). The scores of MAS,FMA,FCA and NDS were significantly improved in the Jin's three-needle combined with physical exercise reduction therapy group and control group after 7-day treatment(P<0.05). The improvement of all indicators in the Jin's three-needle combined with physical exercise reduction therapy group was superior to that in control group(P<0.05). Comparing with before and after 7-day treatment,the indicators in all groups were significantly improved after 14-day treatment(P<0.05),especially in the Jin's three-needle combined with physical exercise reduction therapy group(P<0.05). Conclusion:The Jin's three-needle combined with physical exercise reduction therapy on the basis of conventional medication and rehabilitation training therapy is more effective than only conventional medication and rehabilitation training therapy for post-stroke spastic hemiplegia,which can relieve the spasm and neurological deficits,is worth for application in clinical experience.
Objective:To observe the therapeutic effect of Jin's three-needle combined with physical exercise reduction therapy for post-stroke spastic hemiplegia. Methods:Totally 90 patients were randomized into the Jin's three-needle combined with physical exercise reduction therapy group(the treatment group)and control group,with 45 in each. The patients in the control group were treated with conventional medication and rehabilitation training and the patients in the treatment group were treated with Jin's threeneedle combined with physical exercise reduction therapy on the basis of conventional medication and rehabilitation training,with a course of 2 weeks. Modified Ashworth scales(MAS)of Grading,Fugl-Meyer assessment(FMA),the functional comprehensive assessment(FCA),neurological deficit score(NDS)were recorded before and after 7-day and 14-day treatment. At the same time,the total effective rate of the two groups were recorded and compared after 2 weeks of treatment. Results:The total effective rate of the Jin's three-needle combined with physical exercise reduction therapy group and control group was 93.3%,and 77.8% respectively,with the difference showing statistically significant(P<0.01). The scores of MAS,FMA,FCA and NDS were significantly improved in the Jin's three-needle combined with physical exercise reduction therapy group and control group after 7-day treatment(P<0.05). The improvement of all indicators in the Jin's three-needle combined with physical exercise reduction therapy group was superior to that in control group(P<0.05). Comparing with before and after 7-day treatment,the indicators in all groups were significantly improved after 14-day treatment(P<0.05),especially in the Jin's three-needle combined with physical exercise reduction therapy group(P<0.05). Conclusion:The Jin's three-needle combined with physical exercise reduction therapy on the basis of conventional medication and rehabilitation training therapy is more effective than only conventional medication and rehabilitation training therapy for post-stroke spastic hemiplegia,which can relieve the spasm and neurological deficits,is worth for application in clinical experience.
引文
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[7]国家中医药管理局脑病急症科研协作组.中风病诊断与疗效评定标准[J].北京中医药大学报，1996,19(1),55-56.
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[10]赵建国，徐振华，曹辰虹.针刺锥体区治疗卒中偏瘫痉挛状态的临床研究[J].中国中医药信息杂志，2003,10(7):10-12.
[11]饶明俐.中国脑血管病防治指南[M].北京：人民卫生出版社，207:20-50.
[12]土维治.神经病学[M]. 5版.北京：人民卫生出版社，2004:165.
[13]郎建英，庄礼兴，贾超，等.靳三针疗法治疗缺血性中风后痉挛性偏瘫临床观察[J].新中医，2011,43(11):93-95.
[14] Bohannon R W,Smith M B. Interrater reliability on a modified Ashworth scale of muscle spasticity[J]. Phys Ther,1987,67(2):206-207.
[15]胡永善，吴毅，范文可，等.功能综合评定量表的研究（一）量表设计[J].中国康复医学杂志，2002,17(1):35-38.
[16]范文可，胡永善，吴毅，等.功能综合评定量表效度的研究[J].中国康复医学杂志，2003,18(6):325-329.
[17] Goldstein L B,Bertels C,Davis J N. Interraterreliability Of the NIH strokescale[J]. ArchNeurol,1989,46(6):660-662.
[18]中华人民共和国卫生部医政司.中国康复医学诊疗规范[M].北京：华夏出版社，1999:12.
[19]燕铁斌.临床痉挛指数：痉挛的综合临床评定[J].现代康复，2000,4(1):88-89.
[20]南登昆.康复医学[M].3版.北京：人民卫生出版社，2004:202-208.
[21]窦祖林.痉挛-评估与治疗[M].北京：人民卫生出版社，2004:64-68.
[22]曾访溪，庄礼兴，廖穆熙，等.手足挛三针为主治疗中风后痉挛性瘫痪的临床随机对照研究[J].辽宁中医杂志，2018,45(7):1481-1483.
[23]石新涛，赵霞，张利鑫，等.消栓通络颗粒内服联合“靳三针”治疗脑卒中后痉挛性瘫痪的临床研究[J].重庆医学，2017,46(32):4574-4576.
[24]焦俊杰，郭洪亮，刘丽杰，等.强制性运动疗法对急性脑卒中后偏瘫患者早期神经功能的影响研究[J].中国全科医学，2016,19(16):1968-1971.
[2] Sommerfeld D K,Eek E U,Svensson A,et al. Spasticity after stroke:its occurrence and association with motor impairments and activity limitations[J]. Stroke,2003,35(1):134-139.
[3] Hefter H,Jost W H,Reissig A,et al. Classification of posture in poststroke upper limb spasticity:a potential decision tool for botulinum toxin a treatment?[J]. Int J Rehabil Res,2012,35(3):227-233.
[4] Marciniak C. Poststroke hypertonicity:upper limb assessment and treatment. Topics in Stroke Rehabilitation[J].Top Stroke Rehabli,2011,18(3):179-194.
[5] Naro A,Leo A,Russo M,et al. Breakthroughs in the spasticity management:are non-pharmacological treatments the future?[J].J Clin Neurosc,2017,39(5):16-27.
[6]杨海涛，庄礼兴，刘悦.颞三针配合挛三针治疗中风后痉挛性偏瘫疗效观察[J].中国针灸，2013,33(10):889-892.
[7]国家中医药管理局脑病急症科研协作组.中风病诊断与疗效评定标准[J].北京中医药大学报，1996,19(1),55-56.
[8]唐强.临床康复学[M].上海：上海科学技术出版社，2009:12-24.
[9] B r u n n s t r o m. M o v e m e n t t h e r a p y i n h e m i p l e g i n. A neurophysiological approach[M]. New York:Harper and Row Publishers,1970:5.
[10]赵建国，徐振华，曹辰虹.针刺锥体区治疗卒中偏瘫痉挛状态的临床研究[J].中国中医药信息杂志，2003,10(7):10-12.
[11]饶明俐.中国脑血管病防治指南[M].北京：人民卫生出版社，207:20-50.
[12]土维治.神经病学[M]. 5版.北京：人民卫生出版社，2004:165.
[13]郎建英，庄礼兴，贾超，等.靳三针疗法治疗缺血性中风后痉挛性偏瘫临床观察[J].新中医，2011,43(11):93-95.
[14] Bohannon R W,Smith M B. Interrater reliability on a modified Ashworth scale of muscle spasticity[J]. Phys Ther,1987,67(2):206-207.
[15]胡永善，吴毅，范文可，等.功能综合评定量表的研究（一）量表设计[J].中国康复医学杂志，2002,17(1):35-38.
[16]范文可，胡永善，吴毅，等.功能综合评定量表效度的研究[J].中国康复医学杂志，2003,18(6):325-329.
[17] Goldstein L B,Bertels C,Davis J N. Interraterreliability Of the NIH strokescale[J]. ArchNeurol,1989,46(6):660-662.
[18]中华人民共和国卫生部医政司.中国康复医学诊疗规范[M].北京：华夏出版社，1999:12.
[19]燕铁斌.临床痉挛指数：痉挛的综合临床评定[J].现代康复，2000,4(1):88-89.
[20]南登昆.康复医学[M].3版.北京：人民卫生出版社，2004:202-208.
[21]窦祖林.痉挛-评估与治疗[M].北京：人民卫生出版社，2004:64-68.
[22]曾访溪，庄礼兴，廖穆熙，等.手足挛三针为主治疗中风后痉挛性瘫痪的临床随机对照研究[J].辽宁中医杂志，2018,45(7):1481-1483.
[23]石新涛，赵霞，张利鑫，等.消栓通络颗粒内服联合“靳三针”治疗脑卒中后痉挛性瘫痪的临床研究[J].重庆医学，2017,46(32):4574-4576.
[24]焦俊杰，郭洪亮，刘丽杰，等.强制性运动疗法对急性脑卒中后偏瘫患者早期神经功能的影响研究[J].中国全科医学，2016,19(16):1968-1971.
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