针灸辅助治疗脑卒中后遗症的临床效果
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摘要
目的探讨针灸辅助康复训练治疗脑卒中后遗症的临床效果。方法选取我院2015年1月～2017年12月收治的脑卒中后遗症患者121例,按照随机数字表法分为对照组(n=60)与观察组(n=61)。对照组患者接受单纯康复训练,观察组在康复训练基础上给予针灸治疗。比较两组患者的治疗效果、治疗前后的神经功能缺损评分、日常生活能力评分及脑灌注情况。结果观察组的治疗总有效率为88.52%,显著高于对照组的73.33%,差异有统计学意义(P<0.05)。治疗后,观察组的美国国立卫生研究院卒中量表(NIHSS)评分低于对照组,改良Barthel指数评分高于对照组,差异有统计学意义(P<0.05)。两组患者治疗前的小脑皮质、丘脑核团、枕叶、额叶、顶叶脑灌注脑血流量(CBF)值比较,差异无统计学意义(P>0.05)。治疗后,观察组的额叶、顶叶脑灌注CBF值显著高于对照组,差异有统计学意义(P<0.05)。结论针灸辅助康复训练治疗脑卒中后遗症具有较好的效果,可有效降低神经功能缺损评分,提高日常生活能力,提高脑组织的血流灌注量。
Objective To explore the clinical effect of acupuncture and moxibustion assisting rehabilitation training treating sequelae of stroke. Methods All of 121 patients with sequelae of stroke treated in our hospital from January2015 to December 2017 were selected and they were randomly divided into the control group(n=60) and the observation group(n=61)according to the random number table method. Patients in the control group received simple rehabilitation training, while the observation group received acupuncture and moxibustion treatment on the basis of rehabilitation training. The treatment effect, neurological deficit score, daily living ability score and cerebral perfusion before and after treatment were compared in patients between the two groups. Results The total effective rate of the observation group was 88.52%, which was significantly higher than of the control group(73.33%), and the difference was statistically significant(P<0.05). After treatment, the National Institute of Health stroke scale(NIHSS) score of observation group was lower than that of control group, and the modified Barthel index score was higher than that of control group,and the differences were statistically significant(P<0.05). There was no significant difference in cerebral blood flow(CBF) values of cerebral perfusion in incerebellar cortex, thalamic nucleus, occipital lobe, frontal lobe and parietal lobe before treatment between the two groups(P>0.05). After treatment, the CBF values of cerebral perfusion in frontal lobe and parietal lobe of the observation group were significantly higher than those in the control group, and the differences were statistically significant(P<0.05). Conclusion Acupuncture and moxibustion assisting rehabilitation training has a good effect treating sequelae of stroke. It can effectively reduce the neurological deficit score, improve the ability of daily living, and increase the blood perfusion volume of brain tissue.
Objective To explore the clinical effect of acupuncture and moxibustion assisting rehabilitation training treating sequelae of stroke. Methods All of 121 patients with sequelae of stroke treated in our hospital from January2015 to December 2017 were selected and they were randomly divided into the control group(n=60) and the observation group(n=61)according to the random number table method. Patients in the control group received simple rehabilitation training, while the observation group received acupuncture and moxibustion treatment on the basis of rehabilitation training. The treatment effect, neurological deficit score, daily living ability score and cerebral perfusion before and after treatment were compared in patients between the two groups. Results The total effective rate of the observation group was 88.52%, which was significantly higher than of the control group(73.33%), and the difference was statistically significant(P<0.05). After treatment, the National Institute of Health stroke scale(NIHSS) score of observation group was lower than that of control group, and the modified Barthel index score was higher than that of control group,and the differences were statistically significant(P<0.05). There was no significant difference in cerebral blood flow(CBF) values of cerebral perfusion in incerebellar cortex, thalamic nucleus, occipital lobe, frontal lobe and parietal lobe before treatment between the two groups(P>0.05). After treatment, the CBF values of cerebral perfusion in frontal lobe and parietal lobe of the observation group were significantly higher than those in the control group, and the differences were statistically significant(P<0.05). Conclusion Acupuncture and moxibustion assisting rehabilitation training has a good effect treating sequelae of stroke. It can effectively reduce the neurological deficit score, improve the ability of daily living, and increase the blood perfusion volume of brain tissue.
引文
[1]中华医学会神经病学分会脑血管病学组缺血性脑卒中二级预防指南撰写组.中国缺血性脑卒中和短暂性脑缺血发作二级预防指南2010[J].中国临床医生杂志,2011,3(11):84-93.
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[6]杨玲,郭耀光.头电针配合言语训练治疗脑卒中后失语的临床研究[J].中国康复医学杂志,2017,32(3):305-308.
[7]杨学军.针灸联合康复训练治疗脑中风后遗症78例[J].中医临床研究,2014,22(7):68-69.
[8]Naess H,Kurtz M,Thomassen L,et al.Serial NIHSS scores in patients with acute cerebral infarction[J].Acta Neurol Scand,2016,133(6):415-420.
[9]Quinn TJ,Langhorne P,Stott DJ.Barthel Index for stroke trials development, properties,and application[J].Stroke,2011,42(4):1146-1151.
[10]张海军.针灸联合康复训练治疗脑中风后遗症的临床观察[J].中医临床研究,2015,7(30):103-104.
[11]冯凤坡.针灸联合康复训练治疗脑中风后遗症的效果[J].医学理论与实践,2016,29(15):2028-2029.
[12]廖玲,陈钰莹,李赛群,等.磁共振动脉自旋标记技术在针灸治疗缺血性脑卒中中的应用[J].辽宁中医杂志,2017,44(10):2220-2222.
[13]胡英,陈莉,肖艳,等.正常人3D-ASL脑血流灌注最佳标记后延迟时间分析[J].中国医学影像技术,2016,32(9):1330-1335.
[14]金平,林敏,钱琦,等.正常老年人主要脑功能区血流灌注的3D-ASL初探[J].浙江中医药大学学报,2015,39(4):282-285.
[15]方继良,王小玲,王寅,等.电针正常人足三里和关元穴中枢效应的fMRI脑功能成像比较[J].针刺研究,2012,37(1):46-52.
[2]王薇,赵冬,刘静,等.中国35-64岁人群心血管病危险因素与发病危险预测模型的前瞻性研究[J].中华心血管病杂志,2003,31(12):902-908.
[3]郭洋,李岩.针灸结合康复医学治疗脑卒中后遗症研究进展[J].中国实用乡村医生杂志,2017,24(12):49-51.
[4]张通.中国脑卒中康复治疗指南(2011完全版)[J].中国医学前沿杂志(电子版),2012,4(6):55-76.
[5]赵建国,高长玉,顼宝玉,等.脑梗死和脑出血中西医结合诊断标准(试行)[J].中国中西医结合杂志,2006,26(10):948-949.
[6]杨玲,郭耀光.头电针配合言语训练治疗脑卒中后失语的临床研究[J].中国康复医学杂志,2017,32(3):305-308.
[7]杨学军.针灸联合康复训练治疗脑中风后遗症78例[J].中医临床研究,2014,22(7):68-69.
[8]Naess H,Kurtz M,Thomassen L,et al.Serial NIHSS scores in patients with acute cerebral infarction[J].Acta Neurol Scand,2016,133(6):415-420.
[9]Quinn TJ,Langhorne P,Stott DJ.Barthel Index for stroke trials development, properties,and application[J].Stroke,2011,42(4):1146-1151.
[10]张海军.针灸联合康复训练治疗脑中风后遗症的临床观察[J].中医临床研究,2015,7(30):103-104.
[11]冯凤坡.针灸联合康复训练治疗脑中风后遗症的效果[J].医学理论与实践,2016,29(15):2028-2029.
[12]廖玲,陈钰莹,李赛群,等.磁共振动脉自旋标记技术在针灸治疗缺血性脑卒中中的应用[J].辽宁中医杂志,2017,44(10):2220-2222.
[13]胡英,陈莉,肖艳,等.正常人3D-ASL脑血流灌注最佳标记后延迟时间分析[J].中国医学影像技术,2016,32(9):1330-1335.
[14]金平,林敏,钱琦,等.正常老年人主要脑功能区血流灌注的3D-ASL初探[J].浙江中医药大学学报,2015,39(4):282-285.
[15]方继良,王小玲,王寅,等.电针正常人足三里和关元穴中枢效应的fMRI脑功能成像比较[J].针刺研究,2012,37(1):46-52.