针刺联合肌电反馈疗法治疗重症手足口病并中枢神经系统受损致肌张力异常的临床研究
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摘要
背景中枢神经系统受损致肌张力异常是小儿重症手足口病(HFMD)常见并发症,其治疗及康复已成为临床关注重点。目的观察针刺联合肌电反馈疗法治疗重症HFMD并中枢神经系统受损致肌张力异常的临床疗效,旨在为临床提供参考。方法收集郑州大学附属儿童医院于2015年3月—2018年3月收治的70例重症HFMD并中枢神经系统损害致肌张力异常患儿的临床资料。根据不同康复治疗方式将患儿分为观察组与对照组,各35例。对照组进行常规康复训练;观察组在对照组基础上,采用针刺结合肌电反馈治疗。连续观察8周,比较两组患儿治疗前后神经电生理指标[股神经、胫神经、腓神经感觉神经传导速度(SCV)、运动神经传导速度(MCV)],肌张力分级,残疾儿童综合功能评定(CFA-DC)量表中的运动、自理动作评分,临床疗效。结果治疗后观察组患儿股神经、胫神经、腓神经SCV、MCV快于对照组(P<0.05);两组患儿治疗后股神经、胫神经、腓神经SCV、MCV快于同组治疗前(P<0.05)。治疗后观察组患儿肌张力分级优于对照组(P<0.05);两组患儿治疗后肌张力分级优于同组治疗前(P<0.05)。治疗后观察组患儿运动、自理动作评分高于对照组(P<0.05);两组患儿治疗后运动、自理动作评分高于同组治疗前(P<0.05)。观察组患儿总有效率为94.3%(33/35),高于对照组的77.1%(27/35),差异有统计学意义(P<0.05)。结论针刺联合肌电反馈疗法用于重症HFMD并中枢神经系统受损致肌张力异常患儿,能改善患儿神经电生理指标、肌张力及运动功能,疗效显著。
Background Dystonia caused by central nervous system impairment is a common complication of severe hand-foot-mouth disease(HFMD) in children,and its treatment and rehabilitation have become a focus of attention in clinical practice.Objective To observe the clinical efficacy of acupuncture combined with electromyographic biofeedback therapy for severe HFMD complicated with dystonia caused by central nervous system impairment,so as to provide a reference for clinical treatment of this disease.Methods 70 cases of severe HFMD complicated with dystonia caused by central nervous system impairment who received treatment from Children's Hospital Affiliated of Zhengzhou University from March 2015 to March 2018 were retrospectively analyzed.They were divided into observation group and control group according to the rehabilitation therapy,with 35 cases in each.Both groups received the conventional rehabilitation training,and the observation group additionally received acupuncture combined with electromyographic biofeedback therapy.The intervention lasted for 8 weeks for both groups.Pre-post intervention data about neuroelectrophysiological indicators [sensory nerve conduction velocity(SCV),motor nerve conduction velocity(MCV) of femoral,tibial and peroneal nerves],grading of muscle tension,scores of exercise and selfcare action domains of Comprehensive Functional Assessment for Disabled Children(CFA-DC) Scale and clinical efficacy were compared between the two groups.Results After treatment,the SCV and MCV of femoral,tibial and peroneal nerves were much faster than the baseline levels in both groups(P<0.05).Moreover,intergroup comparison showed that,they were much faster in the observation group compared with those of the control group(P<0.05).Post-intervention grading of muscle tension improved significantly compared with the baseline level in both groups(P<0.05).Furthermore,the grading of muscle tension after treatment in observation group was better than that of the control group(P<0.05).Post-intervention scores of exercise and selfcare action domains increased significantly in both groups compared with the baseline levels(P<0.05).Moreover,intergroup comparison showed that,they were significantly higher in the observation group than those of the control group(P<0.05).The overall response rate in observation group was significantly higher than that in control group [94.3%(33/35) vs 77.1%(27/35)](P<0.05).Conclusion Acupuncture combined with electromyographic biofeedback therapy for children with severe HFMD complicated with dystonia caused by central nervous system impairment can improve the neuroelectrophysiological indicators,muscle strength and motor function,showing remarkable efficacy.
Background Dystonia caused by central nervous system impairment is a common complication of severe hand-foot-mouth disease(HFMD) in children,and its treatment and rehabilitation have become a focus of attention in clinical practice.Objective To observe the clinical efficacy of acupuncture combined with electromyographic biofeedback therapy for severe HFMD complicated with dystonia caused by central nervous system impairment,so as to provide a reference for clinical treatment of this disease.Methods 70 cases of severe HFMD complicated with dystonia caused by central nervous system impairment who received treatment from Children's Hospital Affiliated of Zhengzhou University from March 2015 to March 2018 were retrospectively analyzed.They were divided into observation group and control group according to the rehabilitation therapy,with 35 cases in each.Both groups received the conventional rehabilitation training,and the observation group additionally received acupuncture combined with electromyographic biofeedback therapy.The intervention lasted for 8 weeks for both groups.Pre-post intervention data about neuroelectrophysiological indicators [sensory nerve conduction velocity(SCV),motor nerve conduction velocity(MCV) of femoral,tibial and peroneal nerves],grading of muscle tension,scores of exercise and selfcare action domains of Comprehensive Functional Assessment for Disabled Children(CFA-DC) Scale and clinical efficacy were compared between the two groups.Results After treatment,the SCV and MCV of femoral,tibial and peroneal nerves were much faster than the baseline levels in both groups(P<0.05).Moreover,intergroup comparison showed that,they were much faster in the observation group compared with those of the control group(P<0.05).Post-intervention grading of muscle tension improved significantly compared with the baseline level in both groups(P<0.05).Furthermore,the grading of muscle tension after treatment in observation group was better than that of the control group(P<0.05).Post-intervention scores of exercise and selfcare action domains increased significantly in both groups compared with the baseline levels(P<0.05).Moreover,intergroup comparison showed that,they were significantly higher in the observation group than those of the control group(P<0.05).The overall response rate in observation group was significantly higher than that in control group [94.3%(33/35) vs 77.1%(27/35)](P<0.05).Conclusion Acupuncture combined with electromyographic biofeedback therapy for children with severe HFMD complicated with dystonia caused by central nervous system impairment can improve the neuroelectrophysiological indicators,muscle strength and motor function,showing remarkable efficacy.
引文
[1]陈瑞珊,邸菁华,王岩,等.290例重症手足口病患者的流行病学及病原学特征分析[J].中国病原生物学杂志,2016,11(1):65-67.DOI:10.13350/j.cjpb.160115.CHEN R S,DI J H,WANG Y,et al.Epidemiological and pathogenic characteristics of 290 patients with severe hand-footmouth disease[J].Journal of Pathogen Biology,2016,11(1):65-67.DOI:10.13350/j.cjpb.160115.
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[3]徐雪松.早期康复联合针刺拮抗肌对痉挛性偏瘫患者肌张力的影响[J].世界中医药,2016,11(1):140-142.DOI:10.3969/j.issn.1673-7202.2016.01.037.XU X S.Effects of early rehabilitation combined with acupuncture on antagonistic muscle on muscular tension in patients with spastic hemiplegia[J].World Chinese Medicine,2016,11(1):140-142.DOI:10.3969/j.issn.1673-7202.2016.01.037.
[4]王利江,刘秋燕,于晓明,等.肌电生物反馈治疗痉挛型脑性瘫痪患儿尖足的效果[J].中国康复理论与实践,2016,22(10):1209-1213.DOI:10.3969/j.issn.1006-9771.2016.10.021.WANG L J,LIU Q Y,YU X M,et al.Effect of electromyographic biofeedback on pointed foot in children with spastic cerebral palsy[J].Chinese Journal of Rehabilitation Theory and Practice,2016,22(10):1209-1213.DOI:10.3969/j.issn.1006-9771.2016.10.021.
[5]中华人民共和国卫生部.手足口病诊疗指南(2010年版)[J].国际呼吸杂志,2010,30(24):5.DOI:10.3760/cma.j.issn.1673-436X.2010.024.001.Ministry of Health of the People's Republic of China.Diagnosis and treatment guidelines of hand,foot and mouth disease(2010edition)[J].International Journal of Respiration,2010,30(24):5.DOI:10.3760/cma.j.issn.1673-436X.2010.024.001.
[6]章马兰,刘振寰.针刺对痉挛型脑瘫患儿下肢肌张力的影响[J].中国针灸,2018,38(6):591-596.DOI:10.13703/j.0255-2930.2018.06.006.ZHANG M L,LIU Z H.Effects of acupuncture on muscle tension of lower limbs in children patients with spastic cerebral palsy[J].Chinese Acupuncture and Moxibustion,2018,38(6):591-596.DOI:10.13703/j.0255-2930.2018.06.006.
[7]李玉秀,谢洁珊,何月明,等.残疾儿童综合功能评定量表在脑性瘫痪患儿家庭康复护理中的应用[J].中国康复理论与实践,2017,23(9):1113-1116.DOI:10.3969/j.issn.1006-9771.2017.09.026.LI Y X,XIE J S,HE Y M,et al.Application of comprehensive function assessment for disabled children in family care for children with cerebral palsy[J].Chinese Journal of Rehabilitation Theory and Practice,2017,23(9):1113-1116.DOI:10.3969/j.issn.1006-9771.2017.09.026.
[8]张健,赵澎.电针灸配合针刺治疗手足口病合并急性弛缓性瘫痪疗效观察[J].北京中医药,2017,36(7):607-610.DOI:10.16025/j.1674-1307.2017.07.007.ZHANG J,ZHAO P.Efficacy of electroacupuncture combined with acupuncture on hand-foot-mouth disease complicated with acute flaccid paralysis[J].Beijing Journal of Traditional Chinese Medicine,2017,36(7):607-610.DOI:10.16025/j.1674-1307.2017.07.007.
[9]邓慧玲,张玉凤.肠道病毒71型感染致重症手足口病新认识[J].中华实用儿科临床杂志,2016,31(10):736-743.DOI:10.3760/cma.j.issn.2095-428X.2016.10.005.DENG H L,ZHANG Y F.Further recognition of severe hand,foot and mouth disease caused by enterovirus 71[J].Journal of Applied Clinical Pediatrics,2016,31(10):736-743.DOI:10.3760/cma.j.issn.2095-428X.2016.10.005.
[10]李建明,刘映霞,林益敏,等.258例手足口病中枢神经系统并发症的临床特征及预后分析[J].中华实验和临床病毒学杂志,2014,28(4):241-244.DOI:10.3760/cma.j.issn.1003-9279.2014.04.001.LI J M,LIU Y X,LIN Y M,et al.Analysis of clinical features and prognosis in 258 patients with CNSC of HFMD[J].Chinese Journal of Experimental and Clinical Virology,2014,28(4):241-244.DOI:10.3760/cma.j.issn.1003-9279.2014.04.001.
[11]付晓雪.益气通痹中药合四物汤治疗外伤性周围神经损伤疗效及对神经传导速度、NF-κB及TNF-α水平的影响[J].现代中西医结合杂志,2017,26(19):2071-2073.DOI:10.3969/j.issn.1008-8849.2017.19.006.FU X X.Effects of Yiqi Tongbi Chinese Medicine with Siwu decoction on traumatic peripheral nerve damage and on the speed of nerve conduction,NF-κB and TNF-α[J].Modern Journal of Integrated Traditional Chinese and Western Medicine,2017,26(19):2071-2073.DOI:10.3969/j.issn.1008-8849.2017.19.006.
[12]邹东方,廖建湘,胡雁,等.累及神经系统的手足口病70例[J].中华实用儿科临床杂志,2012,27(22):1716-1719.DOI:10.3969/j.issn.1003-515X.2012.22.006.ZOU D F,LIAO J X,HU Y,et al.Seventy cases of hand-footand-mouth disease with neurological involvement[J].Journal of Applied Clinical Pediatrics,2012,27(22):1716-1719.DOI:10.3969/j.issn.1003-515X.2012.22.006.
[13]鲍劲松,童光磊,周陶成,等.针刺结合肌电生物反馈对痉挛性脑瘫患儿智力及运动功能的影响[J].四川中医,2017,35(8):183-186.BAO J S,TONG G L,ZHOU T C,et al.Effects of acupuncture combined with myoelectric biofeedback on intelligence and motor function in children patients with spastic cerebral palsy[J].Journal of Sichuan of Traditional Chinese Medicine,2017,35(8):183-186.
[14]张志兰,侯宝国,孙金华,等.益肾化痰汤联合针刺治疗对脑卒中患者语言功能及神经功能缺损的影响[J].陕西中医,2017,38(1):10-11.DOI:10.3969/j.issn.1000-7369.2017.01.004.ZHANG Z L,HOU B G,SUN J H,et al.Effects of Yishen Huayu Decoction combined with acupuncture on language function and neurological deficit in stroke patients[J].Shaanxi Journal of Traditional Chinese Medicine,2017,38(1):10-11.DOI:10.3969/j.issn.1000-7369.2017.01.004.
[15]杨阳,胡利杰,蔡西国,等.肌电生物反馈治疗对脑卒中患者肢体功能恢复的影响[J].中华物理医学与康复杂志,2016,38(2):144-146.DOI:10.3760/cma.j.issn.0254-1424.2016.02.016.YANG Y,HU L J,CAI X G,et al.Effects of electromyographic biofeedback therapy on limb function recovery in stroke patients[J].Chinese Journal of Physical Medicine and Rehabilitation,2016,38(2):144-146.DOI:10.3760/cma.j.issn.0254-1424.2016.02.016.
[2]张京,肖娟,杨远滨.肌肉结构参数模型在中枢神经系统所致肌张力异常评价中的作用和分析[J].中国康复医学杂志,2015,30(4):408-411.DOI:10.3969/j.issn.1001-1242.2015.04.026.ZHANG J,XIAO J,YANG Y B.Role and analysis of muscle structure parameter model in the evaluation of dystonia caused by central nervous system[J].Chinese Journal of Rehabilitation Medicine,2015,30(4):408-411.DOI:10.3969/j.issn.1001-1242.2015.04.026.
[3]徐雪松.早期康复联合针刺拮抗肌对痉挛性偏瘫患者肌张力的影响[J].世界中医药,2016,11(1):140-142.DOI:10.3969/j.issn.1673-7202.2016.01.037.XU X S.Effects of early rehabilitation combined with acupuncture on antagonistic muscle on muscular tension in patients with spastic hemiplegia[J].World Chinese Medicine,2016,11(1):140-142.DOI:10.3969/j.issn.1673-7202.2016.01.037.
[4]王利江,刘秋燕,于晓明,等.肌电生物反馈治疗痉挛型脑性瘫痪患儿尖足的效果[J].中国康复理论与实践,2016,22(10):1209-1213.DOI:10.3969/j.issn.1006-9771.2016.10.021.WANG L J,LIU Q Y,YU X M,et al.Effect of electromyographic biofeedback on pointed foot in children with spastic cerebral palsy[J].Chinese Journal of Rehabilitation Theory and Practice,2016,22(10):1209-1213.DOI:10.3969/j.issn.1006-9771.2016.10.021.
[5]中华人民共和国卫生部.手足口病诊疗指南(2010年版)[J].国际呼吸杂志,2010,30(24):5.DOI:10.3760/cma.j.issn.1673-436X.2010.024.001.Ministry of Health of the People's Republic of China.Diagnosis and treatment guidelines of hand,foot and mouth disease(2010edition)[J].International Journal of Respiration,2010,30(24):5.DOI:10.3760/cma.j.issn.1673-436X.2010.024.001.
[6]章马兰,刘振寰.针刺对痉挛型脑瘫患儿下肢肌张力的影响[J].中国针灸,2018,38(6):591-596.DOI:10.13703/j.0255-2930.2018.06.006.ZHANG M L,LIU Z H.Effects of acupuncture on muscle tension of lower limbs in children patients with spastic cerebral palsy[J].Chinese Acupuncture and Moxibustion,2018,38(6):591-596.DOI:10.13703/j.0255-2930.2018.06.006.
[7]李玉秀,谢洁珊,何月明,等.残疾儿童综合功能评定量表在脑性瘫痪患儿家庭康复护理中的应用[J].中国康复理论与实践,2017,23(9):1113-1116.DOI:10.3969/j.issn.1006-9771.2017.09.026.LI Y X,XIE J S,HE Y M,et al.Application of comprehensive function assessment for disabled children in family care for children with cerebral palsy[J].Chinese Journal of Rehabilitation Theory and Practice,2017,23(9):1113-1116.DOI:10.3969/j.issn.1006-9771.2017.09.026.
[8]张健,赵澎.电针灸配合针刺治疗手足口病合并急性弛缓性瘫痪疗效观察[J].北京中医药,2017,36(7):607-610.DOI:10.16025/j.1674-1307.2017.07.007.ZHANG J,ZHAO P.Efficacy of electroacupuncture combined with acupuncture on hand-foot-mouth disease complicated with acute flaccid paralysis[J].Beijing Journal of Traditional Chinese Medicine,2017,36(7):607-610.DOI:10.16025/j.1674-1307.2017.07.007.
[9]邓慧玲,张玉凤.肠道病毒71型感染致重症手足口病新认识[J].中华实用儿科临床杂志,2016,31(10):736-743.DOI:10.3760/cma.j.issn.2095-428X.2016.10.005.DENG H L,ZHANG Y F.Further recognition of severe hand,foot and mouth disease caused by enterovirus 71[J].Journal of Applied Clinical Pediatrics,2016,31(10):736-743.DOI:10.3760/cma.j.issn.2095-428X.2016.10.005.
[10]李建明,刘映霞,林益敏,等.258例手足口病中枢神经系统并发症的临床特征及预后分析[J].中华实验和临床病毒学杂志,2014,28(4):241-244.DOI:10.3760/cma.j.issn.1003-9279.2014.04.001.LI J M,LIU Y X,LIN Y M,et al.Analysis of clinical features and prognosis in 258 patients with CNSC of HFMD[J].Chinese Journal of Experimental and Clinical Virology,2014,28(4):241-244.DOI:10.3760/cma.j.issn.1003-9279.2014.04.001.
[11]付晓雪.益气通痹中药合四物汤治疗外伤性周围神经损伤疗效及对神经传导速度、NF-κB及TNF-α水平的影响[J].现代中西医结合杂志,2017,26(19):2071-2073.DOI:10.3969/j.issn.1008-8849.2017.19.006.FU X X.Effects of Yiqi Tongbi Chinese Medicine with Siwu decoction on traumatic peripheral nerve damage and on the speed of nerve conduction,NF-κB and TNF-α[J].Modern Journal of Integrated Traditional Chinese and Western Medicine,2017,26(19):2071-2073.DOI:10.3969/j.issn.1008-8849.2017.19.006.
[12]邹东方,廖建湘,胡雁,等.累及神经系统的手足口病70例[J].中华实用儿科临床杂志,2012,27(22):1716-1719.DOI:10.3969/j.issn.1003-515X.2012.22.006.ZOU D F,LIAO J X,HU Y,et al.Seventy cases of hand-footand-mouth disease with neurological involvement[J].Journal of Applied Clinical Pediatrics,2012,27(22):1716-1719.DOI:10.3969/j.issn.1003-515X.2012.22.006.
[13]鲍劲松,童光磊,周陶成,等.针刺结合肌电生物反馈对痉挛性脑瘫患儿智力及运动功能的影响[J].四川中医,2017,35(8):183-186.BAO J S,TONG G L,ZHOU T C,et al.Effects of acupuncture combined with myoelectric biofeedback on intelligence and motor function in children patients with spastic cerebral palsy[J].Journal of Sichuan of Traditional Chinese Medicine,2017,35(8):183-186.
[14]张志兰,侯宝国,孙金华,等.益肾化痰汤联合针刺治疗对脑卒中患者语言功能及神经功能缺损的影响[J].陕西中医,2017,38(1):10-11.DOI:10.3969/j.issn.1000-7369.2017.01.004.ZHANG Z L,HOU B G,SUN J H,et al.Effects of Yishen Huayu Decoction combined with acupuncture on language function and neurological deficit in stroke patients[J].Shaanxi Journal of Traditional Chinese Medicine,2017,38(1):10-11.DOI:10.3969/j.issn.1000-7369.2017.01.004.
[15]杨阳,胡利杰,蔡西国,等.肌电生物反馈治疗对脑卒中患者肢体功能恢复的影响[J].中华物理医学与康复杂志,2016,38(2):144-146.DOI:10.3760/cma.j.issn.0254-1424.2016.02.016.YANG Y,HU L J,CAI X G,et al.Effects of electromyographic biofeedback therapy on limb function recovery in stroke patients[J].Chinese Journal of Physical Medicine and Rehabilitation,2016,38(2):144-146.DOI:10.3760/cma.j.issn.0254-1424.2016.02.016.