基于sEMG评价子午流注巨刺法对卒中后肌痉挛的干预效应
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摘要
目的观察应用表面肌电图(surface electromyography, sEMG)评价子午流注纳甲法配合巨刺疗法对卒中后痉挛性偏瘫患者疗效的影响。方法将64例卒中后痉挛性偏瘫患者随机分为治疗组和对照组,每组32例。两组患者均采取常规康复治疗,在此基础上对照组采用传统的循经取穴针刺治疗,治疗组采用子午流注纳甲法配合巨刺疗法针刺治疗。两组患者分别于治疗前与治疗4周后采用改良Ashworth分级、临床痉挛指数(CSI)、临床神经功能缺损程度(NDS)、Barthel指数(BI)及表面电极引导和记录肌电信号并对所测得H波、M波最大波幅及H波/M波最大波幅比值(Hmax/Mmax)的变化情况进行分析。结果两组下肢改良Ashworth分级、CSI评分及NDS评分均较治疗前明显下降(P<0.01),治疗组与对照组比较差异有统计学意义(P<0.05)。两组患者BI评分均较治疗前明显提高(P<0.01),治疗组与对照组比较差异有统计学意义(P<0.05)。两组患者治疗后Hmax/Mmax均降低(P<0.05),且治疗组Hmax/Mmax低于对照组(P<0.05)。结论子午流注纳甲法配合巨刺疗法可以降低偏瘫肢体肌张力,改善肢体运动功能,提高日常生活活动能力。
Objective To evaluate the efficacy of Zi Wu Liu Zhu Na Jia (midnight-noon ebb-flow method) plus contralateral needling in treating post-stroke hemiplegia patients based on surface electromyography (sEMG). Method Sixty-four patients with post-stroke hemiplegia were randomized into a treatment group and a control group, with 32 cases in each group. The two groups both received rehabilitation. In addition, the control group was given conventional acupuncture treatment by selecting acupoints along meridians, while the treatment group was given Zi Wu Liu Zhu Na Jia plus contralateral needling. Before and after four-week treatment, the two groups were estimated by the modified Ashworth scale(MAS), clinical spasticity index(CSI), clinical neurologic deficit scale(NDS), Barthel index(BI) and sEMG. Changes in the maximum amplitudes of H wave(Hmax) and M wave(Mmax) as well as the Hmax/Mmax were analyzed. Result The lower-limb MAS, CSI and NDS scores declined significantly after the treatment in both groups(P<0.01), and there was a significant difference between the two groups(P<0.05). The BI score increased markedly after the treatment in both groups(P<0.01), and the treatment group was significantly different from the control group(P<0.05). After the intervention, the Hmax/Mmax dropped in both groups(P<0.05), and the Hmax/Mmax was lower in the treatment group than in the control group(P<0.05). Conclusion Zi Wu Liu Zhu Na Jia plus contralateral needling can lower the muscle tension in hemiplegia, and improve the motor function and activities of daily living.
Objective To evaluate the efficacy of Zi Wu Liu Zhu Na Jia (midnight-noon ebb-flow method) plus contralateral needling in treating post-stroke hemiplegia patients based on surface electromyography (sEMG). Method Sixty-four patients with post-stroke hemiplegia were randomized into a treatment group and a control group, with 32 cases in each group. The two groups both received rehabilitation. In addition, the control group was given conventional acupuncture treatment by selecting acupoints along meridians, while the treatment group was given Zi Wu Liu Zhu Na Jia plus contralateral needling. Before and after four-week treatment, the two groups were estimated by the modified Ashworth scale(MAS), clinical spasticity index(CSI), clinical neurologic deficit scale(NDS), Barthel index(BI) and sEMG. Changes in the maximum amplitudes of H wave(Hmax) and M wave(Mmax) as well as the Hmax/Mmax were analyzed. Result The lower-limb MAS, CSI and NDS scores declined significantly after the treatment in both groups(P<0.01), and there was a significant difference between the two groups(P<0.05). The BI score increased markedly after the treatment in both groups(P<0.01), and the treatment group was significantly different from the control group(P<0.05). After the intervention, the Hmax/Mmax dropped in both groups(P<0.05), and the Hmax/Mmax was lower in the treatment group than in the control group(P<0.05). Conclusion Zi Wu Liu Zhu Na Jia plus contralateral needling can lower the muscle tension in hemiplegia, and improve the motor function and activities of daily living.
引文
[1]吴兆苏.我国人群脑卒中发病率、死亡率的流行病学研究[J].中华流行病学杂志,2003,24(3):236-239.
[2]孟文婷,李东翔,佟玲,等.缺血性脑卒中的治疗研究进展[J].中国新药杂志,2016,(10):1114-1120.
[3]刘水仙.脑卒中病人的诊断﹑治疗﹑护理要点及体会[J].临床心身疾病杂志,2016,(S2):143-144.
[4]傅建明.脑卒中后患肢痉挛的针刺治疗研究进展[J].现代中西医结合杂志,2007,16(28):4245-4246.
[5]黄宝玲,郑建超.脑卒中患者康复护理体会[J].现代保健(医学创新研究),2007,4(24):94-95.
[6]章薇,刘智,刘伍立.针刺协调肌张力平衡治疗脑卒中痉挛性瘫痪64例临床观察[J].湖南中医药导报,2001,7(9):464-465.
[7]张艳宏,刘保延,赵宏,等.脑卒中痉挛性瘫痪特点及其评定进展[J].中国康复理论与实践,2008,14(2):110-112.
[8]凌方明,陈景亮.养阴熄风通络法治疗脑卒中后痉挛性瘫痪的临床研究[J].中西医结合心脑血管病杂志,2003,1(2):97-98.
[9]饶金柱,关健伟,曹黎明.脑卒中后肌痉挛发病情况调查分析[J].中国实用神经疾病杂志,2013,16(1):74-76.
[10]朱亚琼,解涛,彭楠,等.下肢肌力和膝关节控制训练对改善脑卒中患者膝关节过伸及下肢功能的效果研究[J].中华老年多器官疾病杂志,2015,l4(9):687-691.
[11]谭永霞,刘建国,戚晓昆.急性脑卒中患者过早下肢负重与患肢伸肌痉挛及膝过伸的关系研究[J].神经损伤与功能重建,2012,7(6):433-435.
[12]成娇,余生源,浦创,等.针刀联合针刺治疗脑卒中后痉挛性瘫痪的疗效观察[J].健康之路,2015,(12):3-4.
[13]刘明辉,杨硕.针刀结合针刺治疗中风后痉挛性瘫痪的研究现状[J].中医临床研究,2013,5(9):120-122.
[14]陈艳萍.针刺治疗脑卒中后痉挛性偏瘫的临床研究与应用[J].中国实用医药,2015,10(22):277-278.
[15]宋爱利.子午流注针法临床研究进展[J].中华中医药杂志,2014,29(8):2551-2555.
[16]中华医学会神经病学分会脑血管病学组急性缺血性脑卒中诊治指南撰写组.中国急性缺血性脑卒中诊治指南2010[J].中国临床医生,2011,39(3):67-73.
[17]王玉龙.康复功能评定学[M].北京:人民卫生出版社,2008:457-460,358-359.
[18]杨晓辉,黄演强.子午流注纳甲法治疗痉挛型脑瘫儿童运动功能疗效观察[J].山西中医,2018,34(8):41-42,44.
[19]王秀艳,刘俊蕊,张颖颖,等.针灸联合子午流注纳甲法对中风后遗症的疗效及血清炎性因子的影响[J].广西医科大学学报,2018,35(12):1675-1678.
[20]王冠超,肖伟.表解子午流注纳甲法的临床运用[J].针灸临床杂志,2014,30(5):69-72.
[21]覃晓文,赵彩娇,宗懿,等.子午流注纳甲法的研究概况[J].广西中医药大学学报,2014,17(2):123-126.
[22]张素钊,宁沛,孙翔,等.近10年子午流注针法治疗缺血性脑血管病临床研究进展[J].河北中医,2014,36(12):1899-1902.
[23]袁军,李梅,张素钊,等.子午流注针法配合辨证取穴治疗缺血性脑血管病临床研究[J].河北中医,2014,36(11):1669-1671.
[24]商俊芳,姜华,王金海,等.子午流注纳甲针法对急性缺血性脑血管病大鼠神经功能、脑梗死体积的影响[J].中国中医急症,2014,23(6):1014-1015,1032.
[25]耿霞,冷恩荣,冯同忠,等.巨刺法的临床应用[J].按摩与康复医学,2018,9(18):20-21.
[26]樊留博,刘素芝,刘莹莹,等.基于表面肌电信号评价膝关节控制训练对脑卒中后下肢痉挛的干预效果[J].浙江医学,2015,37(20):1658-1660,1663.
[27]樊留博,江毅卿,王灵芝,等.子午流注纳甲法针刺治疗脑卒中后痉挛性偏瘫临床研究[J].上海针灸杂志,2017,36(3):256-260.
[28]Fan Z,Zhao C,Luo L,et al.Study on s EMG-based exercise therapy for upper limb of severe hemiplegic patients[J].Conf Proc IEEE Eng Med Biol Soc,2013:6643-6646.
[29]Hu X,Rymer WZ,Suresh NL.Reliability of spike triggered averaging of the surface electromyogram for motor unit action potential estimation[J].Muscle Nerve,2013,48(4):557-570.
[2]孟文婷,李东翔,佟玲,等.缺血性脑卒中的治疗研究进展[J].中国新药杂志,2016,(10):1114-1120.
[3]刘水仙.脑卒中病人的诊断﹑治疗﹑护理要点及体会[J].临床心身疾病杂志,2016,(S2):143-144.
[4]傅建明.脑卒中后患肢痉挛的针刺治疗研究进展[J].现代中西医结合杂志,2007,16(28):4245-4246.
[5]黄宝玲,郑建超.脑卒中患者康复护理体会[J].现代保健(医学创新研究),2007,4(24):94-95.
[6]章薇,刘智,刘伍立.针刺协调肌张力平衡治疗脑卒中痉挛性瘫痪64例临床观察[J].湖南中医药导报,2001,7(9):464-465.
[7]张艳宏,刘保延,赵宏,等.脑卒中痉挛性瘫痪特点及其评定进展[J].中国康复理论与实践,2008,14(2):110-112.
[8]凌方明,陈景亮.养阴熄风通络法治疗脑卒中后痉挛性瘫痪的临床研究[J].中西医结合心脑血管病杂志,2003,1(2):97-98.
[9]饶金柱,关健伟,曹黎明.脑卒中后肌痉挛发病情况调查分析[J].中国实用神经疾病杂志,2013,16(1):74-76.
[10]朱亚琼,解涛,彭楠,等.下肢肌力和膝关节控制训练对改善脑卒中患者膝关节过伸及下肢功能的效果研究[J].中华老年多器官疾病杂志,2015,l4(9):687-691.
[11]谭永霞,刘建国,戚晓昆.急性脑卒中患者过早下肢负重与患肢伸肌痉挛及膝过伸的关系研究[J].神经损伤与功能重建,2012,7(6):433-435.
[12]成娇,余生源,浦创,等.针刀联合针刺治疗脑卒中后痉挛性瘫痪的疗效观察[J].健康之路,2015,(12):3-4.
[13]刘明辉,杨硕.针刀结合针刺治疗中风后痉挛性瘫痪的研究现状[J].中医临床研究,2013,5(9):120-122.
[14]陈艳萍.针刺治疗脑卒中后痉挛性偏瘫的临床研究与应用[J].中国实用医药,2015,10(22):277-278.
[15]宋爱利.子午流注针法临床研究进展[J].中华中医药杂志,2014,29(8):2551-2555.
[16]中华医学会神经病学分会脑血管病学组急性缺血性脑卒中诊治指南撰写组.中国急性缺血性脑卒中诊治指南2010[J].中国临床医生,2011,39(3):67-73.
[17]王玉龙.康复功能评定学[M].北京:人民卫生出版社,2008:457-460,358-359.
[18]杨晓辉,黄演强.子午流注纳甲法治疗痉挛型脑瘫儿童运动功能疗效观察[J].山西中医,2018,34(8):41-42,44.
[19]王秀艳,刘俊蕊,张颖颖,等.针灸联合子午流注纳甲法对中风后遗症的疗效及血清炎性因子的影响[J].广西医科大学学报,2018,35(12):1675-1678.
[20]王冠超,肖伟.表解子午流注纳甲法的临床运用[J].针灸临床杂志,2014,30(5):69-72.
[21]覃晓文,赵彩娇,宗懿,等.子午流注纳甲法的研究概况[J].广西中医药大学学报,2014,17(2):123-126.
[22]张素钊,宁沛,孙翔,等.近10年子午流注针法治疗缺血性脑血管病临床研究进展[J].河北中医,2014,36(12):1899-1902.
[23]袁军,李梅,张素钊,等.子午流注针法配合辨证取穴治疗缺血性脑血管病临床研究[J].河北中医,2014,36(11):1669-1671.
[24]商俊芳,姜华,王金海,等.子午流注纳甲针法对急性缺血性脑血管病大鼠神经功能、脑梗死体积的影响[J].中国中医急症,2014,23(6):1014-1015,1032.
[25]耿霞,冷恩荣,冯同忠,等.巨刺法的临床应用[J].按摩与康复医学,2018,9(18):20-21.
[26]樊留博,刘素芝,刘莹莹,等.基于表面肌电信号评价膝关节控制训练对脑卒中后下肢痉挛的干预效果[J].浙江医学,2015,37(20):1658-1660,1663.
[27]樊留博,江毅卿,王灵芝,等.子午流注纳甲法针刺治疗脑卒中后痉挛性偏瘫临床研究[J].上海针灸杂志,2017,36(3):256-260.
[28]Fan Z,Zhao C,Luo L,et al.Study on s EMG-based exercise therapy for upper limb of severe hemiplegic patients[J].Conf Proc IEEE Eng Med Biol Soc,2013:6643-6646.
[29]Hu X,Rymer WZ,Suresh NL.Reliability of spike triggered averaging of the surface electromyogram for motor unit action potential estimation[J].Muscle Nerve,2013,48(4):557-570.