头针久留结合Brunnstrom不同分期电针不同穴位对卒中后下肢运动及平衡障碍的影响
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摘要
目的探讨头穴久留针结合在Brunnstrom不同分期的理论基础上电针不同穴位对脑卒中后下肢运动及平衡障碍的影响。方法将2014年10月—2016年5月杭州市中医院收治的符合纳入标准的100例患者经随机数表法随机分为对照组(普通针刺配合康复治疗)和治疗组(头穴久留针结合Brunnstrom不同分期电针不同穴位配合康复治疗),每组50例。评估2组患者在治疗前、治疗4周后及8周后Berg平衡评分(BBS)、下肢简化FuglMeyer评分(SFMA)和Holden功能步行分类(Holden FAC)的变化。所有患者均住院治疗,针刺及康复疗程均为:每日1次,每周治疗5次,双休日不治疗,连续8周;患者均评估3次,分别在治疗前、治疗4周、8周时。结果治疗4周和8周较治疗前及治疗8周较治疗4周时,2组组内BBS均有升高(均P<0.05)、SFMA亦有升高(均P<0.05)和Holden FAC的等级均提高(均P<0.05),差异有统计学意义;治疗4周及治疗8周时,均同一时点比较,治疗组BBS、SFMA和Holden FAC较对照组均有明显改善,差异有统计学意义(均P<0.05)。结论在常规康复训练的基础上,头穴长时间久留针,同时依据Brunnstrom不同分期患者肢体功能的不同状态电针不同穴位,这种综合疗法能更有效地提高卒中后的偏瘫患者站立平衡的功能,同时可改善其步行能力。
Objective To explore the effects of long-term scalp acupuncture combined with different acpoints with electroacupunctrue in different brunnstromon stage on the lower extremity motor function and balance function after stroke.Methods One hundred cases met the inclusion criteria were randomly divided into control group(traditional acupuncture + rehabilitation) and treatment group(long-term scalp acupuncture + using different acpoints with electroacupunctrue in different brunnstromon stage + rehabilitation),50 cases in each group with the therapy of each group.Berg Balance Scale(BBS),simplified Fugl-Meyer assessment mark(SFMA) and Holden functional ambulation classification(Holden FAC) were observed before and after 4 and 8 weeks' treatment,respectively.Each case was treated on the ward.Treatment course of acupuncture and rehabilitation was once per day,5 times a week,resting at weekends,treated for 8 weeks.Results BBS,SFMA and Holden FAC were improved in same group after 4 and 8 weeks' treatment,compared with before(all P < 0.05),and the indexes after 4 weeks' treatment is superior to that after 4 weeks' treatment(all P < 0.05).After 4 weeks' treatment,BBS,SFMA and Holden FAC of treatment group were better than control group,and the same outcome after 8 weeks' treatment.Conclusion With the basic treatment of routine rehabilitation training,long-term scalp acupuncture combined with different acpoints with electroacupunctrue in di fferent brunnstromon stage is more beneficial to improve low limb dysfunction and balance dysfunction than traditional acupuncture.
Objective To explore the effects of long-term scalp acupuncture combined with different acpoints with electroacupunctrue in different brunnstromon stage on the lower extremity motor function and balance function after stroke.Methods One hundred cases met the inclusion criteria were randomly divided into control group(traditional acupuncture + rehabilitation) and treatment group(long-term scalp acupuncture + using different acpoints with electroacupunctrue in different brunnstromon stage + rehabilitation),50 cases in each group with the therapy of each group.Berg Balance Scale(BBS),simplified Fugl-Meyer assessment mark(SFMA) and Holden functional ambulation classification(Holden FAC) were observed before and after 4 and 8 weeks' treatment,respectively.Each case was treated on the ward.Treatment course of acupuncture and rehabilitation was once per day,5 times a week,resting at weekends,treated for 8 weeks.Results BBS,SFMA and Holden FAC were improved in same group after 4 and 8 weeks' treatment,compared with before(all P < 0.05),and the indexes after 4 weeks' treatment is superior to that after 4 weeks' treatment(all P < 0.05).After 4 weeks' treatment,BBS,SFMA and Holden FAC of treatment group were better than control group,and the same outcome after 8 weeks' treatment.Conclusion With the basic treatment of routine rehabilitation training,long-term scalp acupuncture combined with different acpoints with electroacupunctrue in di fferent brunnstromon stage is more beneficial to improve low limb dysfunction and balance dysfunction than traditional acupuncture.
引文
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[16]孙玉珠,苗芬,徐洁,等.针刺治疗脑梗死肌张力异常对Brunnstrom分期影响的优选[J].中华全科医学,2015,13(11):1853-1855.
[17]KARUNESH A,GANGULY NANCY N,ABRAMS G M.Neurorehabilitation:Motor recovery after stroke as an example[J].Ann Neurol,2013,74(3):373-381.
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[19]李欣,岳阳,陈光荣.脑卒中患者根据Brunnstrom分期采用针对性康复方案效果分析[J].中国现代药物应用,2016,10(6):1-3.
[20]胡德宇,赵明,栗雪梅.电针结合康复训练治疗脑卒中后偏瘫痉挛状态的临床研究[J].针灸临床杂志,2017,33(7):26-29.
[21]佟帅,苏李,吕海波,等.关键点针刺法配合康复治疗脑梗死后痉挛期偏瘫疗效观察[J].中国针灸,2013,33(5):399-402.
[2]王雪茵,胡永华.脑卒中流行病学的家系研究[J].中华流行病学杂志,2013,34(6):647-649.
[3]王颖,宁二青.脑卒中偏瘫患者开展超早期康复护理对其肢体运动功能的作用[J].现代医药卫生,2017,33(13):2056-2057.
[4]屈亚平,孙丽,朱琳,等.平衡训练系统辅助特定任务性平板步行训练对卒中患者下肢运动功能的影响[J].中国脑血管病杂志,2014,11(5):233-237.
[5]肖顺琼,李国俊.针灸治疗中风后抑郁症临床观察[J].实用中医药杂志,2014,30(2):134-136.
[6]GU J,WANG Q,WANG X,et al.Review assessment of registration information on methodological design of acupuncture RCTs:A review of453 registration records retrieved from WHO international clinical trials registry platform[J].Evid Based Complement Alternat Med,2014,2014(8):614850.
[7]陈玉其.培土抑木法治疗中风后呃逆46例[J].中国针灸,2013,33(11):1004.
[8]STRAUBE D,MOORE J,LEECH K,et al.Item analysis of the berg balance scale in individuals with subacute and chronic stroke[J].Top Stroke Rehabil,2015,20(3):241-249.
[9]CHEN B,WANG X,ZOU J,et al.Effect of traditional Chinese exercise on gait and balance for stroke:systematic review and meta-analysis[J].PLo S One,2015,10(8):e219-e220.
[10]高春华,黄晓琳,黄杰,等.下肢康复机器人训练对早期脑卒中偏瘫患者下肢功能的影响[J].中国康复医学杂志,2014,29(4):351-353.
[11]毛忠南,何天有,雒成林.从康复角度看脑卒中的针刺治疗[J].中国针灸,2014,34(3):293-296.
[12]韩超,孙忠人.运用步态分析系统评价焦氏头针对偏瘫步态的临床疗效[J].针灸临床杂志,2017,33(5):26-28.
[13]江玉娟,杨玉霞,项蓉,等.解剖定位下头电针结合康复训练治疗脑卒中言语失用症临床研究[J].中国针灸,2015,35(7):661-664.
[14]朱敏,楚佳梅,包烨华.天柱傍针刺结合平衡区电针对卒中患者平衡功能及步行能力的影响[J].浙江中西医结合杂志,2015,25(11):1018-1020.
[15]汪瑛,朱春沁,陈少飞.头穴久留针治疗血管性痴呆30例[J].安徽中医药大学学报,2014,33(2):56-58.
[16]孙玉珠,苗芬,徐洁,等.针刺治疗脑梗死肌张力异常对Brunnstrom分期影响的优选[J].中华全科医学,2015,13(11):1853-1855.
[17]KARUNESH A,GANGULY NANCY N,ABRAMS G M.Neurorehabilitation:Motor recovery after stroke as an example[J].Ann Neurol,2013,74(3):373-381.
[18]CUMMINGS D,SANTISTEBAN M,MUIR J,et al.The efficacy of two adolescent substance abuse treatments and the impact of comorbid depression:Results of a small randomized controlled trial[J].Psychiatr Rehabilit J,2015,38(1):55-64.
[19]李欣,岳阳,陈光荣.脑卒中患者根据Brunnstrom分期采用针对性康复方案效果分析[J].中国现代药物应用,2016,10(6):1-3.
[20]胡德宇,赵明,栗雪梅.电针结合康复训练治疗脑卒中后偏瘫痉挛状态的临床研究[J].针灸临床杂志,2017,33(7):26-29.
[21]佟帅,苏李,吕海波,等.关键点针刺法配合康复治疗脑梗死后痉挛期偏瘫疗效观察[J].中国针灸,2013,33(5):399-402.