针刺腰夹脊穴配合康复治疗脑卒中后下肢痉挛的临床研究
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摘要
目的:观察针刺腰夹脊穴治疗脑卒中后下肢痉挛的临床疗效。
方法:本研究采用按入院顺序随机分组对照的方法,将60名符合纳入标准的患者,在康复训练的基础上随机分为治疗组(腰夹脊法)30例,对照组30例,分别进行针刺治疗,并采用国际通用的改良的Ashworth痉挛表、下肢临床痉挛指数(CSI)、FAC步行功能分级、Fug-Meyer下肢运动功能评价进行入院时、治疗中(1个月)及治疗后(3个月)的康复学评定,以评价治疗效果所以数据采用SPSS17.0统计软件进行分析。
结果:1.治疗组与对照组在入院时、治疗中、出院后MAS痉挛量表结果无统计学差异(p>0.05)。2.治疗组与对照组在入院时、治疗中下肢CSI结果无统计学差异,但在治疗后治疗组肌张力小于对照组(p<0.05)。3.治疗组与对照组在入院时FAC结果比较无统计学差异(p>0.05),但两组在治疗中及治疗后治疗组优于对照组(p<0.05)。4.治疗组与对照组在治疗中Fugl-Meyer下肢运动功能评定比较无统计学差异(p>0.05)。但在治疗后评定比较治疗组优于对照组(p<0.05)。
结论:腰夹脊法能降低脑卒中后患者的肌张力,缓解肌肉痉挛,从而改善患者的下肢功能的恢复,此方法疗效高于对照组针法,针刺腰夹脊穴是临床治疗脑卒中后下肢痉挛的有效方法之一。
Purpose: To assess therapeutic effect on acupuncture at Jiaji (EX-B) of waist for the treatment of lower extremity spasticity for stroke patients.
Method: This study adopts hospital order according to the method, randomized control. Choose 60 cases of lower extremity spastic paralysis after stroke were randomly divided into two groups which based on rehabilitation training.30cases in the treatment group were treated with acupuncture group at Jiaji acupoints of waist (therapy at Jiaji of waist).30cases in the control group were treated with traditional acupuncture therapy(traditional acupuncture therapy).The evaluation of the functional rehabilitation was carried out by the methods before the treatment and after,Which were improved internationally Ashworth spasms table, lower limb clinical spasms index CSI, FAC walking function classification, Meyer lower limb movement Fug - treatment function evaluation, so data analyzed by SPSS17.0 statistical software.
Result: 1, the treatment group and control group in admission, treatment and out of the hospital about MAS has not statistics significance .(P>0.05). 2, the treatment group and control group in admission and treatment has not statistics significance about CSI. But the treatment group muscle tension at discharge is less than the control group when out of hospital. (P < 0.05) . 3, In admission the treatment group and control group about FAC walking function classification comparison was not statistically significant (p > 0.05), two groups in treatment group than in control group treatment (p < 0.05), two groups in the hospital treatment group than in control group (p < 0.05). 4, Both the treatment group and control group in admission and treatment has not statistics significance about Fugl - treatment of lower extremities Meyer movement function (P>0.05). Compare therapeutic effect of two groups out of hospital, indicating that the treatment group was better than control group (p < 0.05).
Conclusion: Therapy at Jiaji of waist can alleviate spasticity, relieve muscle spasm, thus improving the lower extremity function and therapy at Jiaji of waist is superior to traditional acupuncture when there are serious spasms sufferer. This topic avoided the current clinical debate that the more acupuncturing antagonist muscle can aggravate the increased muscle tension seizures and provocation. Acupuncture waist at Jiaji is an effective method to treat the lower extremity spasticity for stroke patients, also superior to traditional acupuncture point.
方法:本研究采用按入院顺序随机分组对照的方法,将60名符合纳入标准的患者,在康复训练的基础上随机分为治疗组(腰夹脊法)30例,对照组30例,分别进行针刺治疗,并采用国际通用的改良的Ashworth痉挛表、下肢临床痉挛指数(CSI)、FAC步行功能分级、Fug-Meyer下肢运动功能评价进行入院时、治疗中(1个月)及治疗后(3个月)的康复学评定,以评价治疗效果所以数据采用SPSS17.0统计软件进行分析。
结果:1.治疗组与对照组在入院时、治疗中、出院后MAS痉挛量表结果无统计学差异(p>0.05)。2.治疗组与对照组在入院时、治疗中下肢CSI结果无统计学差异,但在治疗后治疗组肌张力小于对照组(p<0.05)。3.治疗组与对照组在入院时FAC结果比较无统计学差异(p>0.05),但两组在治疗中及治疗后治疗组优于对照组(p<0.05)。4.治疗组与对照组在治疗中Fugl-Meyer下肢运动功能评定比较无统计学差异(p>0.05)。但在治疗后评定比较治疗组优于对照组(p<0.05)。
结论:腰夹脊法能降低脑卒中后患者的肌张力,缓解肌肉痉挛,从而改善患者的下肢功能的恢复,此方法疗效高于对照组针法,针刺腰夹脊穴是临床治疗脑卒中后下肢痉挛的有效方法之一。
Purpose: To assess therapeutic effect on acupuncture at Jiaji (EX-B) of waist for the treatment of lower extremity spasticity for stroke patients.
Method: This study adopts hospital order according to the method, randomized control. Choose 60 cases of lower extremity spastic paralysis after stroke were randomly divided into two groups which based on rehabilitation training.30cases in the treatment group were treated with acupuncture group at Jiaji acupoints of waist (therapy at Jiaji of waist).30cases in the control group were treated with traditional acupuncture therapy(traditional acupuncture therapy).The evaluation of the functional rehabilitation was carried out by the methods before the treatment and after,Which were improved internationally Ashworth spasms table, lower limb clinical spasms index CSI, FAC walking function classification, Meyer lower limb movement Fug - treatment function evaluation, so data analyzed by SPSS17.0 statistical software.
Result: 1, the treatment group and control group in admission, treatment and out of the hospital about MAS has not statistics significance .(P>0.05). 2, the treatment group and control group in admission and treatment has not statistics significance about CSI. But the treatment group muscle tension at discharge is less than the control group when out of hospital. (P < 0.05) . 3, In admission the treatment group and control group about FAC walking function classification comparison was not statistically significant (p > 0.05), two groups in treatment group than in control group treatment (p < 0.05), two groups in the hospital treatment group than in control group (p < 0.05). 4, Both the treatment group and control group in admission and treatment has not statistics significance about Fugl - treatment of lower extremities Meyer movement function (P>0.05). Compare therapeutic effect of two groups out of hospital, indicating that the treatment group was better than control group (p < 0.05).
Conclusion: Therapy at Jiaji of waist can alleviate spasticity, relieve muscle spasm, thus improving the lower extremity function and therapy at Jiaji of waist is superior to traditional acupuncture when there are serious spasms sufferer. This topic avoided the current clinical debate that the more acupuncturing antagonist muscle can aggravate the increased muscle tension seizures and provocation. Acupuncture waist at Jiaji is an effective method to treat the lower extremity spasticity for stroke patients, also superior to traditional acupuncture point.
引文
[1]胡雅丽.《金匮》消法初探[J].四川中医,2001,19(4):19.
[2]周天健.康复技术全书[M].北京出版社,1993:801-802.
[3]李佩芳.针刺拮抗肌群治疗脑卒中后肌张力增高[J].中国康复,2001,16(1):42.
[4]章薇,刘伍力,赵艳玲,等.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(1):464.
[5]苏育生.针刺阴经与阳经对比治疗中风后痉李性偏瘫的临床观察[D].硕士论文,2006,1.
[6]胡秋香,透穴针法治疗中风后遗症322例[J]河南中医学院学报2007,22(1): 66.
[7]姜桂美,等.不同刺激量针刺拮抗肌与主动肌治疗脑卒中后痉挛性偏瘫的临床疗效观察[J].针灸临床杂志,2008, 24(11):1..
[8]林秀瑶,陈立典.脑卒中后痉挛性偏瘫的临床研究现状[J].针灸临床杂志,2007,23(4):51-52.
[9]潘永清.透刺加电针治疗脑卒中后肌张力增高44例临床观察[J].江苏中医药,2007,39(1):39~40.
[10]米建平.张中成.阴经电针疗法降低中风偏瘫肢体肌张力疗效观察[J].上海针灸杂志,2003,22(10):7-8.
[11]李哲,郭钢花.电针拮抗肌群治疗脑卒中后肌张力增高[J].中国临床康复,2006, 10 (3): 135.
[12]刘培强,苗红.电针结合康复疗法对脑卒中后肌肉痉挛状态的影响[J].中国临床康复2004, 8(13): 2533.
[13]焦志玲,通电针刺降低中风后肢体肌张力增高的临床观察[J].中国保健(医学研究版),2007,15(24):136-137.
[14]王洪峰,黎明全.头针加恢刺治疗中风痉挛性偏瘫36例[J].吉林中医药,2003,23(4):33-34.
[15]王国书,俞昌德.颅体针结合治疗中风后痉挛瘫痪35例[J].针灸临床杂志,2006,22(8):12-13.
[16]刘登红.针灸治疗脑卒中后功能障碍165例[J].广西中医药,2009,32(2):34.
[17]米建平,张洪来.透针疗法治疗中风偏瘫痉挛状态临床观察[J].中国针灸2004,24: 11.
[18]赵真豪,“醒脑解痉”针法治疗卒中后痉挛性肌张力增高58例临床随机对照研究[J].四川中医,2007,25(10): 113.
[19]张勇,张翠平,李素萍,等.针刀缓解中风偏瘫肌张力增高32例[J].中国针灸,2003,23(4) :246.
[20]陈颖.头针联合经筋刺法治疗卒中后痉挛状态临床观察[J].中华中医药学刊, 2008, 26(5):1110.
[21]孙世晓,武桂娟.滞针兼透刺疗法治疗中风肢体痉挛状态临床观察[J].针灸临床杂志,2006,22(6):37.
[22]沈甜.针刺治疗脑卒中下肢肌张力增高的临床观察[J].中医药学刊,2005,25(11):2089-2091
[23]胡俊霞针刺结合康复训练缓解脑卒中后肌痉挛状态临床观察[J].中国中医药信息杂志,2007 14(8): 64.
[24]薛茜,熊国星,霍国敏,等.电针阳明经穴位对偏瘫患者运动功能康复的影响[J].中国康复论与实践,2007,13(11): 1056.
[25]陈金连王麟鹏“王氏夹脊穴”逆针灸治疗对脑卒中偏瘫痉挛状态117例随机对照观察[J].北京中医,2007,26(8)467.
[26]吴雪梅.颖梅针刺背俞穴、夹脊穴治疗脑卒中后痉挛性瘫痪的临床研究[J]2009.28(7)494-496
[27]陈小凯吴虹.刺华佗夹脊穴治疗脑血管意外后偏瘫疗效观察[J]上海针灸杂志2003.22(10)9
[28]王玉霞,刘兰芳.通络擦剂加推拿治疗中风后肌张力增高的临床观察[J].社区医学杂志,2005,3(6):49-50
[29]杨榕,曲崇正,庞维萍.针灸配合推拿治疗中风痉挛性偏瘫的临床研究[J].按摩与导引,2005,21(10):7-8.
[30]王朝霞,赵曼丽.养阴止痉颗粒治疗卒中后肌张力增高[J].中西医结合心脑血管病杂志,2003,4(5):450-451.
[31]周炜,王丽平.腹针治疗脑血管病后痉挛性瘫痪的疗效观察[J].中国针灸,2005,25(11):757-759.
[32] Bohannon RW, Smith MB. Interrater reliability on a Modified Ashworth Scale of muscle spasticity [J].Pher Ther, 1987,67: 206-207·
[33]倪克锋,葛芳,包烨华.脑卒中后肌张力增高的机制研究[J].2008年浙江省物理医学与康复学术年会,2008:175.
[34]窦祖林主编.痉挛评估与治疗[M].北京:人民卫生出版社,2004:5-26.
[2]周天健.康复技术全书[M].北京出版社,1993:801-802.
[3]李佩芳.针刺拮抗肌群治疗脑卒中后肌张力增高[J].中国康复,2001,16(1):42.
[4]章薇,刘伍力,赵艳玲,等.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(1):464.
[5]苏育生.针刺阴经与阳经对比治疗中风后痉李性偏瘫的临床观察[D].硕士论文,2006,1.
[6]胡秋香,透穴针法治疗中风后遗症322例[J]河南中医学院学报2007,22(1): 66.
[7]姜桂美,等.不同刺激量针刺拮抗肌与主动肌治疗脑卒中后痉挛性偏瘫的临床疗效观察[J].针灸临床杂志,2008, 24(11):1..
[8]林秀瑶,陈立典.脑卒中后痉挛性偏瘫的临床研究现状[J].针灸临床杂志,2007,23(4):51-52.
[9]潘永清.透刺加电针治疗脑卒中后肌张力增高44例临床观察[J].江苏中医药,2007,39(1):39~40.
[10]米建平.张中成.阴经电针疗法降低中风偏瘫肢体肌张力疗效观察[J].上海针灸杂志,2003,22(10):7-8.
[11]李哲,郭钢花.电针拮抗肌群治疗脑卒中后肌张力增高[J].中国临床康复,2006, 10 (3): 135.
[12]刘培强,苗红.电针结合康复疗法对脑卒中后肌肉痉挛状态的影响[J].中国临床康复2004, 8(13): 2533.
[13]焦志玲,通电针刺降低中风后肢体肌张力增高的临床观察[J].中国保健(医学研究版),2007,15(24):136-137.
[14]王洪峰,黎明全.头针加恢刺治疗中风痉挛性偏瘫36例[J].吉林中医药,2003,23(4):33-34.
[15]王国书,俞昌德.颅体针结合治疗中风后痉挛瘫痪35例[J].针灸临床杂志,2006,22(8):12-13.
[16]刘登红.针灸治疗脑卒中后功能障碍165例[J].广西中医药,2009,32(2):34.
[17]米建平,张洪来.透针疗法治疗中风偏瘫痉挛状态临床观察[J].中国针灸2004,24: 11.
[18]赵真豪,“醒脑解痉”针法治疗卒中后痉挛性肌张力增高58例临床随机对照研究[J].四川中医,2007,25(10): 113.
[19]张勇,张翠平,李素萍,等.针刀缓解中风偏瘫肌张力增高32例[J].中国针灸,2003,23(4) :246.
[20]陈颖.头针联合经筋刺法治疗卒中后痉挛状态临床观察[J].中华中医药学刊, 2008, 26(5):1110.
[21]孙世晓,武桂娟.滞针兼透刺疗法治疗中风肢体痉挛状态临床观察[J].针灸临床杂志,2006,22(6):37.
[22]沈甜.针刺治疗脑卒中下肢肌张力增高的临床观察[J].中医药学刊,2005,25(11):2089-2091
[23]胡俊霞针刺结合康复训练缓解脑卒中后肌痉挛状态临床观察[J].中国中医药信息杂志,2007 14(8): 64.
[24]薛茜,熊国星,霍国敏,等.电针阳明经穴位对偏瘫患者运动功能康复的影响[J].中国康复论与实践,2007,13(11): 1056.
[25]陈金连王麟鹏“王氏夹脊穴”逆针灸治疗对脑卒中偏瘫痉挛状态117例随机对照观察[J].北京中医,2007,26(8)467.
[26]吴雪梅.颖梅针刺背俞穴、夹脊穴治疗脑卒中后痉挛性瘫痪的临床研究[J]2009.28(7)494-496
[27]陈小凯吴虹.刺华佗夹脊穴治疗脑血管意外后偏瘫疗效观察[J]上海针灸杂志2003.22(10)9
[28]王玉霞,刘兰芳.通络擦剂加推拿治疗中风后肌张力增高的临床观察[J].社区医学杂志,2005,3(6):49-50
[29]杨榕,曲崇正,庞维萍.针灸配合推拿治疗中风痉挛性偏瘫的临床研究[J].按摩与导引,2005,21(10):7-8.
[30]王朝霞,赵曼丽.养阴止痉颗粒治疗卒中后肌张力增高[J].中西医结合心脑血管病杂志,2003,4(5):450-451.
[31]周炜,王丽平.腹针治疗脑血管病后痉挛性瘫痪的疗效观察[J].中国针灸,2005,25(11):757-759.
[32] Bohannon RW, Smith MB. Interrater reliability on a Modified Ashworth Scale of muscle spasticity [J].Pher Ther, 1987,67: 206-207·
[33]倪克锋,葛芳,包烨华.脑卒中后肌张力增高的机制研究[J].2008年浙江省物理医学与康复学术年会,2008:175.
[34]窦祖林主编.痉挛评估与治疗[M].北京:人民卫生出版社,2004:5-26.