提插补泻手法治疗中风偏瘫临床疗效观察
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摘要
研究目的:观察提插补泻手法治疗中风偏瘫的临床疗效,并初步探讨其作用机理,为临床探索一种疗效确切、易于操作的治疗方法。
研究方法:将符合诊断标准和纳入标准的60例中风偏瘫患者随机分为提插补泻手法治疗组30例和电针对照组30例。两组选取相同穴位,治疗时间为每周五次,每天治疗一次,休息两天后继续治疗,连续治疗4周,并于4周后进行疗效评价。疗效评价采用《中风病诊断疗效评定标准》(《二代标准》)、脑卒中患者临床神经功能缺损程度评分标准以及日常生活能力(ADL)改良Barthel指数评定表。
研究结果:治疗后两组总体疗效比较经Ridit检验,差异有显著性意义(P＜0.05),提插补泻组疗效优于电针组;两组患者治疗后临床神经功能缺损程度及日常生活活动能力均有明显改善,两组自身治疗前后比较,经配对t检验,差异均有显著性意义(P＜0.05);组间比较,经两独立样本t检验,差异有显著性意义(P＜0.05),治疗组疗效优于对照组。
研究结论:针刺提插补泻手法与电针治疗中风偏瘫均有明显效果,都能改善患者的神经功能缺损症状及提高患者日常生活活动能力。治疗后治疗组总体疗效优于对照组,治疗组神经功能缺损程度及日常生活活动能力改善更明显,且组间比较差异有统计学意义。
Objective:To observe the clinical efficacy of treating apoplexy hemiplegia with reducing and reinforcing manipulations by lifting and inserting the needle and to discuss initially its mechanism so as to explore the clinical treatment approach that has acknowledged effect and is easy to use.
Methods:According to the diagnostic criteria and inclusion criteria,60 stroke patients with apoplexy hemiplegia were selected and were randomly divided into treatment group and control group,with 30 cases in each group. The treatment group were treated with reducing and reinforcing manipulations by lifting and inserting the needle while the control group were treated by electro-acupuncture.For both groups,the same acupoints were chosen and the treatment frequency was five times a week,one time each day.After a rest for two days,the treatment continued and the total treatment duration was two weeks.Efficacy evaluation was conducted after two weeks' treatment according to the《stroke diagnosis and efficacy evaluation criteria》("second-generation standard"),the standards for scoring the degree of neurological deficit of stroke patients as well as Barthel Index scale which was modified from activities of daily living(ADL).
Results:After treatment,comparing the overall effects of the two groups by Ridit test,the difference was statistically significant(P＜0.05),indicating that the treatment group had better effect than electro-acupuncture group; For patients in both groups,their clinical neurological deficits and activities of daily living had been significantly improved after treatment, compared with each other,by independent samples t test,the difference was statistically significant(P＜0.05);for patients in each group,comparing their clinical neurological deficits and activities of daily living before and after the treatment,by paired t test,the differences were statistically significant(P＜0.05);indicating the treatment group had better effect than the control group.
Conclusion:Both reducing and reinforcing manipulations by lifting and inserting the needle and electro-acupuncture have remarkable effect in treating apoplexy hemiplegia patients.Both methods can improve symptoms of the degree of neurological deficit and enhance their activities of daily living. After treatment,the overall efficacy of the treatment group was better than the control group and the treatment group had a more obvious improvement in neurological deficits and activities of daily living.Comparing the two groups with each other,the difference was statistically significant.
研究方法:将符合诊断标准和纳入标准的60例中风偏瘫患者随机分为提插补泻手法治疗组30例和电针对照组30例。两组选取相同穴位,治疗时间为每周五次,每天治疗一次,休息两天后继续治疗,连续治疗4周,并于4周后进行疗效评价。疗效评价采用《中风病诊断疗效评定标准》(《二代标准》)、脑卒中患者临床神经功能缺损程度评分标准以及日常生活能力(ADL)改良Barthel指数评定表。
研究结果:治疗后两组总体疗效比较经Ridit检验,差异有显著性意义(P＜0.05),提插补泻组疗效优于电针组;两组患者治疗后临床神经功能缺损程度及日常生活活动能力均有明显改善,两组自身治疗前后比较,经配对t检验,差异均有显著性意义(P＜0.05);组间比较,经两独立样本t检验,差异有显著性意义(P＜0.05),治疗组疗效优于对照组。
研究结论:针刺提插补泻手法与电针治疗中风偏瘫均有明显效果,都能改善患者的神经功能缺损症状及提高患者日常生活活动能力。治疗后治疗组总体疗效优于对照组,治疗组神经功能缺损程度及日常生活活动能力改善更明显,且组间比较差异有统计学意义。
Objective:To observe the clinical efficacy of treating apoplexy hemiplegia with reducing and reinforcing manipulations by lifting and inserting the needle and to discuss initially its mechanism so as to explore the clinical treatment approach that has acknowledged effect and is easy to use.
Methods:According to the diagnostic criteria and inclusion criteria,60 stroke patients with apoplexy hemiplegia were selected and were randomly divided into treatment group and control group,with 30 cases in each group. The treatment group were treated with reducing and reinforcing manipulations by lifting and inserting the needle while the control group were treated by electro-acupuncture.For both groups,the same acupoints were chosen and the treatment frequency was five times a week,one time each day.After a rest for two days,the treatment continued and the total treatment duration was two weeks.Efficacy evaluation was conducted after two weeks' treatment according to the《stroke diagnosis and efficacy evaluation criteria》("second-generation standard"),the standards for scoring the degree of neurological deficit of stroke patients as well as Barthel Index scale which was modified from activities of daily living(ADL).
Results:After treatment,comparing the overall effects of the two groups by Ridit test,the difference was statistically significant(P＜0.05),indicating that the treatment group had better effect than electro-acupuncture group; For patients in both groups,their clinical neurological deficits and activities of daily living had been significantly improved after treatment, compared with each other,by independent samples t test,the difference was statistically significant(P＜0.05);for patients in each group,comparing their clinical neurological deficits and activities of daily living before and after the treatment,by paired t test,the differences were statistically significant(P＜0.05);indicating the treatment group had better effect than the control group.
Conclusion:Both reducing and reinforcing manipulations by lifting and inserting the needle and electro-acupuncture have remarkable effect in treating apoplexy hemiplegia patients.Both methods can improve symptoms of the degree of neurological deficit and enhance their activities of daily living. After treatment,the overall efficacy of the treatment group was better than the control group and the treatment group had a more obvious improvement in neurological deficits and activities of daily living.Comparing the two groups with each other,the difference was statistically significant.
引文
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[27]靳瑞.颞三针治疗中风后遗症的临床观察[J].中国针灸,1993,13(1):11-2.
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[29]陈小凯.针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 10
[30]陈有国.头针为主治疗急性脑梗塞近期疗效对比观察[J].中国针灸,2001,21(10):589-590.
[31]郁云亚.针灸治疗脑梗塞120例[J].上海针灸杂志,1993,12(2):54-55.
[32]罗素珍.穴位注射配合针刺治疗中风病78例临床观察[J].上海针灸杂志,1998,17(2):10-11.
[33]江杰士.电针加埋线治疗中枢性偏竣108例疗效观察[J].中国针灸,1997,17(1):9-10.
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[37]周继曾.醒脑开窍针刺治疗中风后遗症的临床研究[J].中国针灸,1995,15(3):6-8.
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[2]第三届全国神经外科血管内介入治疗会议论文汇编,天津:中华医学会神轻外科学会.1995 8
[3]方定华.神经康复学.中华神经精神科杂志,1995.4:236
[4]章薇,刘伍立,赵艳玲.针刺阳陵泉为主治疗痉挛瘫痪52例临床观察、中国医刊,1999,34(3):180:
[5]陈玉华,赵勃,隋秋珍·按外风针治中风偏瘫162例临床观察[J].上海针灸杂志1993.12(1)。12:
[6]李静铭·试谈阴经穴在针灸治疗中风偏瘫中的作用·江苏中医2000,21(8):9~11
[7]睢明河.针刺手少阳经穴治疗中风后上臂痉挛的临床观察.针刺研究.2001,26(2):131~132.
[8]谢牡丹,中风偏瘫后遗症的针灸治疗.中医药研究.2001,17(2):19.
[9]王玉明.阴阳经穴位平衡刺治疗脑血管意外后遗症312例疗效观察.中国针灸.1993,13(2):1-2.
[10]郭泽新,汪润生.分部针刺治疗中风偏瘫痉挛68例临床观察.中国针灸1995,15(5):7-8.
[11]李蕙兰,孙岚,徐基民,赵蕾.针刺结合康复治疗偏瘫疗效观察.中国针灸.1996,16(10):3.
[12]刘志顺,李以松.针灸治疗中风偏瘫之我见.甘肃中医.1997,10(3):37-38.
[13]郑谅,江钢辉.调和阴阳法治疗中风偏瘫的临床研究.针刺研究.1999,24(9):249~252.
[14]孙琳.中风偏瘫的针灸探索[J].上海针灸杂志.1996,15(1):13-14.
[15]陆寿康.提高中风偏瘫针灸疗效的途径和方法[J].中医杂志.1995,36(2):110-112.
[16]张毅明.解惑刺法分期治疗中风51例[J].上海针灸杂志.1996,15(5):13-14.
[17]王元潮.中风虚实补泻临床应用[J].针灸临床杂志.2000,16(4):15-16.
[18]桂清民.平调阴阳跷脉治疗中风后遗症足内外翻110例临床观察[J].针灸临床杂志.1994,10(3):18.
[19]冯伟民.一穴双针合循经理筋法治疗中风偏瘫[J].针灸临床杂志.1997,13(2):30~31.
[20]许曙.浅述中风后遗症半身不遂的治疗[J].针灸临床杂志.1997,13(4):5-6.
[21]王宏志.论偏瘫的分三期针刺治疗[J].中医杂志.1987,28(7):51-52.
[22]王宏志.针刺治疗中风偏瘫1620例临床观察.中国针灸.1991,11(6):1-2.
[23]雷秀珍.针刺配合药物治疗脑血栓形成40例.中国针灸.1995,15(4):28。
[24]秦黎虹.头针交叉刺久留针治疗中风后偏瘫疗效观察[J].中国针灸,2002, 22(6):397-398
[25]江钢辉,李艳慧,黄勇,等.头颅磁共振成像定位围针对中风偏瘫患者血液流变学的影响[J].针刺研究,2004,29(1):63-68
[26]郑宗昌.头穴配腰骶穴治疗中风后遗症634例[j].上海针灸杂志,1996,15(5):15-16.
[27]靳瑞.颞三针治疗中风后遗症的临床观察[J].中国针灸,1993,13(1):11-2.
[28]仇惠艳.头针与体针结合治疗中风96例疗效观察[J].针灸临床杂志,2002,18(4):16-17.
[29]陈小凯.针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 10
[30]陈有国.头针为主治疗急性脑梗塞近期疗效对比观察[J].中国针灸,2001,21(10):589-590.
[31]郁云亚.针灸治疗脑梗塞120例[J].上海针灸杂志,1993,12(2):54-55.
[32]罗素珍.穴位注射配合针刺治疗中风病78例临床观察[J].上海针灸杂志,1998,17(2):10-11.
[33]江杰士.电针加埋线治疗中枢性偏竣108例疗效观察[J].中国针灸,1997,17(1):9-10.
[34]杨本瑜.穴位埋线治疗中风偏瘫100例疗效分析[J].中国针灸1994,14(5):31-32.
[35]黄劲柏.刺血疗法治疗急性脑梗塞近期疗效观察[J].上海针灸杂志,2002,21(4):7-8.
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