分消走泄法与Bobath技术改善脑卒中偏瘫临床研究
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摘要
脑卒中是一种急性脑血管疾病,多由于急性脑血管破裂或闭塞,从而导致局部或全脑神经功能障碍。祖国医学认为是因气血逆乱,产生风、火、痰、瘀,导致脑脉痹阻或血溢脑脉。脑卒中急性期多见痰瘀阻络,痰瘀阻络易致痹阻脉络从而引起的三焦气机失调及肢体不遂者疾病。是属脑血管科的常见和多发病,具有较高的致残率和病死率,发病后约有60～80%的患者遗留有不同程度的肢体运动功能障碍。
分消走泄法是《温病学》的治疗法则之一,主治邪热与痰湿留连三焦,三焦气化失司,而致痰热阻遏之证,其代表方为“温胆汤”,以宣开上焦、畅通中焦、渗泄下焦,分消痰湿病邪,调整气机的宣展。
康复训练是遵循人类生长发育的自然规律,按照正常的运动模式,增强神经肌肉的兴奋性,提高肌张力,增强稳定性,加强抑制降低痉挛肌肉的张力。抑制脑卒中偏瘫运动功能障碍的异常运动模式。Bobath技术为现在较多人所使用的康复技术之一,对于控制了患肢的痉挛的出现,减少因痉挛而加重肢体的运动功能障碍的程度,以及使偏瘫肢体可以从新获得肢体的运动感觉。对脑卒中偏瘫患者的功能恢复起一定的效果。
本研究将中医辨证治疗与现代医学中康复技术相结合,用治于脑卒中偏瘫,从临床观察角度,客观的评价分消走泄法与Bobath技术结合改善脑卒中偏瘫临床疗效,以期更好的更好的推广应用于临床上。
方法:急性期脑卒中偏瘫患者60例,分为治疗组30例,采用温胆汤加减与Bobath康复技术和入院常规药物治疗结合治疗。对照组30例,采用住院常规药物治疗。临床指标:改良的Ashworth肌张力分级;简式Fugl—Meyer运动功能评定法;改良的Bathel计分法。研究对象:两组患者60例来源于广州中医药大学第一附属医院四内科住院病人。
治疗方法:
1.治疗组
(1)中药:以温胆汤为主基本方,其方药组成半夏、竹茹、枳实、橘皮、甘草、茯苓。兼证配伍:头晕目眩痰重者加天麻,钩藤;血瘀久日者:莪术,水蛭;上肢偏瘫重者桂枝,桑枝;下肢偏瘫重者牛膝,续断;手足痛者加细辛、玄胡。服用方法:中药每日1剂,分2次口服,每次150毫升。
(2)西药:使用常规脑卒中住院相关药物治疗。
(3)康复治疗:根据Brunnstrom分期以Bobath技术训练。
Ⅰ、Ⅱ期:应将患肢放于正确位置,防止痉挛及共同运动的定型化。翻身训练:训练患者可自行床上向患侧或健侧翻身。上肢训练:被动活动肩胛带、双手抓握上举,防止肩胛的退缩、下降、肩痛何不全脱位。下肢训练:屈膝训练、屈踝训练、骨盆提起转向前同时屈膝伸髋训练、控制患腿不受健腿活动影响的训练。坐位及坐位平衡训练:训练患者从仰卧位坐到床沿、训练坐位的平衡。
Ⅲ、Ⅳ期:解除上下肢痉挛、躯干痉挛、肩痉挛、手痉挛、肘痉挛、指痉挛等对抗性治疗。坐下和站起训练:锻炼患者可自行控制坐下和站起的平衡功能。走前训练:训练患者可以抗痉挛的模式站立,控制站立时的平衡性,练习屈膝与背屈踝的功能,练习在不屈髋的条件下屈膝,确保髋、膝、踝关节的松弛,达到屈髋屈膝迈步。上肢训练:上肢控制训练、伸肘与肘的独立功能训练。
Ⅴ、Ⅵ期:痉挛与共同运动逐渐减少,可给予简单的组合运动指导。上肢训练:伸腕训练、手前臂旋后训练、拇指外展及与其它各指对掌训练。手掌精细功能训练。下肢训练:站立平衡训练、迈步和著地训练、骨盆旋转练习、行走训练、下肢精细协调训练。
(4)治疗疗程:每周连续治疗6天,每天上午下午各锻炼1小时,休息1天,每两周为一个治疗观察疗程。
2.对照组
(1)中药:脑卒中痰瘀阻络证型,以化痰通络汤为主。服用方法:中药每日1剂,分2次口服,每次150毫升。
(2)西药:使用常规脑卒中住院相关药物治疗。
结果:1.治疗前两组各项指标无明显差异。表明两组样本来自于同一个总体,具有可比性。
2.治疗后两组各项指标相比较具有显著性差异
3.两组治疗前后组内各项指标相比较具有显著差异
结论:本临床研究显示:使用分消走泄法与Bobath技术结合改善脑卒中偏瘫,临床研究疗效与常规住院治疗有明显性的差异,分消走泄法与Bobath技术结合改善脑卒中偏瘫为临床上有效改善肢体功能障碍的治疗方法。
Stroke is an acute cerebral vascular disease,and more as a result of rupture or acute cerebral vascular occlusion,resulting in partial or total brain dysfunction.Chinese medicine is considered what with disorder of gas-blood,bring on wind、fire、phlegm、haemostasis come into being,leading to blood stagnant in cerebral venation or overflow.Most of the acute phase of stroke are the type of phlegm and blood stasis obstructing,which can easily lead to the triple burners' Qi-activity disorder,led to air-limb disorders.Section is the cerebrovascular common and frequently-occurring disease with high morbidity and mortality, morbidity,about 60～80%of patients in varying degrees left over from motor dysfunction.
The way of diffluence is one of the treatment of the law of "Science of Seasonal Febrile Diseases".Treat the heat and dampness evils attending linger triple burners,result to the triple burner gasification-disorder, heat-phlegmon stasis the vein,the behalf formulas is the "Wendan Decoction" to declare open the upper burner,free the middle turner, seepage the under burner,eliminate dampness points,adjusting the air-show of propaganda.
Rehabilitation training is to follow the natural law of human growth and development,in accordance with the normal movement patterns,and enhance neuromuscular excitability and improve muscle tone,enhance stability,to strengthen the inhibition of muscle spasms to reduce tension. Inhibition of hemiplegia after stroke motor dysfunction of the abnormal movement patterns.Bobath technology is now used by more people,one of the rehabilitation techniques for the control of the spastic limb emergence, reduce spasticity and increase the body of the extent of motor dysfunction, as well as limb paralysis can be obtained from the motor and sensory limb. Stroke patients with hemiplegia on the functional recovery from certain effects.
In this study,TCM treatment and rehabilitation techniques of modern medicine in combination with governance in post-stroke hemiplegia,from the perspective of clinical observation and objective evaluation of diffluence method and Bobath walking vent technology to improve the clinical effects of hemiplegia after stroke,with a view to better used to promote better clinical practice.
Methods:The acute phase of stroke patients with hemiplegia 60 cases, 30 cases divided into treatment group,using Wendan Decoction with Bobath rehabilitation technology and hospital treatment combined with conventional drug therapy.30 cases of the control group,the use of conventional hospital treatment.Clinical indicators:improved muscle tone Ashworth grading;Brief Fugl-Meyer assessment of motor function; Bathel improved scoring method.Subjects:two groups of 60 patients from Guangzhou University of Traditional Chinese Medicine First Affiliated Hospital of Internal MedicineⅣpatients.
Treatment:
1.The treatment group
(1) Chinese Medicine:The Decoction Wendan basic side,the composition of its prescriptions Banxia,Zhuru,Zhishi,Jupi,Gancao.Fuling. Compatibility and certification:dizzy gastrodin sputum increase in serious cases,Gouteng;Blood stasis long days:Ezhu,leech;upper limb hemiplegia were Guizhi,Sangzhi,serious cases of lower limb paralysis,Niuxi,xuduan,One who chiropodaligia,Xixin,Xuan Hu.Use of methods:traditional Chinese medicine one dose a day,2 times of oral, per 150 milliliters.
(2) Western medicine:use the conventional medical treatment in stroke-related hospitalization.
(3) rehabilitation therapy:According to Brunnstrom staging technical training in acrossding to Bobath.
Ⅰ,Ⅱperiod:limb should be put in the correct position to prevent the cramps and the common stereotypes of sport.Stand up the training: Training provided to patients suffering from bed to turn over to the side or contralateral.Upper limb training:passive motion shoulder girdle and hands lifting grip to prevent the retreat of scapula,down,shoulder luxation why.Training of lower limbs:flexion training,training of ankle flexion,pelvis before turning at the same time to bring hip knee extensor training,control patients without health legs leg training activities. Sitting and sitting balance training:Training of patients come to the edge from the supine position,sitting balance training.
Ⅲ,Ⅳstages:the lifting of the lower limbs cramps,body cramps, shoulder cramps,hand cramps,elbow cramps,confrontational means,such as the treatment of spasticity.Sit down and stand up training:training in patients with self-control to sit down and stand up and balance function. Go before the training:training in patients with anti-spasm model can stand up,control the balance immediately,with dorsiflexion of ankle flexion exercises the functions of and practice in the indomitable knees under the conditions of the hip to ensure that the hip,knee,ankle relaxation,to Qu Moving the hip flexion.Upper limb training:training in upper limb control,elbow extensor and elbow function of the independent training.
Ⅴ,Ⅵperiod:cramps and joint movement gradually reduced to a combination of simple movement to give guidance.Upper limb training: extensor carpi training hand forearm supination training,outreach and thumb with the other hand refers to the training.Fine hand function training.Lower extremity training:standing balance training,to go and the training,pelvic rotation exercises,walking training,training of lower limb co-ordination fine.
(4) in the treatment of treatment:treatment for 6 days a week,twice a day,one hour in the morning and one hour in the afternoon,every two weeks for a course of treatment.
2.The control group
(1) Chinese Medicine:Stroke Syndromes of phlegm and blood obstruct the venation,mainly in the Huatan Tongluo Tang.Use of methods: traditional Chinese medicine one dose a day,twice of oral,per 150 milliliters.
(2) Western medicine:use the conventional medical treatment in stroke-related hospitalization.
Results:1.The treatment of the former two groups had no significant differences in the indicators.Show that the two sets of samples from the same general,comparable.
2.After treatment compared to the targets of the two groups with significant difference
3.The targets of the two groups before and after treatment are significant difference
Conclusion:The clinical studies have shown:the use of the method of diffluence and Bobath walking vent technology combined to improve post-stroke hemiplegia,clinical research and routine patient treatment effects are obvious differences,the method of diffluence and Bobath walking vent technology combined to improve the clinical stroke hemiplegia effectively improve the physical dysfunction treatment.
分消走泄法是《温病学》的治疗法则之一,主治邪热与痰湿留连三焦,三焦气化失司,而致痰热阻遏之证,其代表方为“温胆汤”,以宣开上焦、畅通中焦、渗泄下焦,分消痰湿病邪,调整气机的宣展。
康复训练是遵循人类生长发育的自然规律,按照正常的运动模式,增强神经肌肉的兴奋性,提高肌张力,增强稳定性,加强抑制降低痉挛肌肉的张力。抑制脑卒中偏瘫运动功能障碍的异常运动模式。Bobath技术为现在较多人所使用的康复技术之一,对于控制了患肢的痉挛的出现,减少因痉挛而加重肢体的运动功能障碍的程度,以及使偏瘫肢体可以从新获得肢体的运动感觉。对脑卒中偏瘫患者的功能恢复起一定的效果。
本研究将中医辨证治疗与现代医学中康复技术相结合,用治于脑卒中偏瘫,从临床观察角度,客观的评价分消走泄法与Bobath技术结合改善脑卒中偏瘫临床疗效,以期更好的更好的推广应用于临床上。
方法:急性期脑卒中偏瘫患者60例,分为治疗组30例,采用温胆汤加减与Bobath康复技术和入院常规药物治疗结合治疗。对照组30例,采用住院常规药物治疗。临床指标:改良的Ashworth肌张力分级;简式Fugl—Meyer运动功能评定法;改良的Bathel计分法。研究对象:两组患者60例来源于广州中医药大学第一附属医院四内科住院病人。
治疗方法:
1.治疗组
(1)中药:以温胆汤为主基本方,其方药组成半夏、竹茹、枳实、橘皮、甘草、茯苓。兼证配伍:头晕目眩痰重者加天麻,钩藤;血瘀久日者:莪术,水蛭;上肢偏瘫重者桂枝,桑枝;下肢偏瘫重者牛膝,续断;手足痛者加细辛、玄胡。服用方法:中药每日1剂,分2次口服,每次150毫升。
(2)西药:使用常规脑卒中住院相关药物治疗。
(3)康复治疗:根据Brunnstrom分期以Bobath技术训练。
Ⅰ、Ⅱ期:应将患肢放于正确位置,防止痉挛及共同运动的定型化。翻身训练:训练患者可自行床上向患侧或健侧翻身。上肢训练:被动活动肩胛带、双手抓握上举,防止肩胛的退缩、下降、肩痛何不全脱位。下肢训练:屈膝训练、屈踝训练、骨盆提起转向前同时屈膝伸髋训练、控制患腿不受健腿活动影响的训练。坐位及坐位平衡训练:训练患者从仰卧位坐到床沿、训练坐位的平衡。
Ⅲ、Ⅳ期:解除上下肢痉挛、躯干痉挛、肩痉挛、手痉挛、肘痉挛、指痉挛等对抗性治疗。坐下和站起训练:锻炼患者可自行控制坐下和站起的平衡功能。走前训练:训练患者可以抗痉挛的模式站立,控制站立时的平衡性,练习屈膝与背屈踝的功能,练习在不屈髋的条件下屈膝,确保髋、膝、踝关节的松弛,达到屈髋屈膝迈步。上肢训练:上肢控制训练、伸肘与肘的独立功能训练。
Ⅴ、Ⅵ期:痉挛与共同运动逐渐减少,可给予简单的组合运动指导。上肢训练:伸腕训练、手前臂旋后训练、拇指外展及与其它各指对掌训练。手掌精细功能训练。下肢训练:站立平衡训练、迈步和著地训练、骨盆旋转练习、行走训练、下肢精细协调训练。
(4)治疗疗程:每周连续治疗6天,每天上午下午各锻炼1小时,休息1天,每两周为一个治疗观察疗程。
2.对照组
(1)中药:脑卒中痰瘀阻络证型,以化痰通络汤为主。服用方法:中药每日1剂,分2次口服,每次150毫升。
(2)西药:使用常规脑卒中住院相关药物治疗。
结果:1.治疗前两组各项指标无明显差异。表明两组样本来自于同一个总体,具有可比性。
2.治疗后两组各项指标相比较具有显著性差异
3.两组治疗前后组内各项指标相比较具有显著差异
结论:本临床研究显示:使用分消走泄法与Bobath技术结合改善脑卒中偏瘫,临床研究疗效与常规住院治疗有明显性的差异,分消走泄法与Bobath技术结合改善脑卒中偏瘫为临床上有效改善肢体功能障碍的治疗方法。
Stroke is an acute cerebral vascular disease,and more as a result of rupture or acute cerebral vascular occlusion,resulting in partial or total brain dysfunction.Chinese medicine is considered what with disorder of gas-blood,bring on wind、fire、phlegm、haemostasis come into being,leading to blood stagnant in cerebral venation or overflow.Most of the acute phase of stroke are the type of phlegm and blood stasis obstructing,which can easily lead to the triple burners' Qi-activity disorder,led to air-limb disorders.Section is the cerebrovascular common and frequently-occurring disease with high morbidity and mortality, morbidity,about 60～80%of patients in varying degrees left over from motor dysfunction.
The way of diffluence is one of the treatment of the law of "Science of Seasonal Febrile Diseases".Treat the heat and dampness evils attending linger triple burners,result to the triple burner gasification-disorder, heat-phlegmon stasis the vein,the behalf formulas is the "Wendan Decoction" to declare open the upper burner,free the middle turner, seepage the under burner,eliminate dampness points,adjusting the air-show of propaganda.
Rehabilitation training is to follow the natural law of human growth and development,in accordance with the normal movement patterns,and enhance neuromuscular excitability and improve muscle tone,enhance stability,to strengthen the inhibition of muscle spasms to reduce tension. Inhibition of hemiplegia after stroke motor dysfunction of the abnormal movement patterns.Bobath technology is now used by more people,one of the rehabilitation techniques for the control of the spastic limb emergence, reduce spasticity and increase the body of the extent of motor dysfunction, as well as limb paralysis can be obtained from the motor and sensory limb. Stroke patients with hemiplegia on the functional recovery from certain effects.
In this study,TCM treatment and rehabilitation techniques of modern medicine in combination with governance in post-stroke hemiplegia,from the perspective of clinical observation and objective evaluation of diffluence method and Bobath walking vent technology to improve the clinical effects of hemiplegia after stroke,with a view to better used to promote better clinical practice.
Methods:The acute phase of stroke patients with hemiplegia 60 cases, 30 cases divided into treatment group,using Wendan Decoction with Bobath rehabilitation technology and hospital treatment combined with conventional drug therapy.30 cases of the control group,the use of conventional hospital treatment.Clinical indicators:improved muscle tone Ashworth grading;Brief Fugl-Meyer assessment of motor function; Bathel improved scoring method.Subjects:two groups of 60 patients from Guangzhou University of Traditional Chinese Medicine First Affiliated Hospital of Internal MedicineⅣpatients.
Treatment:
1.The treatment group
(1) Chinese Medicine:The Decoction Wendan basic side,the composition of its prescriptions Banxia,Zhuru,Zhishi,Jupi,Gancao.Fuling. Compatibility and certification:dizzy gastrodin sputum increase in serious cases,Gouteng;Blood stasis long days:Ezhu,leech;upper limb hemiplegia were Guizhi,Sangzhi,serious cases of lower limb paralysis,Niuxi,xuduan,One who chiropodaligia,Xixin,Xuan Hu.Use of methods:traditional Chinese medicine one dose a day,2 times of oral, per 150 milliliters.
(2) Western medicine:use the conventional medical treatment in stroke-related hospitalization.
(3) rehabilitation therapy:According to Brunnstrom staging technical training in acrossding to Bobath.
Ⅰ,Ⅱperiod:limb should be put in the correct position to prevent the cramps and the common stereotypes of sport.Stand up the training: Training provided to patients suffering from bed to turn over to the side or contralateral.Upper limb training:passive motion shoulder girdle and hands lifting grip to prevent the retreat of scapula,down,shoulder luxation why.Training of lower limbs:flexion training,training of ankle flexion,pelvis before turning at the same time to bring hip knee extensor training,control patients without health legs leg training activities. Sitting and sitting balance training:Training of patients come to the edge from the supine position,sitting balance training.
Ⅲ,Ⅳstages:the lifting of the lower limbs cramps,body cramps, shoulder cramps,hand cramps,elbow cramps,confrontational means,such as the treatment of spasticity.Sit down and stand up training:training in patients with self-control to sit down and stand up and balance function. Go before the training:training in patients with anti-spasm model can stand up,control the balance immediately,with dorsiflexion of ankle flexion exercises the functions of and practice in the indomitable knees under the conditions of the hip to ensure that the hip,knee,ankle relaxation,to Qu Moving the hip flexion.Upper limb training:training in upper limb control,elbow extensor and elbow function of the independent training.
Ⅴ,Ⅵperiod:cramps and joint movement gradually reduced to a combination of simple movement to give guidance.Upper limb training: extensor carpi training hand forearm supination training,outreach and thumb with the other hand refers to the training.Fine hand function training.Lower extremity training:standing balance training,to go and the training,pelvic rotation exercises,walking training,training of lower limb co-ordination fine.
(4) in the treatment of treatment:treatment for 6 days a week,twice a day,one hour in the morning and one hour in the afternoon,every two weeks for a course of treatment.
2.The control group
(1) Chinese Medicine:Stroke Syndromes of phlegm and blood obstruct the venation,mainly in the Huatan Tongluo Tang.Use of methods: traditional Chinese medicine one dose a day,twice of oral,per 150 milliliters.
(2) Western medicine:use the conventional medical treatment in stroke-related hospitalization.
Results:1.The treatment of the former two groups had no significant differences in the indicators.Show that the two sets of samples from the same general,comparable.
2.After treatment compared to the targets of the two groups with significant difference
3.The targets of the two groups before and after treatment are significant difference
Conclusion:The clinical studies have shown:the use of the method of diffluence and Bobath walking vent technology combined to improve post-stroke hemiplegia,clinical research and routine patient treatment effects are obvious differences,the method of diffluence and Bobath walking vent technology combined to improve the clinical stroke hemiplegia effectively improve the physical dysfunction treatment.
引文
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[2]米曙光,张安生.醒脑开窍法结合康复训练对脑卒中偏瘫康复疗效的观察[J].武警医学,2007,18(3):186-188.
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[11]胡国贤.益气活血通络法化裁治疗缺血性中风恢复期[J].湖南中医药导报,2008,8(8):485.
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[14]刘绍峰,刘洪荣.益气活血通络开窍醒脑充髓法治疗缺血性脑卒中后痴呆[J].四川中医,2005,23(10):53-54.
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[17]吴静.甘露醇与1,6-二磷酸果糖联合治疗脑梗塞急性期64例分析[J].青海医药杂志,2001,31(1):43-44.
[18]曹忠.尼莫地平和654-2在脑梗塞急性期的应用[J].中国冶金工业医学杂志,1996,13(3):146-148.
[19]柳浩然.胞二磷胆碱治疗轻度脑梗塞急性期52例的疗效分析[J].海南医学,2001,12(10):2-3. 杂志,1999,2(5):14-15.
[21]林琳,楚佳梅.针灸配合康复技术对中风后遗症患者瘫痪肢体促分离运动疗效的临床研究[J]中华中医药学刊,2008,26(6):1251-1253.
[22]王新德.神经康复学[M].人民军医出版社,2003:149-153.
[23]陈寿明.早期康复治疗对脑梗死偏瘫患者愈后的影响[J].临床和实验医学杂志,2008,7(7):82-83.
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[25]丁新华,尤春景.脑卒中患者Brunnsteom分期及其运动功能恢复[J].中国康复,1996,11(3):110-111.
[26]耿吉冬,李乐,景磊,赵可为.主被动训练仪结合康复训练对中风后偏瘫肢体的治疗作用研究[J].(中国保健)医学研究版,2008,16(24):1160-1161.
[27]陆露晶.中药加康复运动治疗急性期缺血性中风30例[J].辽宁中医学院院报,1999,1(3):182-183.
[28]李英,郭智轶.脑中风早期功能锻炼及康复指导探要[J].实用中医内科杂志,2008,22(5):115.
[29]文颖娟,邓中甲.温胆汤研究进展探析[J].光明中医,2008,23(8):1234-1237.
[30]李永.清以前温胆汤类方药物加减变化分析[J].光明中医,2008,23(11):1813-1814.
[31]潘小永.温胆汤加味治疗心系病症的体会[J].中国中医药现代远程教育,2008,6(4):349.
[32]于仁义.温胆汤在心脏病中的应用[J].中国中医急症,2008,17(5):704-705.
[33]陈晓锋.温胆汤在神经内科疾病治疗中的临床体会[J].中西医结合心脑血管病杂志,2008,6(10):1253-1254.
[34]赵保国.温胆汤治疗血管神经性头痛76例临床观察[J].长治医学院学报,2007,21(2):144-145.
[35]侯显庆.温胆汤运用的临床体会[J].贵阳中医学院学报,1988,(4):30-32.
[36]苏娟萍.温胆汤加减治疗单纯性脂肪肝体会[J].Chinese Journal of Informatiom on TCM,2005,12(12):60.
[37]柏向阳.温胆汤加味治疗慢性支气管炎急性发作32例[J].湖南中医杂志,2005,21(6):45-46.
[38]郭涛荣.温胆汤的灵活应用[J].辽宁中医学院学报,2005,7(6):558.
[39]李莉芬.温胆汤加减治疗糖尿病味轻瘫59例[J].中国实验方剂学杂志,2005,11(4):69-70.
[40]杨平.温胆汤临床应用举例[J].河南中医学院学报,2008,23(138):70-71.
[41]杨洪涛,王改敏.温胆汤治疗慢性胆囊炎的体会[J].中国实用医药,2008,3(11):144-145.
[42]柏涛,黄小玲,李之清,等.张赤志治疗高胆红素血症经验举[J].中西医结合肝病杂志,2008,18(2):112.
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[50]廖莉琴.彭胜权教授治疗病毒性脑炎继发癫痫验案[J].新中医,2001,6:11
[51]许启蒙.熊继柏运用温胆汤治疗心脑病证经验[J].中医杂志,2003,3:177
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