腕踝针结合电针治疗缺血性中风偏瘫的临床研究
详细信息    本馆镜像全文|  推荐本文 |  |   获取CNKI官网全文
摘要
缺血性中风是指各种原因所致脑部血液供应障碍,导致脑组织缺血、缺氧性坏死,出现相应神经功能缺损。现代医学将缺血性中风分为脑血栓形成、脑栓塞、腔隙性脑梗死三种类型。其作为神经系统的常见病,是目前导致人类死亡的三大主要疾病之一,并且存活的患者遗留不同程度的残疾,严重影响患者的生活及工作。
     目的:
     本研究将腕踝针应用于缺血性中风偏瘫的临床治疗,并与对照组比较,通过比较患者治疗前后Barthel指数评分(MBI)和神经功能缺损程度评分(NDS),观察腕踝针结合电针治疗缺血性中风偏瘫的临床疗效。探寻治疗缺血性中风的有效的治疗方案。
     方法:
     1通过复习文献研究,总结缺血性中风的中西医发病机制及治疗的研究进展,以探究本治疗方案的理论依据及可行性。
     2临床研究方面,将60例缺血性中风的患者,按随机简单数字表法将其分为治疗组和对照组各30例。对照组采用电针治疗,治疗组采用腕踝针结合电针,隔日一次,疗程为28天。治疗前后分别对两组患者进行Barthel指数评分(MBI)和神经功能缺损程度评分(NDS),并统计两组的临床疗效。
     结果:
     1治疗前,治疗组与对照组的一般情况、MBI评分和NDS评分经统计学处理后,P>0.05,无显著差异,无统计学意义,具有可比性。
     2经治疗后,在临床疗效上,治疗组总有效率为93.3%,对照组的为73.3%,治疗组和对照组的总有效率比较,差异具有统计学意义(P<0.05),说明治疗组疗效明显优于对照组。
     3两组缺血性中风患者Barthel指数评分比较:经不同的针刺干预后,两组患者Barthel指数评分均有提高,治疗组与对照组Barthel指数评分比较,两组间Barthel指数评分差异具有统计学意义(P<0.05),表明腕踝针结合电针能显著改善患者日常生活能力,且疗效优于对照组。
     4两组缺血性中风患者NDS评分比较:经不同的针刺干预后,两组患者NDS评分均有降低,治疗组与对照组NDS评分比较,两组间NDS评分差异比较具有统计学意义(P<0.05),表明腕踝针结合电针能明显改善患者神经功能,且疗效优于对照组。
     结论:
     1腕踩针结合电针疗法可以明显提高患者Barthel指数评分,显著改善患者日常生活能力,其临床疗效明显优于对照组。
     2腕踝针结合电针疗法可以明显降低患者神经功能缺损评分,明显改善患者神经功能,且其临床疗效明显优于对照组。
     3通过对纳入病例的综合评价,腕踝针结合电针治疗缺血性中风偏瘫具有较好的临床疗效。
schemic stroke is brain blood supply obstacle caused by various of reasons, which leads to cerebral ischemia, oxygen deficiency necrosis, thereby appears the corresponding neural function defect. Modern medicine divides ischemic stroke into cerebral thrombosis, cerebral embolism and lacunar infarction three types. As a common disease of the nervous system, Ischemic stroke is one of the three major diseases that lead to human death at present, and the survival patients are living with varying degrees of disability, which have serious affect on patient's life and work.
     Objective:
     The study use wrist-ankle acupuncture for Ischemic Stroke hemiplegia treatment, by comparing with the control group, the MB I and NDS scores of patients before and after treatment, to observe the clinical efficacy for Ischemic Stroke hemiplegia when using wrist-ankle acupuncture combined with acusector, so as to find out a more-effective treatment for Ischemic Stroke hemiplegia.
     Methods:
     1Based on study and review of literature,to summarize the pathogenesis and research progress on treatment of Ischemic Stroke hemiplegia in Traditional Chinese Medicine and modern medicine, in order to disscuss the theoretical foundation and feasibility of this treatment program.
     2In the clinical research,60patients with Ischemic Stroke hemiplegia were randomly divided into two groups(treatment group30cases and control group30cases). The control group use acusector for treatment and the treatment group were treated by wrist-ankle acupuncture combined with acusector.Both of the two groups were treated once every other day, a period of treatment is28days. MBI and NDS scores of the two groups of patients were observed before and after the treatment respectively and the clinical efficacy of two groups were analysed.
     Results:
     1Before treatment, there was no significant difference in general conditions, MBI and NDS scores between the two groups after statistic analysis (P>0.05), comparability was available.
     2After the treatment, in clinical efficacy, the total effective rate was93..3%for the treatment group and73.3%for the cotrol group. There was significant difference between the two groups total effective rate (P<0.05), which suggests the treatment group better than the control group in clinical efficacy.
     3MBI Scale test for two groups:after different acupuncture intervention, the scores of MBI for both group were improved, there was significant difference in MBI between the two groups (P<0.05), it indicates that Wrist ankle acupuncture combined with acusector can improve patients'daily living skills significantly and the clinical efficacy is better than the cotrol group.
     4NDS Scale test for two groups:after different acupuncture intervention,the scores of NDS for both group were declined, there was significant difference in NDS scores between the two groups (P<0.05), it indicates that Wrist ankle acupuncture combined with acusector can improve patients'neurological functions and the clinical efficacy is better than the cotrol group.
     Conlusion:
     1Wrist ankle acupuncture combined with acusector can markedly improve patients's MBI scores and daily living skills, the clinical efficacy is significantly better than the cotrol group.
     2Wrist ankle acupuncture combined with acusector can markedly reduce patients's NDS score, it can improve patients'neurological functions significantly, the clinical efficacy is obviously better than the cotrol group.
     3According to the overall evalution of the caces accepted, wrist-ankle acupuncture combined with acusector has good clinical curative effect on ischemic stroke hemiplegia.
引文
[1]张国瑾,赵增荣.国外脑血管疾病研究进展[M].北京:中医医药科技出版社,2001,21.
    [2]胡明亮.小续命汤加减治疗中风偏瘫45例临床观察[J].云南中医中药杂志,2010,31(2):34-35.
    [3]焦河玲,唐成定.参芪通脉汤治疗中风偏瘫50例[J].中医杂志,2008,49(3):244-245.
    [4]潘裕辉.瘫复汤外熏配合中药内服治疗中风偏瘫70例临床观察[J].上海中医药杂志,2001,(8):20-21.
    [5]喻长远,田夏元,刘向前.偏瘫灵颗粒剂治疗中风偏瘫100例临床观察[J].中草药,1999,30(4):285-287.
    [6]杨志安.自拟灯盏花汤合再造散治疗中风偏瘫94例[J].新中医,1998,30(7):27-28.
    [7]张英强,任培清,梅建伟,等.补肾强肝活血法治疗中风偏瘫60例临床观察[J].四川中医,2009,27(11):76-78.
    [8]牛文民,李忠仁.CT定位电头针治疗缺血性中风机理研究[J].上海针灸杂志,2006,25(7):3-4.
    [9]秦黎虹.头针交叉刺久留针法治疗中风后偏瘫疗效观察[J].中国针灸,2002,22(6):397-398.
    [10]黄国明.头针滞针法治疗中风偏瘫50例[J].中医杂志,2004,15(11):846-847.
    [11]陈道翼.头针为主治疗中风病307例[J].中国针灸,1999,增刊:21-22.
    [12]高彦堂,高旭,王霏.瘫康灵内外合治中风偏瘫500例[J].陕西中医,2003,24(2):136-137.
    [13]刘晓娟.针刺督脉穴为主治疗中风偏瘫疗效观察[J].甘肃中医,2008,21(11):57.
    [14]金泽,王琳晶.针刺夹脊穴治疗中风偏瘫痉挛状态临床观察[J].上海针灸杂志,2010,29(6):362-363.
    [15]崔明.电针治疗中风偏瘫172例疗效观察[J].针灸临床杂志,1998,14(9):2-4.
    [16]韩新强.针刺血海穴为主治疗中风偏瘫30例临床观察[J].河北中医,2003,25(12):948.
    [17]刘月芝,杨甲三,张国瑞,等.针刺治疗中风肢体运动功能障碍的临床研究[J].中国针灸,1999,(2): 69-71.
    [18]蔡少华,严亮华,聂斌.俞募穴电针治疗中风偏瘫临床观察[J].中医药临床杂志,2010,22(2):124-126.
    [19]刘贵仁.针刺治瘫三穴治疗中风偏瘫234例.[J]陕西中医,1995,16(10):463-464.
    [20]韩虹虹,崔卫东,郭青.滞针法对中风偏瘫肢体肌力的疗效观察[J].光明中医,2009,24(1):44-45.
    [21]苗广宇,周立秋.浮针疗法治疗脑卒中后偏瘫痉挛状态150例[J].中国针灸,2009年增刊.
    [22]田雨青,田哲.舌针治疗中风偏瘫的临床研究[J].针灸临床杂志,1999,15(1):38-40.
    [23]戴铁成,时国臣,李复峰.热灸仪治疗巾风偏瘫48例[J].中国针灸,1994增刊.
    [24]曾杰红.电针加麦粒灸治疗中风后遗症的疗效观察[J].上海针灸杂志,2000,19(1):22.
    [25]唐云华.神阙灸法治疗中风偏瘫临床观察[J].中医学报,2010,25(151):1216-1217.
    [26]李安.刮痧合刺络拔罐治疗中风后遗症40例[J].陕西中医,2008,29(9):1222.
    [27]刘东生,郭元琦,符文彬,等.井穴刺络对针刺治疗急性缺血中风偏瘫增效作用的研究[J].中华中医药学刊,2008,26(2):430-433.
    [28]鲁清源.督脉拔罐治疗中风偏瘫36例疗效观察[J].针刺研究,1998,3期.
    [29]林涛,岳敬峰.“抽添之法”针刺治疗中风偏瘫[J].内蒙古中医药,2001,2.
    [30]胡爱中,周国平.全经针刺法治疗中风偏瘫的临床研究[D].硕十论文,湖南中医药大学,5,2006.
    [31]陈幸生.芒针治疗中风偏瘫120例对照观察[J].针灸临床杂志,1995,11(6):4-5.
    [32]黄国明.头针滞针久留针治疗中风偏瘫疗效观察[J].北京中医药大学学报,2004,11(2):28-30.
    [33]于海波,詹晓惠.二针组穴针刺法配合温灸法治疗中风偏瘫的临床观察[J].针灸临床杂志,2010,26(6):33-34.
    [34]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.
    [35]黄景城.醒脑开窍针法治疗中风偏瘫疗效观察[J].黑龙江中医药,2007,5.
    [36]王进,高晓红.烧山火手法治疗中风肢体功能障碍49例[J].上海针灸杂志,1994,13(2):63.
    [37]李枉,刘俊洪,张君幸.“闪动效应”针刺法治疗脑梗死的疗效观察[J].中国针灸,2005,25(7):487-489.
    [38]朱慎勇.夹脊穴埋线治疗中风偏瘫临床观察[J].中医药临床杂志,2007,19(4):395-396.
    [39]许朝刚.穴位注射治疗中风偏瘫60例[J].中国针灸,2000,(2):79.
    [40]吴思平,叶嵘.丹参注射液穴位注射合电针治疗中风偏瘫临床观察[J].现代食品与药品杂志,2006,16(4):47-49.
    [41]孙观良,高立行.川芎嗪穴位注射治疗中风偏瘫208例[J].上海针灸杂志,1994,13(6):251.
    [42]杨爱平,张汾生.胞二磷胆碱穴位注射治疗中风偏瘫症46例临床报告[J].针灸临床杂志,1998,14(7):5-6.
    [43]徐建军.加兰他敏穴位注射治疗偏瘫21例[J].针灸临床杂志,2005,21(7):26.
    [44]郭珩.电针加穴位注氧治疗中风偏瘫200例[J].针灸临床杂志,1998,14(7):34.
    [45]詹敏.敷贴涌泉穴配合针刺治疗中风偏瘫疗效观察[J].湖北中医杂志,2008,30(11):48.
    [46]杨迎民.红花熏洗液配合康复训练治疗中风偏瘫165例[J].现代中西医结合杂志,2008,17(9):1351-1352.
    [47]谢波.针灸配合现代促通技术综合治疗中风偏瘫27例[J].新中医,1996,7.
    [48]郭汝爱,唐秀华,李兆风,等.头针肢动法对偏瘫肌力恢复的研究[J].针灸临床杂志,1998,14(5):24-26.
    [49]程爱军.综合方法治疗中风后遗症[J].针灸临床杂志,2001,17(5):16.
    [50]王风安.WHA型多功能电子诊疗仪治疗中风偏瘫的疗效观察[J].中国针灸,1994,增刊.
    [51]罗春常.经络导气仪对中风后遗症的疗效观察[J].中国针灸,1994,增刊.
    [52]sitzerM, MullerW, SieblerM, etal. Plaque ulceration And lumen thrombus are the main sources of cerebral microemboli in high-grade internal carotid artery stenosis stroke. 1995,26:1231.
    [53]张映琦,周华东,陈曼峨,等.缺血性脑血管病患者颈动脉粥样硬化的研究[J].中国解剖与临床,2000,5(3):136-139.
    [54]林文华,吴江.炎症对动脉粥样硬化及缺血性脑卒中的作用[J].中风与神经疾病杂志,2007,24(6):750-752.
    [55]张宝坤.脑卒中与高血压[J].中国现代药物应用,2009,3(23):107-108.
    [56]陈灏珠.实用内科学(第十二版)[M].北京:人民卫生出版社,2005,5.
    [57]贾建平.神经病学(第六版卫生部“十一五”规划教材,全国高等医药教材建设研究会规划教材)[M].北京:人民卫生出版社,2008,6:176-177.
    [58]黄胜洋,庄礼兴.针刺颞三针为主治疗缺血性中风偏瘫的临床研究[D].博十论文,4-5,广州中医药大学,2010.
    [59]任乐民,张云升,孟雅娟.溶栓药物的研究进展[J].实用中西医结合临床,2006,6(3):91-92.
    [60]张元媛,柯开富.CT灌注成像指导下动脉内溶栓治疗急性缺血性脑卒中的研究[J].南通大学学报(医学版),2010,30(4):239-241.
    [61]黄如训,王艺东.脑卒中的脱水治疗[J].中国神经精神疾病杂志,1998,24(3):188-189.
    [62]LiY, Chen J, Wang L, Lu M, Chopp M. Treatment of stroke in rat with intraearotid Administration of marrow Stromal eells[J]. Neurology.2001,56(12):1666-1672.
    [63]周朝晖,庄礼兴.靳三针疗法治疗缺血性中风偏瘫的临床研究[D].硕十论文,广州中医药大学,9-10,2010.
    [64]赵彦霞,张越秋.脑血管疾病偏瘫的心理护理[J].中国现代药物应用,2010,4(10):174-175.
    [65]张心曙.腕踝针[M].北京:人民军医出版社,1997.
    [66]孙瑜,高碧霄.中国腕踝针疗法[M].上海:上海中医药大学出版社,1999.
    [67]黄运拼.腕踝针临床应用举隅[J].中国民族民间医药杂志,2006,83:341-343.
    [68]孙瑜,高碧霄.中国腕踝针疗法[M].上海:上海中医药大学出版社,1999.
    [69]叶晓翔.腕踝针治疗中风后遗症[J].中国针灸,21(1):49.
    [70]王浩.腕踝针结合CT定位围针法治疗中风后遗症58例[J].巾国中医药咨讯,2010,2(10):128.
    [71]中华神经科学会.各类脑血管疾病诊断要点[J].中华神经科杂志,1996,29(6):379-382.
    [72]国家中医药管理局脑病急症协作约.中风病诊断与疗效评定标准(试行)[J].北京中医药大学学报,1996,19(1):55-56.
    [73]饶明俐.中国脑血.管病防治指南[M].北京:人民卫生出版社,2007.
    [74]王永炎.中医内科学[M].上海:上海科学技术出版社,1997.
    [75]张心曙.腕踝针[M].北京:人民军医出版社,1997.
    [76]孙国杰.针灸学[M],上海:上海科技出版社,1998:234-236.
    [77]Shah S, Vanclay F, Cooper B. Improving the sensitivity of the Barthel Index for stroke rehabilitation[J]. Journal of Clinical Epidemiology,1989,42(8),703—709.
    [78]Shah S, Vanclay F,Cooper B. Predicting Discharge Status at Commencement of Stroke Rehabilitation[J]. Stroke,1989,20:766-769.
    [79]乔文雷.腕踝针疗法原理初探[J].江苏中医,1991:12(6):27-29.
    [80]张亚平.浮针一种全新的针刺镇痛疗法[J].针灸临床杂志,1998,14(12):36-38.

© 2004-2018 中国地质图书馆版权所有 京ICP备05064691号 京公网安备11010802017129号

地址:北京市海淀区学院路29号 邮编:100083

电话:办公室:(+86 10)66554848;文献借阅、咨询服务、科技查新:66554700