艾灸结合康复训练对脑卒中偏瘫痉挛状态的临床研究
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摘要
目的：观察艾灸结合康复训练对脑卒中偏瘫痉挛状态患者痉挛状态、运动功能、日常生活活动能力及生存质量的影响,探讨艾灸结合康复训练对脑卒中偏瘫痉挛状态患者的治疗作用,为寻求脑卒中偏瘫痉挛状态行之有效的治疗方法及其临床应用提供循证医学证据。
方法：
1.病例选择：将符合纳入标准的68例脑卒中偏瘫痉挛状态患者,随机分为艾灸康复组(36例)和康复组(32例)。
2.治疗方法：康复组患者在控制血压、血糖、血脂,抗血小板聚集、神经营养药等常规治疗等基础上配合康复训练(以Bobath技术为主),艾灸康复组另外配合艾灸治疗,艾灸选穴为：肩髃、曲池、手三里、外关、合谷,阳陵泉、足三里、悬钟、三阴交、中脘。康复训练及艾灸治疗均1次/日,5日/周,共治疗4周。
3.疗效评定：在治疗前、治疗2周、治疗4周(结束时)、治疗后1个月、治疗后3个月、治疗后6个月评定两组患者脑卒中偏瘫痉挛状态。采用改良的痉挛程度量表Ashworth(Modified Ashworth Scale,MAS)、临床痉挛指数(Clinic Spasticity Index, CSI)评定痉挛状态,采用偏瘫运动功能Brunnstrom分期量表和简化Fugl-Meyer肢体运动功能(FMA)评定肢体运动功能,采用日常生活活动能力量表(Barthel指数,BI)评价患者日常生活能力,采用基于患者报告的结局(Patient Reported Outcomes,PRO量表)评价患者生存质量。
结果：
1.基线比较
两组患者年龄、病程,性别、族别、诊断(西医),以及治疗前痉挛状态、肢体运动功能、日常生活活动功能和生存质量评分比较差异无统计学意义(P>0.05)。
2.痉挛程度
两组患者上肢、手、下肢MAS分级及CSI指数在治疗2周、治疗4周、治疗后1个月、治疗后3个月和治疗后6个月均显著优于治疗前(P<0.05)。艾灸康复组患者MAS分级及CSI指数结果在各时间点均显著优于康复组(P<0.05)。
3.肢体运动功能
两组患者在治疗2周、治疗4周、治疗后1个月、治疗后3个月和治疗后6个月上肢、手、下肢Brunnstrom分期量表和FMA结果显著优于治疗前(P<0.05)。艾灸康复组患者FMA结果在各时间点均优于康复组(P<0.05)；上肢和手的Brunnstrom分期量表结果在治疗4周、治疗后1个月、治疗后3个月显著优于康复组(P<0.05),在治疗2周和治疗后6个月与康复组无显著性差异(P>0.05)；下肢Brunnstrom分期量表结果在治疗后1个月、治疗后3个月显著优于康复组(P<0.05),在治疗2周、治疗4周和治疗后6个月与康复组无显著差异(P>0.05)。
4.日常生活活动能力和生存质量
两组患者BI指数和PRO量表结果在治疗2周、治疗4周、治疗后1个月、治疗后3个月和治疗后6个月显著优于治疗前(P<0.05)。艾灸康复组患者BI指数和PRO量表结果在各时间点均显著优于康复组(P<0.05)。
结论：
1.艾灸结合康复治疗和单一的康复治疗均能有效缓解脑卒中偏瘫患者的痉挛状态、促进患者运动模式的恢复、改善肢体运动功能、提高患者日常生活活动能力和生存质量。
2.与单一的康复治疗相比,艾灸结合康复治疗能更早的重建患者正常运动模式。艾灸与康复训练在脑卒中偏瘫痉挛状态患者的治疗中具有良好的协同作用.
Objective:To observe the effects of moxibustion combined with rehabilit-ation training on spasticity, motor function, activities of daily living (ADL), and the quality of life of spastic hemiplegia patients after stroke, to study the thera-peutic effects of moxibustion combined with rehabilitation training on spastic hemiplegia patients after stroke, to supply the evidence of effective therapy for its clinical application.
Methods:
1.Selection of subjects:68cases subjecting to inclusion criteria of spastic hem-iplegia after stroke were randomized into moxibustion combined with rehabi-litation training group (MRT group, N=36), and rehabilitation training group (RT group, N=32).
2.Therapies:The basic treatment for the two groups including drugs for contro-lling blood pressure, blood sugar, and blood lipid, and the therapy for platelet agg-regation and neurotrophic. Based on this, give rehabilitation training for the pati-ents of two groups, and give moxibustion treatment for the patients of MRT group. The aupoint prescription is Jianyu(LI15),Quchi(LI11),ShouSanli(LI10),Wai-guan(TE5),Hegu(LI4),Yanglingquan(GB34),Zusanli(ST36),Xuanzhong(GB39), Sanyinjiao(SP6),and Zhongwan(CV12).Both the rehabilitation training and mox-ibustion treatment were given1times a day, the treatment were given5days a week,lasted for4weeks.
3. Evaluation of therapeutic effect:Before treatment,2weeks and4weeks during the treatment,1month,3months,and6months after the treatment,impairment was evaluated by relevant scale function:impairment of spastic was evaluated with modified Ashworth scale (MAS) and Clinic spasticity index(CSI), motor function with Brunnstrom grade and simplified Fugl-Meyer Motor Scale(FMA),and the changes of the activities of daily living (ADL) with Barthel index(BI),the quality of life with Patient Reported Outcomes(PRO).
Results:
1. Compared to the baseline
There was no significant difference of age, course of disease, gender, ethn-icities, diagnosis(Western medicine), spasticity, motor function, activities of daily living (ADL), and the quality of life of spastic hemip-legia patients after stroke before the treatment(P>0.05).
2. Spasticity
The results of CSI index and MAS (Modified Ashworth Scale) of the upper limbs, the hands, and the lower limbs were significantly improved at2weeks and4weeks during the treatment,1month,3months,and6months after the treatment(P <0.05).Comp-ared with the two groups the results of CSI index and MAS were significantly improved at each time points(P<0.05).
3. Motor function
Compared with before, the results of Brunnstrom grade and simplified Fugl-Meyer Motor Scale(FMA) of the upper limbs, the hands, and the lower limbs were significantly improved at2weeks and4weeks during the treatment,1month,3months,and6months after the treatment(P<0.05). Compared with the two groups, the results of FMA were significantly improved at each time points(P<0.05); for the Brunnstrom grade of the upper limbs and the hands, there were significant differences at4weeks during the treatment,1month,3months after the trea-tment(P<0.05), and no differences2weeks during the treatment and6months after the treatment(P>0.05); there were significant differences of the the lower limbs at1month and3months after the treatment(P<0.05), and no differences at other time points(P>0.05).
4. Activities of daily living (ADL) and the quality of life
Compared with before treatment, there were significant differe-nces of BI index and PRO score at each time points (P<0.05). Compared with the two groups, the results of MRT group significantly better than the RT group at each time points (P<0.05)
Conclusion:
1. Both of the moxibustion and moxibustion combined with rehabilitation training treatments can relieve spasticity, promote the motion model recovery, improve the motor function, the activities of daily living, and the quality of life.
2. Compared with the single rehabilitation treatment, to select the treatment of moxibustion combined with rehabilitation training can help the spastic hemiplegia patients after stroke reconstruct the normal movement model earlier. There is a synergetic effect of moxibustion and rehabilitation training in the therapy of spastic hemiplegia patients after stroke.
方法：
1.病例选择：将符合纳入标准的68例脑卒中偏瘫痉挛状态患者,随机分为艾灸康复组(36例)和康复组(32例)。
2.治疗方法：康复组患者在控制血压、血糖、血脂,抗血小板聚集、神经营养药等常规治疗等基础上配合康复训练(以Bobath技术为主),艾灸康复组另外配合艾灸治疗,艾灸选穴为：肩髃、曲池、手三里、外关、合谷,阳陵泉、足三里、悬钟、三阴交、中脘。康复训练及艾灸治疗均1次/日,5日/周,共治疗4周。
3.疗效评定：在治疗前、治疗2周、治疗4周(结束时)、治疗后1个月、治疗后3个月、治疗后6个月评定两组患者脑卒中偏瘫痉挛状态。采用改良的痉挛程度量表Ashworth(Modified Ashworth Scale,MAS)、临床痉挛指数(Clinic Spasticity Index, CSI)评定痉挛状态,采用偏瘫运动功能Brunnstrom分期量表和简化Fugl-Meyer肢体运动功能(FMA)评定肢体运动功能,采用日常生活活动能力量表(Barthel指数,BI)评价患者日常生活能力,采用基于患者报告的结局(Patient Reported Outcomes,PRO量表)评价患者生存质量。
结果：
1.基线比较
两组患者年龄、病程,性别、族别、诊断(西医),以及治疗前痉挛状态、肢体运动功能、日常生活活动功能和生存质量评分比较差异无统计学意义(P>0.05)。
2.痉挛程度
两组患者上肢、手、下肢MAS分级及CSI指数在治疗2周、治疗4周、治疗后1个月、治疗后3个月和治疗后6个月均显著优于治疗前(P<0.05)。艾灸康复组患者MAS分级及CSI指数结果在各时间点均显著优于康复组(P<0.05)。
3.肢体运动功能
两组患者在治疗2周、治疗4周、治疗后1个月、治疗后3个月和治疗后6个月上肢、手、下肢Brunnstrom分期量表和FMA结果显著优于治疗前(P<0.05)。艾灸康复组患者FMA结果在各时间点均优于康复组(P<0.05)；上肢和手的Brunnstrom分期量表结果在治疗4周、治疗后1个月、治疗后3个月显著优于康复组(P<0.05),在治疗2周和治疗后6个月与康复组无显著性差异(P>0.05)；下肢Brunnstrom分期量表结果在治疗后1个月、治疗后3个月显著优于康复组(P<0.05),在治疗2周、治疗4周和治疗后6个月与康复组无显著差异(P>0.05)。
4.日常生活活动能力和生存质量
两组患者BI指数和PRO量表结果在治疗2周、治疗4周、治疗后1个月、治疗后3个月和治疗后6个月显著优于治疗前(P<0.05)。艾灸康复组患者BI指数和PRO量表结果在各时间点均显著优于康复组(P<0.05)。
结论：
1.艾灸结合康复治疗和单一的康复治疗均能有效缓解脑卒中偏瘫患者的痉挛状态、促进患者运动模式的恢复、改善肢体运动功能、提高患者日常生活活动能力和生存质量。
2.与单一的康复治疗相比,艾灸结合康复治疗能更早的重建患者正常运动模式。艾灸与康复训练在脑卒中偏瘫痉挛状态患者的治疗中具有良好的协同作用.
Objective:To observe the effects of moxibustion combined with rehabilit-ation training on spasticity, motor function, activities of daily living (ADL), and the quality of life of spastic hemiplegia patients after stroke, to study the thera-peutic effects of moxibustion combined with rehabilitation training on spastic hemiplegia patients after stroke, to supply the evidence of effective therapy for its clinical application.
Methods:
1.Selection of subjects:68cases subjecting to inclusion criteria of spastic hem-iplegia after stroke were randomized into moxibustion combined with rehabi-litation training group (MRT group, N=36), and rehabilitation training group (RT group, N=32).
2.Therapies:The basic treatment for the two groups including drugs for contro-lling blood pressure, blood sugar, and blood lipid, and the therapy for platelet agg-regation and neurotrophic. Based on this, give rehabilitation training for the pati-ents of two groups, and give moxibustion treatment for the patients of MRT group. The aupoint prescription is Jianyu(LI15),Quchi(LI11),ShouSanli(LI10),Wai-guan(TE5),Hegu(LI4),Yanglingquan(GB34),Zusanli(ST36),Xuanzhong(GB39), Sanyinjiao(SP6),and Zhongwan(CV12).Both the rehabilitation training and mox-ibustion treatment were given1times a day, the treatment were given5days a week,lasted for4weeks.
3. Evaluation of therapeutic effect:Before treatment,2weeks and4weeks during the treatment,1month,3months,and6months after the treatment,impairment was evaluated by relevant scale function:impairment of spastic was evaluated with modified Ashworth scale (MAS) and Clinic spasticity index(CSI), motor function with Brunnstrom grade and simplified Fugl-Meyer Motor Scale(FMA),and the changes of the activities of daily living (ADL) with Barthel index(BI),the quality of life with Patient Reported Outcomes(PRO).
Results:
1. Compared to the baseline
There was no significant difference of age, course of disease, gender, ethn-icities, diagnosis(Western medicine), spasticity, motor function, activities of daily living (ADL), and the quality of life of spastic hemip-legia patients after stroke before the treatment(P>0.05).
2. Spasticity
The results of CSI index and MAS (Modified Ashworth Scale) of the upper limbs, the hands, and the lower limbs were significantly improved at2weeks and4weeks during the treatment,1month,3months,and6months after the treatment(P <0.05).Comp-ared with the two groups the results of CSI index and MAS were significantly improved at each time points(P<0.05).
3. Motor function
Compared with before, the results of Brunnstrom grade and simplified Fugl-Meyer Motor Scale(FMA) of the upper limbs, the hands, and the lower limbs were significantly improved at2weeks and4weeks during the treatment,1month,3months,and6months after the treatment(P<0.05). Compared with the two groups, the results of FMA were significantly improved at each time points(P<0.05); for the Brunnstrom grade of the upper limbs and the hands, there were significant differences at4weeks during the treatment,1month,3months after the trea-tment(P<0.05), and no differences2weeks during the treatment and6months after the treatment(P>0.05); there were significant differences of the the lower limbs at1month and3months after the treatment(P<0.05), and no differences at other time points(P>0.05).
4. Activities of daily living (ADL) and the quality of life
Compared with before treatment, there were significant differe-nces of BI index and PRO score at each time points (P<0.05). Compared with the two groups, the results of MRT group significantly better than the RT group at each time points (P<0.05)
Conclusion:
1. Both of the moxibustion and moxibustion combined with rehabilitation training treatments can relieve spasticity, promote the motion model recovery, improve the motor function, the activities of daily living, and the quality of life.
2. Compared with the single rehabilitation treatment, to select the treatment of moxibustion combined with rehabilitation training can help the spastic hemiplegia patients after stroke reconstruct the normal movement model earlier. There is a synergetic effect of moxibustion and rehabilitation training in the therapy of spastic hemiplegia patients after stroke.
引文
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