“醒脑解痉”针法治疗卒中后痉挛性肌张力增高随机对照研究
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摘要
目的：探讨“醒脑解痉”针法对脑卒中后肢体痉挛性肌张力增高的临床疗效,为卒中后痉挛性肌张力增高的临床治疗提供一种新思路与新方法。
对象和方法：由计算机产生随机号,采用系列编号的、不透光的、密封的信封随机分配治疗方案,将三所医院总共收治的240例符合标准的患者随机分为治疗组(“醒脑解痉”针刺组)120例,对照组(常规针刺组)120例。两组病人每周治疗5天,周六,周日休息,前后治疗4周,共20次。疗效判定：(1)肌张力评定：采用改良Ashworth量表(Modified Ashworth Scale, MAS); (2)肌力改变评定：采用Robert Lovett法；(3)随访期末死亡／残废率：采用Barthel Index (BI)记分法。利用SPSS软件包对资料进行分析处理。
结果：(1)两组病例入选时基线资料具有可比性(P>0.05)；(2)治疗组改善肌张力愈显率36.67%,对照组愈显率30.83%,治疗组略高于对照组,但差异无统计学意义(P>0.05)；治疗组改善肌张力总有效率为79.17%；对照组总有效率64.17%,治疗组高于对照组,两组比较,差异有统计学意义(P<0.05)；(3)两组MAS评分比较：两组治疗后MAS评分均较治疗前下降,差异有统计学意义(P<0.05)；治疗组治疗后MAS评分小于对照组,差异有统计学意义(P<0.05)；(4)肌力评分方面：两组治疗后肌力评分均较治疗前下降,差异有统计学意义(P<0.05)；治疗组治疗后上肢肌力评分低于对照组,差异有统计学意义(P<0.05)；但治疗组治疗后下肢肌力评分与对照组比较,差异无统计学意义(P>0.05)；(5)3个月及6个月随访时治疗组的死亡／残废率较对照组略有降低,但差异无统计学意义(P>0.05)；(6)两组均未出现严重副作用。
结论：①本研究设计及实施方案具有可行性和较好的可操作性；②“醒脑解痉”针法对于改善肌张力增高以及增强肌力具有较好的临床疗效且无明显副作用,值得推广；③“醒脑解痉”针法在改善肌力方面与其它针法疗效之间的差异则需要进一步研究及临床观察。
Objective:To research the clinical therapeutic effect of the "reviving spirit and relieving spasm" acupuncture therapy on post-stroke hyperexplexia, and provide a new idea and approach for post-hypereplexia.
Methods:240 patients from three hospitals were collected according to the inclusion and exclusion criteria, and randomized divided into 2 groups, as 1:1 proportion. The observation group was treated with the "reviving spirit and relieving spasm”acupuncture therapy, the control group was treated with traditional acupuncture therapy. Both groups were treated 5 days a week for 4 weeks, a total of 20 times. Curative effect determination:Modified Ashworth Scale(MAS), Robert Lovett Law and Barthel Index scoring method were respectively used to research change of muscular tension, muscular strength and death/cripple rate. The results were analyzed with SPSS package.
Results:(1) Baseline evaluation:The baseline conditions in both groups were comparable, P> 0.05; (2) Comparison after treatment:Markedly effective rate of observation group (36.67%) to improve muscular tension was slightly higher than that of control group (30.83%). But there were no significant statistical differences between two groups(P>0.05); Total effective rate of observation group(79.17%) to improve muscular tension was higher than that of control group (64.17%). There were significant statistical differences between the two groups(P<0.05). (3) comparing MAS score of the two groups:The MAS score of the two groups after treatment was lower than before, there were significant statistical differences between two groups(P<0.05); Comparison of two groups after treatment, MAS score of the treatment group was lower than the control group, there were significant statistical differences between two group(P<0.05); (4) Muscular strength evaluation:The score of muscular strength of the two groups after treatment was lower than before, there were significant statistical differences between two groups(P<0.05):the treatment group score of muscular strength of upper limb is lower than the control group, there were significant statistical differences between two groups(P<0.05); but the treatment group score of muscle strength of lower limb compared with the control group was no significant difference(P>0.05); (5) Death/cripple rate in 3 months and 6 months later of observation group was lower than that of control group. But there were no significant statistical differences between two groups(P>0.05):(6) No severe side effect was observed in both groups.
Conclusion:This research approach is feasible and practical. The "reviving spirit and relieving spasm" acupuncture therapy is worth of promoting, cause it can improve muscular tension and muscular strength of post-stroke patients, and has no side effect. Effect difference of the "reviving spirit and relieving spasm" acupuncture therapy and other acupuncture therapy methods to improve muscular strength needs for further research and clinical observation.
对象和方法：由计算机产生随机号,采用系列编号的、不透光的、密封的信封随机分配治疗方案,将三所医院总共收治的240例符合标准的患者随机分为治疗组(“醒脑解痉”针刺组)120例,对照组(常规针刺组)120例。两组病人每周治疗5天,周六,周日休息,前后治疗4周,共20次。疗效判定：(1)肌张力评定：采用改良Ashworth量表(Modified Ashworth Scale, MAS); (2)肌力改变评定：采用Robert Lovett法；(3)随访期末死亡／残废率：采用Barthel Index (BI)记分法。利用SPSS软件包对资料进行分析处理。
结果：(1)两组病例入选时基线资料具有可比性(P>0.05)；(2)治疗组改善肌张力愈显率36.67%,对照组愈显率30.83%,治疗组略高于对照组,但差异无统计学意义(P>0.05)；治疗组改善肌张力总有效率为79.17%；对照组总有效率64.17%,治疗组高于对照组,两组比较,差异有统计学意义(P<0.05)；(3)两组MAS评分比较：两组治疗后MAS评分均较治疗前下降,差异有统计学意义(P<0.05)；治疗组治疗后MAS评分小于对照组,差异有统计学意义(P<0.05)；(4)肌力评分方面：两组治疗后肌力评分均较治疗前下降,差异有统计学意义(P<0.05)；治疗组治疗后上肢肌力评分低于对照组,差异有统计学意义(P<0.05)；但治疗组治疗后下肢肌力评分与对照组比较,差异无统计学意义(P>0.05)；(5)3个月及6个月随访时治疗组的死亡／残废率较对照组略有降低,但差异无统计学意义(P>0.05)；(6)两组均未出现严重副作用。
结论：①本研究设计及实施方案具有可行性和较好的可操作性；②“醒脑解痉”针法对于改善肌张力增高以及增强肌力具有较好的临床疗效且无明显副作用,值得推广；③“醒脑解痉”针法在改善肌力方面与其它针法疗效之间的差异则需要进一步研究及临床观察。
Objective:To research the clinical therapeutic effect of the "reviving spirit and relieving spasm" acupuncture therapy on post-stroke hyperexplexia, and provide a new idea and approach for post-hypereplexia.
Methods:240 patients from three hospitals were collected according to the inclusion and exclusion criteria, and randomized divided into 2 groups, as 1:1 proportion. The observation group was treated with the "reviving spirit and relieving spasm”acupuncture therapy, the control group was treated with traditional acupuncture therapy. Both groups were treated 5 days a week for 4 weeks, a total of 20 times. Curative effect determination:Modified Ashworth Scale(MAS), Robert Lovett Law and Barthel Index scoring method were respectively used to research change of muscular tension, muscular strength and death/cripple rate. The results were analyzed with SPSS package.
Results:(1) Baseline evaluation:The baseline conditions in both groups were comparable, P> 0.05; (2) Comparison after treatment:Markedly effective rate of observation group (36.67%) to improve muscular tension was slightly higher than that of control group (30.83%). But there were no significant statistical differences between two groups(P>0.05); Total effective rate of observation group(79.17%) to improve muscular tension was higher than that of control group (64.17%). There were significant statistical differences between the two groups(P<0.05). (3) comparing MAS score of the two groups:The MAS score of the two groups after treatment was lower than before, there were significant statistical differences between two groups(P<0.05); Comparison of two groups after treatment, MAS score of the treatment group was lower than the control group, there were significant statistical differences between two group(P<0.05); (4) Muscular strength evaluation:The score of muscular strength of the two groups after treatment was lower than before, there were significant statistical differences between two groups(P<0.05):the treatment group score of muscular strength of upper limb is lower than the control group, there were significant statistical differences between two groups(P<0.05); but the treatment group score of muscle strength of lower limb compared with the control group was no significant difference(P>0.05); (5) Death/cripple rate in 3 months and 6 months later of observation group was lower than that of control group. But there were no significant statistical differences between two groups(P>0.05):(6) No severe side effect was observed in both groups.
Conclusion:This research approach is feasible and practical. The "reviving spirit and relieving spasm" acupuncture therapy is worth of promoting, cause it can improve muscular tension and muscular strength of post-stroke patients, and has no side effect. Effect difference of the "reviving spirit and relieving spasm" acupuncture therapy and other acupuncture therapy methods to improve muscular strength needs for further research and clinical observation.
引文
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