张力平衡针法对脑卒中痉挛状态肢体运动功能及表面肌电的影响
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摘要
目的:评价张力平衡针法对脑卒中痉挛状态患者肢体运动功能及表面肌电的影响。方法:选取2016年1月至2018年12月湖南中医药大学第一附属医院收治的脑卒中痉挛状态患者60例作为研究对象,按照随机数字表法随机分为观察组和对照组,每组30例,观察组采用张力平衡针刺疗法,对照组采用常规针刺疗法,2组针刺治疗10次为1个疗程,并观察2个疗程。比较2组治疗前后的改良Ashworth痉挛量表(MAS)、Fugl-Meyer运动功能(F-M)评分、NDS整体评分、总体临床疗效及表面肌电测试RMS值。结果:1)观察组总有效率为86. 67%,对照组总有效率为73. 33%,2组疗效比较,差异无统计学意义(P> 0. 05)。2)治疗后,2组MAS的评分均有明显降低,差异有统计学意义(P <0. 05);治疗后组间比较,观察组MAS的评分较对照组有明显降低,差异有统计学意义(P <0. 05)。3) 2组均能有效改善脑卒中痉挛状态患者的简化F-M评分;与治疗前比较,2组治疗后简化F-M评分均有不同程度的升高,差异有统计学意义(P <0. 01);观察组治疗后改善F-M评分优于对照组,观察组的简化F-M评分在治疗后高于对照组,差异有统计学意义(P <0. 01)。4)观察组治疗后NDS整体评分低于对照组,差异有统计学意义(P <0. 05);与治疗前较,2组治疗后NDS整体评分均有不同程度的降低,差异有统计学意义(P <0. 05),2种治疗方法均能改善NDS整体评分,且观察组于整体临床神经功能缺损程度方面优于对照组。5)与治疗前比较,2组治疗后肱二头肌、股四头肌RMS值均有不同程度的降低,差异有统计学意义(P <0. 05),且观察组治疗后肱二头肌、股四头肌RMS值低于对照组,差异有统计学意义(P <0. 05),2种治疗方法均能改善肱二头肌、股四头肌RMS值,且观察组优于对照组。结论:1)张力平衡针法和常规针刺法治疗脑卒中痉挛状态疗效良好。2)张力平衡针法和常规针刺法均能降低神经功能缺损的影响以及改善脑卒中痉挛状态患者的肢体运动功能,且观察组疗效优于对照组。
Objective: To evaluate the effects of tension balance needling on limb motor function and surface electromyography in patients with spastic state of stroke. Methods: A total of 60 patients with spastic state of stroke were included from the First Affiliated Hospital of Hunan University of Traditional Chinese Medicine from January 2016 to December 2018,and randomly divided into observation group( 30 cases) and control group( 30 cases). In the 2 groups,a course of treatment consisted of 10 times of acupuncture treatment,and 2 courses of treatment were observed. Before and after treatment,the Modified Ashworth Spasm Scale( MAS),Fugl-Meyer Motor Function( F-M) score,NDS overall score,overall clinical efficacy and RMS value of surface electromyography were compared between the 2 groups. Results: 1) The total effective rate of the observation group was 86. 67%,and that of the control group was 73. 33%. The curative effects of the 2 groups were compared( P > 0. 05). 2) After treatment,the scores of MAS in both groups were significantly decreased( P < 0. 05); after treatment,the score of MAS in the observation group was significantly lower than that in the control group( P < 0. 05). 3) The simplified F-M score of patients with spastic state of stroke in both groups can be effectively improved. Compared with the simplified F-M score before treatment,the score of the 2 groups increased in different degrees after treatment( P < 0. 01). The improved F-M score of the observation group was better than that of the control group after treatment,and the simplified F-M score of the observation group was higher than that of the control group after treatment( P <0. 05). 4) After treatment,the overall score of NDS in the observation group was lower than that in the contrl group( P < 0. 05);compared with before treatment,the overall score of NDS in the 2 groups decreased in varying degrees after treatment( P < 0. 05).Both treatments could improve the overall score of NDS,and the observation was superior to the control group in terms of the degree of overall clinical neurological deficits. 5) Compared with before treatment,the RMS values of biceps brachii and quadriceps femoris in the 2 groups decreased in different degrees after treatment( P < 0. 05),and the RMS values of biceps brachii and quadriceps femoris in the observation were lower than those in the control group( P < 0. 05). Both treatments could improve the RMS values of biceps brachii and quadriceps femoris,and the observation group was better than the control group. Conclusion: 1) Tension balance needling and routine needling are effective in treating spastic state of stroke. 2) Both tension balance needling and routine needling can reduce the influence of neurological deficit and improve limb motor function in patients with spastic stroke,and the long-term effect of the observation group is better than that of control group.
Objective: To evaluate the effects of tension balance needling on limb motor function and surface electromyography in patients with spastic state of stroke. Methods: A total of 60 patients with spastic state of stroke were included from the First Affiliated Hospital of Hunan University of Traditional Chinese Medicine from January 2016 to December 2018,and randomly divided into observation group( 30 cases) and control group( 30 cases). In the 2 groups,a course of treatment consisted of 10 times of acupuncture treatment,and 2 courses of treatment were observed. Before and after treatment,the Modified Ashworth Spasm Scale( MAS),Fugl-Meyer Motor Function( F-M) score,NDS overall score,overall clinical efficacy and RMS value of surface electromyography were compared between the 2 groups. Results: 1) The total effective rate of the observation group was 86. 67%,and that of the control group was 73. 33%. The curative effects of the 2 groups were compared( P > 0. 05). 2) After treatment,the scores of MAS in both groups were significantly decreased( P < 0. 05); after treatment,the score of MAS in the observation group was significantly lower than that in the control group( P < 0. 05). 3) The simplified F-M score of patients with spastic state of stroke in both groups can be effectively improved. Compared with the simplified F-M score before treatment,the score of the 2 groups increased in different degrees after treatment( P < 0. 01). The improved F-M score of the observation group was better than that of the control group after treatment,and the simplified F-M score of the observation group was higher than that of the control group after treatment( P <0. 05). 4) After treatment,the overall score of NDS in the observation group was lower than that in the contrl group( P < 0. 05);compared with before treatment,the overall score of NDS in the 2 groups decreased in varying degrees after treatment( P < 0. 05).Both treatments could improve the overall score of NDS,and the observation was superior to the control group in terms of the degree of overall clinical neurological deficits. 5) Compared with before treatment,the RMS values of biceps brachii and quadriceps femoris in the 2 groups decreased in different degrees after treatment( P < 0. 05),and the RMS values of biceps brachii and quadriceps femoris in the observation were lower than those in the control group( P < 0. 05). Both treatments could improve the RMS values of biceps brachii and quadriceps femoris,and the observation group was better than the control group. Conclusion: 1) Tension balance needling and routine needling are effective in treating spastic state of stroke. 2) Both tension balance needling and routine needling can reduce the influence of neurological deficit and improve limb motor function in patients with spastic stroke,and the long-term effect of the observation group is better than that of control group.
引文
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[2]朱镛连.神经康复学[M].北京:人民卫生出版社,2001:526.
[3]曹晓岚,郭闫葵,陈建强,等.缺血性中风患者392例临床流行病学回顾性调查[J].中西医结合心脑血管病杂志,2012,10(1):48-49.
[4]李瀚,周鸿飞.针灸治疗脑卒中后痉挛性瘫痪研究进展[J].辽宁中医药大学学报,2017,19(8):117-120.
[5]胡建芳,陈朝俊,毕小丽,等.疏肝活血汤合针灸早期干预对卒中后抑郁患者预后的影响[J].中国中药杂志,2013,38(14):2403.
[6]李宁,滕飞,陈玉辉,等.缺血性卒中后痉挛发生情况及预测因素分析[J].中国卒中杂志,2016,11(6):443-448.
[7]章薇.张力平衡针法治疗中风后痉挛瘫痪技术[J].中国乡村医药,2008,15(9):77-78.
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[9]王启才.针灸治疗学(新世纪全国高等中医药院校规划教材)[M].北京:中国中医药出版社,2003:66.
[10]燕铁斌.临床痉挛指数:痉挛的综合临床评定[J].现代康复,2000,4(1):88-89.
[11]周维金,孙启良.瘫痪康复评定手册[M].北京:人民卫生出版社,2006:43-44.
[12]方文垚,刘昊,杨柳,等.脑机接口技术在脑卒中偏瘫患者下肢运动功能康复治疗中的应用[J].山东医药,2018,58(10):66-68.
[13]孙润洁,田亮,方晓丽,等.“金钩钓鱼”针法结合Bobath技术治疗脑卒中后上肢痉挛状态的临床研究[J].中国针灸,2017,37(4):372-376.
[14]窦祖林.痉挛评估与治疗[M].北京:人民卫生出版社,2004:41-42.
[15]刘焕,段瑞蒙,祝艺菡,等.瞬时受体电位香草酸亚型1在脑卒中神经损伤中的作用研究进展[J].新乡医学院学报,2016,33(12):1101-1104.
[16]中华医学会神经病学分会脑血管病学组急性缺血性脑卒中治疗指南撰写组.中国急性缺血性脑卒中诊治指南2010[J].中华神经科杂志,2010,43(2):146.
[17]章薇.张力平衡针法在中风偏瘫康复中的应用[J].中国临床医生,2004,32(6):38-40.
[18]王颖男,于学平.于学平教授针灸治疗中风病经验撷要[J].针灸临床杂志,2012,28(5):59.
[19]章薇,刘智,娄必丹.张力平衡针法对脑梗死患者血清IL-1和s I-CAM-1、s VCAM-1的影响[J].中国针灸,2005,25(3):214-216.
[20]娄必丹,章薇,刘智,等.张力平衡针法对脑卒中痉挛瘫痪患者血脂和血糖的调节作用[J].中国康复,2006,21(2):81-82.
[21]刘智,章薇,娄必丹,等.张力平衡针法改善脑卒中痉挛瘫痪及对血清Ca2+的影响[J].中国临床医生,2005,33(12):27-28.
[22]娄必丹,章薇,刘智,等.张力平衡针法对脑卒中下肢功能及独立生活能力的影响[J].中国康复,2012,6(4):255-256.
[23]娄必丹,章薇,刘智,等.张力平衡针法改善脑卒中痉挛瘫痪患者残损功能的临床评价[J].中国针灸,2010,30(2):89-92.
[24]窦祖林.痉挛的评定与治疗[J].继续医学教育,2006,20(30):17-22.
[25]汪菲,何晴,李建华.表面肌电在中枢神经系统疾病肌痉挛患者评价中的研究现状[J].中国康复医学杂志,2016,31(11):1277-1280.
[26]Kim KS,Seo JH,Song CG.Portable measurement system for the objective evaluation of the spasticity of hemiplegic patients based on the tonic stretch reflex threshold[J].Med Eng Phys,2011,33(1):62-69.
[27]Sullivan K J,Tilson J K,Cen S Y,et al.Fugl-Meyer assessment of sensorimotor function after stroke:standardized training procedure for clinical practice and clinical trials[J].Stroke,2011,442(2):427-432.
[2]朱镛连.神经康复学[M].北京:人民卫生出版社,2001:526.
[3]曹晓岚,郭闫葵,陈建强,等.缺血性中风患者392例临床流行病学回顾性调查[J].中西医结合心脑血管病杂志,2012,10(1):48-49.
[4]李瀚,周鸿飞.针灸治疗脑卒中后痉挛性瘫痪研究进展[J].辽宁中医药大学学报,2017,19(8):117-120.
[5]胡建芳,陈朝俊,毕小丽,等.疏肝活血汤合针灸早期干预对卒中后抑郁患者预后的影响[J].中国中药杂志,2013,38(14):2403.
[6]李宁,滕飞,陈玉辉,等.缺血性卒中后痉挛发生情况及预测因素分析[J].中国卒中杂志,2016,11(6):443-448.
[7]章薇.张力平衡针法治疗中风后痉挛瘫痪技术[J].中国乡村医药,2008,15(9):77-78.
[8]国家食品药品监督管理局.中药新药临床研究指导原则(试行)[M].北京:中国医药科技出版社,2002:54-58.
[9]王启才.针灸治疗学(新世纪全国高等中医药院校规划教材)[M].北京:中国中医药出版社,2003:66.
[10]燕铁斌.临床痉挛指数:痉挛的综合临床评定[J].现代康复,2000,4(1):88-89.
[11]周维金,孙启良.瘫痪康复评定手册[M].北京:人民卫生出版社,2006:43-44.
[12]方文垚,刘昊,杨柳,等.脑机接口技术在脑卒中偏瘫患者下肢运动功能康复治疗中的应用[J].山东医药,2018,58(10):66-68.
[13]孙润洁,田亮,方晓丽,等.“金钩钓鱼”针法结合Bobath技术治疗脑卒中后上肢痉挛状态的临床研究[J].中国针灸,2017,37(4):372-376.
[14]窦祖林.痉挛评估与治疗[M].北京:人民卫生出版社,2004:41-42.
[15]刘焕,段瑞蒙,祝艺菡,等.瞬时受体电位香草酸亚型1在脑卒中神经损伤中的作用研究进展[J].新乡医学院学报,2016,33(12):1101-1104.
[16]中华医学会神经病学分会脑血管病学组急性缺血性脑卒中治疗指南撰写组.中国急性缺血性脑卒中诊治指南2010[J].中华神经科杂志,2010,43(2):146.
[17]章薇.张力平衡针法在中风偏瘫康复中的应用[J].中国临床医生,2004,32(6):38-40.
[18]王颖男,于学平.于学平教授针灸治疗中风病经验撷要[J].针灸临床杂志,2012,28(5):59.
[19]章薇,刘智,娄必丹.张力平衡针法对脑梗死患者血清IL-1和s I-CAM-1、s VCAM-1的影响[J].中国针灸,2005,25(3):214-216.
[20]娄必丹,章薇,刘智,等.张力平衡针法对脑卒中痉挛瘫痪患者血脂和血糖的调节作用[J].中国康复,2006,21(2):81-82.
[21]刘智,章薇,娄必丹,等.张力平衡针法改善脑卒中痉挛瘫痪及对血清Ca2+的影响[J].中国临床医生,2005,33(12):27-28.
[22]娄必丹,章薇,刘智,等.张力平衡针法对脑卒中下肢功能及独立生活能力的影响[J].中国康复,2012,6(4):255-256.
[23]娄必丹,章薇,刘智,等.张力平衡针法改善脑卒中痉挛瘫痪患者残损功能的临床评价[J].中国针灸,2010,30(2):89-92.
[24]窦祖林.痉挛的评定与治疗[J].继续医学教育,2006,20(30):17-22.
[25]汪菲,何晴,李建华.表面肌电在中枢神经系统疾病肌痉挛患者评价中的研究现状[J].中国康复医学杂志,2016,31(11):1277-1280.
[26]Kim KS,Seo JH,Song CG.Portable measurement system for the objective evaluation of the spasticity of hemiplegic patients based on the tonic stretch reflex threshold[J].Med Eng Phys,2011,33(1):62-69.
[27]Sullivan K J,Tilson J K,Cen S Y,et al.Fugl-Meyer assessment of sensorimotor function after stroke:standardized training procedure for clinical practice and clinical trials[J].Stroke,2011,442(2):427-432.