【作者】 杨正成；

【导师】 庄礼兴；

【作者基本信息】 广州中医药大学 ， 针灸推拿学， 2012， 博士

【摘要】 目的：观察张力平衡针法治疗中风后痉挛性瘫痪的疗效和安全性,并初步探讨其治疗中风后痉挛性瘫痪机理,为临床探索一种疗效确切、易于操作的治疗方法。方法：将符合纳入标准的60例中风后痉挛性瘫痪患者随机分为张力平衡针法组30例和常规针刺组30例,在基础药物治疗的基础上,治疗组给予张力平衡针法治疗,常规针刺组按照常规取穴,给予针刺治疗,两组患者均每天治疗1次,连续治疗10次为1个疗程,休息2天再继续针灸,共治疗2个疗程。治疗前后分别对两组患者进行肌力、改良Ashworth痉挛分级量表评分、临床痉挛指数评定、日常生活活动能力改良Barthel指数评分及肢体运动功能Fugl-Meyer评测,以及临床疗效进行比较,以评价两种方法的临床疗效差别。结果：治疗前两组患者性别、年龄、病程、卒中性质情况经卡方及t检验测定,差异无统计学意义(P>0.05),提示两组具可比性。两组患者治疗后肌力、Barthel指数积分、Fugl-Meyer积分、关节活动度评分较治疗前均有提高,临床痉挛指数(CSI)、神经功能缺损程度评分明显降低(p<0.05)。相比较常规针刺组,张力平衡针法组改善肌力、临床痉挛指数(CSI)、Barthel指数积分、Fugl-Meyer积分、关节活动度评分、神经功能缺损程度评分更优,组间比较差异有统计学意义(p<0.05)。两组患者治疗后Ashworth分级情况较治疗前均有降低,张力平衡针法组治疗前后差异有统计学意义(p<0.05),常规针刺组治疗前后差异无统计学意义(p>0.05)。张力平衡针法组与常规针刺组均可改善患者Barthel指数积分,但组间比较差异无统计学意义(p>0.05)。基于临床痉挛CSI评分的临床疗效分析,张力平衡针法组在改善患者肌力,痉挛状态,肢体运动,关节活动度及神经功能缺损程度方面的临床疗效均明显优于对照组(p<0.05)。结论：张力平衡针法可以安全有效地改善患者偏瘫肢体的痉挛程度、提高肢体运动功能,尤其在改善患者痉挛程度、降低痉挛指数及提高肢体运动功能方面明显优于常规针刺组。更多还原

【Abstract】 Objective:To observe the effect of balanced muscular tension needling method for improving disabled functionof stroke patients with spastic paralysis.Methods:Sixty cases with post-stroke spastic paralysis were randomly divided into observation group (30cases) with balanced muscular tension needling method and control group (30cases) with routine acupuncture method. The observation group was treated by acupunctureat the side of extensor and flexor of limbs; while the control group was treated with acupuncture at Jian yu(LI15), Qu chi (LI11), Wai guan(TE5) etc. The changes of muscle strength, muscle tonus, muscle spasticity (Ashworth Ranking and CSI grade), range of joint motion, Barthel index, Fugl-Meyer index, Clinical nerve function damage degree and Clinical effect based on CSI grade were evaluated before and after treatment.Results:After22days of treatment, muscle strength, muscle tonus, muscle spasticity, range of joint motion, Fugl-Meyer index were improved in the two groups, and the observation group was superior to the control group (all P<0.05). The Ashworth Ranking before and after treatment in the control group has no significant difference(P>0.05). Both groups could improve the Barthel index and with no significant difference(P>0.05). After the treatment, the total effective rate based on CSI was83.87%in the observation group and superior to that of46.67%in the control group (P<0.05).Conclusion:Balanced muscular tension needling method can significantly improve the muscle strength, muscle tonus, muscle spasticity and the range of joint motion of posl-stroke patients with spastic paralysis. Acupuncture with balanced muscular tension needling method and routine acupuncture method could both improve the Barthel index.更多还原