【作者】 赖耀铭；

【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】 目的观察调和阴阳经刺法治疗中风痉挛性偏瘫的临床疗效,评价调和阴阳经刺法、常规针刺法对缺血性中风后痉挛性偏瘫患者的临床痉挛指数、综合功能、四肢运动功能和日常生活能力的影响,并比较两种治疗方案的疗效优劣,探讨调和阴阳经刺法对缺血性中风痉挛性偏瘫的治疗作用及作用机理,为进一步推广应用调和阴阳经刺法提供科学的理论和实践依据。方法1、病例选择：60例符合诊断标准和纳入标准、发病在2周到半年的缺血性中风后痉挛性瘫痪患者,随机分为调和阴阳经刺法组30例和常规针刺法组30例。两组病例入选时基线资料比较,P>0.05,具有可比性。2、基础治疗：两组患者在基础药物给药基础上进行针刺治疗。3、治疗方法：两组均加用头针：取选患者瘫痪肢体对侧的顶颞前斜线、顶旁1线、顶旁2线,留针。(1)调和阴阳经刺法组：体针：上肢：肩髃极泉尺泽曲池内关外关；下肢：血海梁丘阴陵泉阳陵泉悬钟三阴交照海申脉；刺法：针刺患侧肢体,得气后用提插捻转手法补泻,每5-10min行针1次,留针30min。上肢的极泉、尺泽、内关和下肢的血海、阴陵泉、三阴交、照海提插捻转得气后,行大指向后,食指向前并上提针的提插捻转泻法；上肢的肩髃、曲池、外关和下肢的阳陵泉、梁丘、悬钟、申脉提插捻转得气后,行大指向前,食指向后并下按针的提插捻转补法。随症取穴：口角歪斜加颊车、地仓：语言不利加通里、廉泉、哑门。辨证配穴：肝阳上亢加太冲、太溪；风痰阻络加丰隆、合谷；痰热腑实加内庭、丰隆；气虚血瘀加气海、膈俞；阴虚风动加太溪、风池。所有穴位均规定具体的针刺方法、针刺深度、针刺角度、行针次数等参数。(2)常规针刺法组：参考第六版《针灸学》教材取穴。4、疗程：各组疗程均为28天,各组疗法均为：每日治疗1次,每周5次,休息2天再继续治疗,共治疗4周；常规基础药物治疗28天。5、疗效评定：对所有患者均于治疗前、治疗14天后、治疗28天后分别采用临床痉挛指数评分(CSI)、日常生活能力评分量表(ADL. Barthel指数)、四肢简化Fugl-Meyer运动功能评分量表、功能综合评定量表(FCA),分别评定其临床痉挛指数、日常生活能力、运动功能和综合功能,以此评价两种方法的治疗效果。结果1.临床痉挛指数评分(CSI)：治疗前两组病例临床痉挛指数评分比较,差别无统计学意义(P>0.05),经过14天治疗,两组治疗后临床痉挛指数评分分别较治疗前降低,均有显著性差异(P<0.05)。调和阴阳经刺法组和常规针刺组比较有显著性差异(P<0.05)。经过28天治疗,两组治疗后临床痉挛指数评分分别较治疗前明显降低,均有显著性差异(P<0.05)。调和阴阳经刺法组和常规针刺组之间比较有非常显著性差异(P<0.01),表明两组在降低患者临床痉挛指数方面,调和阴阳经刺法组优于常规针刺组。临床挛指数(CSI)疗效比较,治疗14天后,经x2检验,两组有效率比较无统计学意义(P>0.05)。但是从总有效率看,调和阴阳经刺法组降低患者临床痉挛指数,改善患者肢体痉挛状态的疗效优于常规针刺组。治疗28天后,经x2检验,两组有效率比较差异有统计学意义(P<0.05),表明调和阴阳经刺法组降低患者临床痉挛指数,改善患者肢体痉挛状态的疗效优于常规针刺组。2.日常生活活动能力(ADL)：治疗前两组病例日常生活活动能力评分比较差别无统计学意义(P>0.05),经过14天治疗,两组治疗后ADL评分分别较治疗前增高,有显著性差异(P<0.05)。调和阴阳经刺法组和常规针刺组有显著性差异(P<0.05)。经过28天治疗,两组治疗后ADL评分分别较治疗前明显增高,有显著性差异(P<0.05)。调和阴阳经刺法组和常规针刺组有非常显著性差异(P<0.01),表明两组在提高患者日常生活能力方面,调和阴阳经刺法组要优于常规针刺组。3.四肢运动功能评分(简化Fugl-Meyer)：治疗前两组病例四肢简化Fugl-Meyer评分比较,差别无统计学意义(P>0.05),经过14天治疗,两组治疗后四肢简化Fugl-Meyer评分分别较治疗前增高,有显著性差异(P<0.05)。调和阴阳经刺法组和常规针刺组比较无显著性差异(P>0.05)。经过28天治疗,两组治疗四肢简化Fugl-Meyer评分分别较治疗前明显增高,有显著性差异(P<0.05)。调和阴阳经刺法组和常规针刺组有非常显著性差异(P<0.01),表明两组在提高患者四肢运动功能方面,调和阴阳经刺法组要优于常规针刺组。4.功能综合评分(FCA)：治疗前两组病例功能综合评分比较,差别无统计学意义(P>0.05)。经过14天治疗,两组治疗后功能综合评分分别较治疗前增高,有显著性差异(P<0.05)。调和阴阳经刺法组和常规针刺组有显著性差异(P<0.05)。经过28天治疗,两组治疗后功能综合评分分别较治疗前明显增高,有显著性差异(P<0.05)。调和阴阳经刺法组和常规针刺组有非常显著性差异(P<0.01)。表明两组在提高患者功能综合评分方面,调和阴阳经刺法组要优于常规针刺组。结论调和阴阳经刺法在改善中风后痉挛性偏瘫的临床痉挛指数、日常生活活动能力、肢体运动功能、综合功能方面的疗效优于常规针刺组,表明调和阴阳经刺法对于缺血性中风痉挛性偏瘫患者具有良好的效果,能较快地缓解患者肢体痉挛,改善痉挛偏瘫状态,促进肢体运动功能的恢复,提高患者日常生活活动能力,改善其生活质量,加快病情恢复,使患者早日回归家庭、回归社会,具有良好的推广意义。更多还原

【Abstract】 Objective to observe the therapeutic effect of balance yin-yang acupuncture on the spastic states of stroke patients, to make evaluation and comparison among the methods of balance yin-yang acupuncture, routine acupuncture by clinical spasticity index (CSI). integrated function. limb motor function and activity of daily living. To investigate the efficacy and mechanism of balance yin-yang acupuncture on the spastic states of stroke patients, to provide scientific theoretical and practical to further promote the application of balance yin-yang acupuncture.Methods:1. Case selection:90cases met the diagnostic criteria and inclusion criteria, patients are in the spastic states caused by ischemic stroke from2weeks to half year,90cases were randomized into3treatment groups with30cases in each group, named balance yin-yang needling group, routine acupuncture group. The base-line materials of two groups selected were comparable at fist (P>0.05).2. Basic treatment:The patients in two groups applied basic drug treatment which referred to Prevention Guidelines for Cerebral Vascular Disease (Ministry of Health Disease Control Division, Chinese Medical Association Academy of Neurology,2005) to control blood pressure. blood sugar. blood lipid, to give anti-platelet aggregation. nutrition nerve. symptomatic treatment. prevention of complications and so on.3. Treat method:All the groups add scalp acupuncture To select points from Anterior oblique line of vertex-temporal (MS6).Lateral Line1of Vertex and Lateral Line2of Vertex on opposite-side of the affected limbs, then retaining the needles.(1) The balance yin-yang needling group: Body acupuncture Application:Needling the affected limbs, to use reinforcing or reducing method by Lifting-Thrusting or Rotating-Twirling the needles after developing needle sensation. Every5-10min moved the needles, retain30min. To apply reducing method in Jiquan (HT1). Chize(LU5). Neigan (PC6) of upper limbs and Xuehai (SP10). Yinlingquan (SP9) Sanyinjiao(SP6). Zhaohai (KI16) of lower limbs. To apply reinforcing method in Jianyu(LI15). Quchi(LI11). Waiguan(TE5) of upper limbs and Yanglingquan (GB34). Liangqiu (ST34) Xuanzhong(GB39). Shenmai(BL62) of lower limbsSelection of Points according to Signs:wry mouth and eyes add the points of Jiache(ST4) and Dicang(ST6); Stiff tongue with poor speech add the points of Yamen(dul5). Lianquan (RN23). Tongli (HT5)Point Select Syndrome Differ:Hyperactivity of the Liver-Yang add the points of Taichong(LI3) and Taixi (KI3); Interior Retention of Phlegm Dampness add the points of Fenglong(ST40) Hegu(LI4); Deficiency of Qi and Blood add the points of Qihai (RN6). Geshu(BL17); phlegm-heat and sthenia of fu-organ add the points of Nei ting(ST44) and Penglong (ST40); yin-deficiency and up-stirring syndrome add the points of Taixi (KI4) and Fengchi(GB20).All points must follow specific needling methods, needling depth.needling direction.the times of manipulation and so or(2) The routine acupuncture group(group C):Reference regular higher education in Traditional Chinese Medicine sixth edition (Acupuncture and Moxibustion) to select the points4. Duration of treatment:the course of treatment was28days, each group therapy as follow:daily treatment five times a week to rest two days to continue treatment, a total of4weeks of treatment; a regular basis of drug treatment to28days.5. Efficacy evaluation:all patients before treatment,14days and28days after the treatment adapted clinical spasticity index score (CSI), activities of daily living rating scale (ADL, Barthel Index), limbs simplify the Fugl-Meyer Rating Scale for motor function, functional comprehensive assessment (FCA), respectively, to assess its clinical spasticity index, activities of daily living, motor function and function, in order to evaluate the therapeutic effect above three methods of acupuncture.Result:1. A clinical spasticity score index (CSI):treatment of the first two cases of clinical spasticity index score was no significant difference (P>0.05), clinical spasticity index score after14days of treatment, two groups after treatment were lower than before treatment, There were significant differences (P<0.05). The differences between balance yin-yang needling group with routine acupuncture group were significant (P<0.05). After28days of treatment, two groups clinical spasm index scores was significantly reduced than before treatment, there were significant differences (P<0.05). There are significant differences to compare balance yin-yang needling group with routine acupuncture group (P<0.01). On reducing clinical spasticity score index, yin and yang needling group is much better than routine acupuncture group.The clinical efficacy twin index (CSI),14days treatment later, by x2test, two groups there were no statistically significant differences (P>0.05). But from the total efficiency, the balance yin-yang needling group on reducing clinical spasticity index and improving limb spasticity is much more effective than the routine acupuncture group.Treatment for28days, three groups the difference was statistically significant (P<0.05), indicating that yin-yang needling group to reduce clinical spasticity index to improve limb spasticity in patients with more effective than the routine acupuncture group.2. Activities of daily living (ADL):Before the treatment, there are no statistically significant differences to compare the activities of daily living score between the two groups (P>0.05). After14days treatment all the ADL scores of patients in the two groups was increased than before, there was significant difference (P<0.05). The differences between the balance yin-yang group and the routine acupuncture group are significant (P<0.05). After28days of treatment, ADL scores after treatment are significantly higher than before treatment in the two groups (P<0.05). There are significant differences to compare balance yin-yang needling group with routine acupuncture group (P<0.01). On improvement of the patients’daily living skills, balance yin and yang needling group is much better than routine acupuncture group.3. Limb motor function score (simplified by Fugl-Meyer):Before the treatment, there are no statistically significant differences to compare the four limbs motor function score between the two groups (P>0.05). After14days treatment, all the Fugl-Meyer scores of patients in the two groups was increased than before, there was significant difference (P<0.05). There were no significant differences between the balance yin-yang group and the routine acupuncture group (P>0.05). After28days of treatment, Fugl-Meyer scores after treatment are significantly higher than before treatment in the two groups (P<0.05). There are significant differences to compare balance yin-yang needling group with routine acupuncture group (P<0.01). On improvement of the patients’four limbs motor function, balance yin and yang needling group is much better than routine acupuncture group.4. Functional composite score (FCA):Before the treatment, there are no statistically significant differences to compare the functional composite score in three groups (P>0.05). After14days treatment, all the ADL scores of patients in the two groups was increased than before, there are significant differences(P<0.05).The differences between the balance yin-yang group and routine acupuncture group have significant differences (P<0.05). After28days of treatment, the functional composite scores in the two groups are significantly higher than before treatment (P<0.05). There are significant differences to compare balance yin-yang needling group with routine acupuncture group (P<0.01). On improvement of the patients’functional composite score, balance yin and yang needling group is much better than routine acupuncture group.Conelus ion:The acupuncture method of balance yin-yang has advantage to compare with the routine acupuncture group on improve clinical spasticity score index (CSI). activities of daily living (ADL). four limbs motor function score (simplified by Fugl-Meyer). Functional composite score (FCA). So balance yin-yang acupuncture has good treatment on the spastic states of stroke patients, which would have faster remission the limbs spasticity, improve the state of spastic hemiplegia, promote the recovery of motor function of limbs, improve patients’activities of daily living, improve their quality of life, and accelerate disease recovery, so that patients would early return home, return to society, with the promotion of good significance.更多还原