【作者】 黄国威；

【导师】 李忠仁；

【作者基本信息】 南京中医药大学 ， 针灸推拿， 2012， 博士

【摘要】 研究目的：本研究通过临床观察针刺介入中风后大小便失禁患者的康复疗效变化,探索针灸治疗中风后大小便失禁的临床疗效。研究方法：将临床90例患者随机分为治疗组45例、对照组45例。对照组给予针对性康复治疗,包括肢体康复、语言训练和心理康复等。治疗组给予针刺结合康复治疗。观察两组治疗前、1疗程后和2疗程后患者失禁程度、大小便症状、FIM表括约肌控制功能、生活质量量表(ADL)和改良Bartnel指数大小便评分的变化。研究结果：①两组患者大小便失禁程度和症状均较前好转(P<0.05),患者的失禁症状包括大小便的频率、形状、性质、肠蠕动次数等均较前改善(p<0.05)。治疗组症状评分改善效果优于对照组(p<0.05)。2个疗程结束后,治疗组患者大小便失禁程度多数降至0级、Ⅰ级、Ⅱ级,而对照组0级、Ⅰ级的人数较少,多数为Ⅱ级和Ⅲ级,两组比较,差异有统计学意义(P<0.05)。②2个疗程结束后,两组患者括约肌控制功能的提高均有效果,但治疗组改善程度明显优于单纯康复组治疗。③两组患者日常生活能力中大小便功能的评价均较前改善,其中治疗组患者大小便功能在1个疗程后就得到明显改善,对日常生活能力的影响显著降低(p<0.05),患者在中风康复治疗期间,其日常生活能力改善明显,多数能独立完成或辅助完成,而不需极度依赖帮助,优于对照组(p<0.05)。结论：①综合疗效方面,针刺介入中风后二便失禁患者的康复治疗能够有效改善其二便失禁症状及程度,总有效率为88.9%。②针刺介入能提高患者括约肌的控制能力。③针刺介入中风后二便失禁的康复治疗,能够有效提高患者日常生活能力,并具有起效快,改善作用明显的特点。更多还原

【Abstract】 Objective:In this study, the clinical effect change of rehabilitation effect was observed in patients with acupuncture intervention on the incontinence after stroke, which exploring for the clinical efficacy of acupuncture treatment.Methods:90cases of clinical patients were randomly divided into treatment group (45cases), and a control group of45cases. The control group received a targeted rehabilitation, including physical rehabilitation, language training and psychological rehabilitation. The treatment group received acupuncture treatment combined with rehabilitation therapy. Before the treatment, after the first stage of treatment and after the second stage of treatment, incontinence degree of bowel and bladder symptoms, sphincter control functions of the FIM table, the quality of life scale (ADL) and improvement Bartnel index urine score changes in patients were observed。Results:①After the second stage of treatment, the symptoms and degree on the two groups of patients with bowel and bladder incontinence were easer than those before the treatment (P <0.05). Fecal and urine incontinence symptoms include urine frequency, shape, and peristalsis number was better than before (p<0.05). The treatment group symptom score improvement than the control group (p<0.05). After the second stage of treatment, patients treated with urine the majority of incontinence extent dropped to class0, class Ⅰ, class Ⅱ, while the control group0. minority of Level Ⅰ, and the majority of Class Ⅱ and Class Ⅲ, the two groups. The difference was statistically significant (P<0.05).②After the second stage of treatment, sphincter control functions in two groups of patients were improved, and the effect of treatment group, improvement was significantly better than simple rehabilitation group therapy.③The bowel and bladder function with activities of daily living in patients was improved both groups compared with before the treatment. The function after the1st stage of treatment was significantly improved, and the impact of the activities of daily living was significantly lower (p<0.05). Patients during stroke rehabilitation therapy, daily living skills improved significantly, and most independent or secondary to complete, without having to rely heavily on help, than the control group (p<0.05). Conclusion:①In the comprehensive efficacy, after the second stage of treatment, acupuncture intervention can effectively improve the symptoms and the degree of the fecal and urine incontinence in patients with rehabilitation, total effective rate of88.9%.②Acupuncture intervention can improve the ability of patients with sphincter control.③Acupuncture treatment intervention with the stroke incontinence patients rehabilitation, the activities of daily living has a rapid onset, and improving obviously.更多还原