【作者】 黄振彰；

【导师】 庄礼兴；

【作者基本信息】 广州中医药大学 ， 针灸推拿， 2008， 博士

【摘要】 目的:探讨分别以强刺激、弱刺激方法针刺痉挛侧、非痉挛侧穴位治疗脑卒中后痉挛性偏瘫肌力、痉挛程度、肢体功能活动及日常生活能力的影响。方法:符合脑卒中后痉挛性偏瘫诊断标准和纳入标准的患者120例,随机分为四组,分别为针刺痉挛侧穴位强刺激组、针刺痉挛侧穴位弱刺激组和针刺非痉挛侧穴位强刺激组、针刺非痉挛侧穴位弱刺激组各30例,非痉挛侧穴位强、弱刺激组上肢均取肩髃、臂臑、天井、四渎、外关、阳溪、偏历、中渚;下肢均取殷门、阴包、足三里、绝骨、申脉、丘墟、足临泣,针刺手法以平补平泻法。强刺激捻转角度大于180度,提插深度大于0.5cm;弱刺激捻转角度小于90度,提插深度小于0.3cm。痉挛侧穴位强、弱刺激组上肢均取极泉、尺泽、曲泽、曲池、手三里、内关、大陵、劳宫;下肢均取髀关、伏兔、委中、承山、三阴交、太溪、照海、涌泉。强刺激和弱刺激方法同前述,每日1次,每6天休息1天,4周为1疗程,一疗程后观察疗效。评价指标采用Robert Lovett法评测肌力,采用改良Ashworth评分法和临床痉挛指数评测痉挛程度,采用简化Fugl-Meyer评定量表的测定肢体运动功能,采用日常生活能力Barthel指数来评定日常生活能力。结果:1.研究发现非痉挛侧穴位强、弱刺激组和痉挛侧穴位强、弱刺激组患者的上、下肢肌力均有一定改善,治疗后较治疗前有显著性差异(P＜0.05),但是四种治疗方法之间未见明显差异(P＞0.05)。2.研究发现上下肢非痉挛侧穴位强、弱刺激组治疗前后Ashworth评分有显著性差异(P＜0.05),痉挛侧穴位强、弱刺激组治疗前后Ashworth评分无明显差异(P＞0.05)。组间比较发现治疗后非痉挛侧穴位弱刺激组Ashworth评分明显小于痉挛侧穴位强刺激组与弱刺激组(P＜0.05),非痉挛侧穴位强刺激组治疗后较痉挛侧穴位强、弱刺激组的Ashworth评分也显著减轻(P＜0.05)。治疗前后差值的组间比较发现,非痉挛侧穴位强刺激与弱刺激两组均较痉挛侧穴位强刺激和弱刺激两组有显著性差异(P＜0.05或0.01),非痉挛侧穴位强刺激与弱刺激两组治疗前后的差值无显著性差异(P＞0.05)。3.研究发现上下肢非痉挛侧穴位强、弱刺激组CSI较治疗前显著降低(P＜0.05),痉挛侧穴位强、弱刺激组治疗前后未见显著性差异(P＞0.05)。治疗后4组比较发现,非痉挛侧穴位强、弱刺激组较痉挛侧穴位强刺激组、痉挛侧穴位弱刺激组2组CSI均显著降低。治疗前后差值比较发现,非痉挛侧穴位强刺激与弱刺激两组均较痉挛侧穴位强刺激和弱刺激两组有显著性差异(P＜0.05),非痉挛侧穴位弱刺激组与非痉挛侧穴位强刺激比较未见有显著性差异(P＞0.05)。4.研究提示治疗后非痉挛侧穴位强刺激组、弱刺激组与非痉挛侧穴位强刺激组、弱刺激组四组的FM计分明显高于治疗前(P＜0.05)。治疗前后的差值比较,4组未见显著性差异(P＞0.05)。表明4组在改善肢体运动功能方面效果基本相当。5.研究提示非痉挛侧穴位强刺激组、弱刺激组与痉挛侧穴位强刺激组、弱刺激组四组治疗后ADL评分均较治疗前ADL明显提高(P＜0.05),治疗后4组患者的ADL未见明显差异(P＞0.05)。治疗前后的差值比较发现,4组未见显著性差异(P＞0.05)。结论:非痉挛侧穴位强刺激组、弱刺激组与痉挛侧穴位强刺激组、弱刺激组四组均可以改善肌力、FM评分、日常生活能力评分,但四组之间差异无统计学意义。针刺非痉挛侧穴位强、弱刺激组治疗前后在临床痉挛指数、Ashworth评分较其他组有明显改善。针刺非痉挛侧穴位强、弱刺激均能改善脑卒中后痉挛性偏瘫的痉挛程度,能降低肌张力,而且弱刺激、强刺激未见明显差异。而针刺痉挛侧穴位强、弱刺激治疗前后临床痉挛指数、Ashworth评分未见明显改善,强、弱刺激之间也未见明显差别。4种不同方法对痉挛性偏瘫的肢体活动能力、日常生活能力、肌力均能起到改善作用,但是4种方法之间肢体活动能力、日常生活能力、肌力比较未见明显差别。研究证实针刺非痉挛侧穴位穴位可能减低肢体肌张力。更多还原

【Abstract】 Objective: To study the impact of myodynamia, spasm degree, limb function and activities of daily living of hemiplegia spasm after a stroke treated by acupuncture Spasm side and Non-Spasm side point respectively in the strong and weak way.Methods: 120 cases of the patients conformed to spastic hemiplegia After the stroke diagnostic criteria and inclusion criteria were randomly divided into four groups, namely the acupuncture spasm side group respectively by the strong and weak way and the acupuncture non-spasm side group respectively in the strong and weak way. The two non-spasm side groups stimulates Jianyu, Binao, Tianjing, Sidu, Waiguan, Yangxi, Pianli, Zhongzhu on the upper limbs ;lower limbs were admitted Yinmen, Yinbao, Zusanli, Juegu, Shenmai, Qiuxu,, Qiuxu, Zulinqi. Needle method is used by normal reinforcement and normal reduction. Strong stimulation is that holding-twisting angle is more than 180 degrees and the inserted depth greater than 0.5 cm; weak stimulation is that holding-twisting angle is less than 90 degrees and the inserted depth less than 0.3 cm; Both spasm side groups stimulates Jiquan, Chize, Quze, Quchi, Shousanli, Neiguan, Daling, Laogong on the upper limbs; lower limbs were admitted Biguan, Futu, Weizhong,, Chenshan, Sanyinjiao, Zhaohai, Yongquan . Strong and weak stimulation is as foregoing. Once a day, every six days rest one day, four weeks for a course of treatment, the efficacy is evaluated after a course of treatment. Myodynamia is evaluated by Robert Lovett measure, with improved Ashworth score and clinical spasm index muscular tone is evaluated, simplified Fugl-Meyer scale is used to evaluate limbs function, and Barthel index is used to evaluate activities of daily living.Results: 1. Both the strong or weak non-spasm side stimulation and the strong or weak spasm side stimulation can improve Myodynamia, and there is significantly difference after treatment than before treatment (P< 0.05) , but no significant difference among the four groups(P> 0.05). 2. There is significantly difference of ashworth scale in the strong and weak non-spasm side groups after treatment than before treatment (P< 0.05), but no significantly difference in the strong and weak spasm side groups after treatment than before treatment (P>0.05). ashworth scales of both strong and weak non-spasm side groups is better than strong and weak spasm side groups. The difference of discrepancy is significant before and after the treatment in spasm side groups and non-spasm side groups (P <0.05 or 0.01). There is no significantly difference between the strong and weak non-spasm side groups (P> 0.05). 3.the CSI scale of the strong and weak stimulation non-spasm side groups on the upper and lower limb reduced significantly than before treatment (P <0.05). There is no significant difference in the the strong and weak stimulation spasm side groups before and after treatment. (P> 0.05). Among 4 groups, the CSI scale of the two non-spasm side groups is lower than the two spasm side groups after treatment. The difference of discrepancy is significant before and after the treatment in stimulated- spasm side groups and stimulated non-spasm side groups (P <0.05). There is no significantly difference between the strong and weak stimulated non-spasm side groups (P> 0.05). 4. The FM scale of the two non-spasm side groups and the two spasm side groups is higher than s before treatment (P <0.05) . There is no significant difference of discrepancy before and after treatment P >0.05). That means all groups can improve the limbs function. 5. The ADL scale of the two non-spasm side groups and the two spasm side groups is higher than before treatment (P <0.05) . There is no significant difference of discrepancy before and after treatment (P >0.05). that means all groups can improve the limbs function.Conclusion: All the four groups can improve myodynamia, FM scale, ADL scale, but no significant difference among each other. The CSI scale and ashworth scale is improved significantly in Acupuncture non-spasm side groups by strong and weak stimulation, but the other two insignificantly. Acupuncturing non-spasm side by strong and weak stimulation both can improve spasm and decrease muscular tone, but no significant difference between strong and weak stimulation. The four methods all can improve limbs function, activaties daily life, myodynamia, but no significant difference among four methods. The study of acupuncture points non-spasm side may reduce the limb muscle tension.更多还原