【作者】 谭启虹；

【导师】 庄礼兴；

【作者基本信息】 广州中医药大学 ， 针灸推拿学， 2010， 博士

【摘要】 目的：探讨张力平衡针法对中风痉挛性偏瘫的痉挛程度、偏瘫程度、肢体功能活动及日常生活能力的影响。方法：将符合中风痉挛性偏瘫诊断标准和纳入标准的患者60例,随机分为两组,分别为张力平衡针法治疗组与传统针刺法对照组各30例。治疗组选穴：上肢屈肌侧均取极泉、尺泽、大陵,下肢伸肌侧均取血海、梁丘、照海,均位于主动肌群,并采用弱刺激；上肢伸肌侧均取肩髃、天井、阳池,下肢屈肌侧均取髀关、曲泉、解溪、申脉,均位于在拮抗肌群方面,并采用强刺激。对照组在患肢取肩髃、合谷、曲池、手三里、外关；在下肢部位取患侧髀关、伏兔、足三里、丰隆、解溪。治疗时间为每天治疗一次,5天为一疗程,疗程之间隔2天,连续治疗观察4疗程。评价指标采用：(1) CSI临床痉挛指数量表,(2)Brunnstrom偏瘫功能恢复量表,(3)Fugl-Meyer肢体功能活动量表,(4)ADL日常生活能力量表等。主要观察患者治疗前后肢体痉挛状态的改善程度,探讨二种疗法对中风痉挛性偏瘫患者的疗效差异,(5)改良的Ashworth痉挛量表,主要作为临床疗效判定标准。结果：(1)在临床痉挛指数(CSI)评分评价中,治疗组、对照组治疗前后自身比较,差异均有统计学意义(P<0.01)。两组间治疗后差值比较(P<0.01),差异亦有统计学意义。在个别腱反射、肌张力及阵挛方面的结果差异亦均有统计学意义。(2)在偏瘫功能(Brunnstrom)评分评价中,治疗组、对照组治疗前后自身比较,差异均有统计学意义(P＜0.01)。两组间治疗后差值比较,差异亦有统计学意义(P<0.01)。(3)在肢体功能活动(简式Fugl-Meyer)评分评价中,治疗组、对照组治疗前后自身比较,差异有统计学意义(P＜0.01)。两组间治疗后差值比较,差异亦有统计学意义,P<0.01。(4)在日常生活能力(ADL)评分评价中,治疗组、对照组治疗前后自身比较,差异有统计学意义(P＜0.01)。两组间治疗后差值比较,差异亦有统计学意义(P＜0.01)。(5)在评价患者的临床疗效中,两组治疗后临床总体疗效比较,差异有统计学意义(P＜0.05)。而两组治疗后上肢疗效比较,差异无统计学意义(P＞0.05)。下肢疗效比较,差异有统计学意义,P＜0.05。结论：(1)张力平衡针法可改善中风痉挛性偏瘫患者的痉挛程度,包括腱反射、肌张力及阵挛,且其疗效优于传统针刺疗法。(2)张力平衡针法可促使中风痉挛性偏瘫患者的偏瘫功能恢复,且疗效优于传统针刺疗法。(3)张力平衡针法可改善中风痉挛性偏瘫患者的肢体活动功能,且疗效优于传统针刺疗法。(4)张力平衡针法可改善中风痉挛性偏瘫患者的日常生活能力,且疗效优于传统针刺疗法。(5)张力平衡针法的临床疗效优于传统针刺疗法,尤其下肢的临床疗效明显优于传统针刺疗法。本研究证明张力平衡针法对中风痉挛性偏瘫确实具有一定的治疗作用,不仅可改善中风痉挛性偏瘫患者的痉挛程度、偏瘫程度,亦可促使患者的肢体活动功能及日常生活能力的恢复,且临床疗效明显优于传统针刺疗法。因此,本研究说明张力平衡针法适合应用于临床上常见的气虚血瘀型中风之痉挛性偏瘫患者,值得临床上推广应用。更多还原

【Abstract】 Objective To investigate the clinical effect of tone-balance acupuncture in treating post-stroke spasm, paralysis, limb disfunction and daily life disabilities.Methods 60 patients conformed to the diagnostic criteria consistent spastic hemiplegia and inclusion criteria, were randomly divided into two groups, the tone-balance acupuncture treatment group and the traditional acupuncture control group,30 cases each. In the aspects of the treatment group, the side of active muscles used to the weakening technique, then the flexor side of the upper limb stimulates Jiquan, Quze, Daling, and the extensor side of the lower limb stimulates Xuehai, Liangqiu, Zhaohai; the side of antagonistic muscles used to the enhanced techniques, then the extensor side of the upper limb stimulates Jianyu, Tianjing, Yangchi, and the flexor side of the lower limb stimulates biguan, ququan, Jiexi, Shenmai. In the aspects of the control group, the upper limb stimulates Jianyu, Hegu, Quchi, Shousanli, Waiguan, and the lower limb stimulates Biguan, Futu, Zusanli, Fenglong, Jiexi. All patients were treated one time per day,5 days for a course of treatment, A observed period of treatment was 4 weeks and 2 days interval between treatments. We evaluated the improvement of limb spasticity of every patient and the clinical efficacy according to the following items (1) Clinical Spasticity Index (CSI), (2) functional recovery of hemiplegia Index (Brunnstrom), (3) limb function Index (Fugl-Meyer), (4) activities of daily living Index (ADL), (5) we used "the modified Ashworth Spasticity Index" as a clinical indicator criteria to determined the clinical efficacy of spastic hemiplegia after a stroke.Results (1) In the score evaluation of clinical spasticity index (CSI), there is a statistically significant difference between after treatment and before treatment of the treatment group (P<0.01), and there is a statistically significant difference between after treatment and before treatment of the control group (P<0.01). The difference between after treatment of the treatment group and control group, is also statistically significant difference (P<0.01), and the individual results of tendon reflexes, tone or clonus are the same. (2) In the score evaluation of Brunnstrom index, there is a statistically significant difference between after treatment and before treatment of the treatment group (P<0.01), and there is a statistically significant difference between after treatment and before treatment of the control group (P<0.01). (3) In the score evaluation of Fugl-Meyer index, there is a statistically significant difference between after treatment and before treatment of the treatment group (P<0.01), and there is a statistically significant difference between after treatment and before treatment of the control group (P<0.01). (4) In the score evaluation of activities of daily living Index (ADL), there is a statistically significant difference between after treatment and before treatment of the treatment group (P<0.01), and there is a statistically significant difference between after treatment and before treatment of the control group (P<0.01). (5) In the evaluation of clinical efficacy, there is a statistically significant difference between the treatment group and the control group. However, the differences were not statistically significant in the number of cases of upper limb after treatment between the two groups (P>0.05), the differences were statistically significant in the number of cases of lower limb after treatment between the two groups (P<0.05).Conclusion (1) The treatment of tone-balance acupuncture can improve the spasm degree of spastic hemiplegia after a stroke, including tendon reflexes, tone or clonus, and it is more effective than the traditional acupuncture. (2) The treatment of tone-balance acupuncture can improve the hemiplegic degree of spastic hemiplegia after a stroke, and it is more effective than the traditional acupuncture. (3) The treatment of tone-balance acupuncture can improve the limb function of spastic hemiplegia after a stroke, and it is more effective than the traditional acupuncture. (4) The treatment of tone-balance acupuncture can improve the activities of daily living of spastic hemiplegia after a stroke, and it is more effective than the traditional acupuncture. (5) The clinical efficacy of tone-balance acupuncture is superior to the traditional acupuncture. In particular, the clinical efficacy of lower limb was better than the traditional acupuncture. Above, this study demonstrated that tone-balance acupuncture does have a therapeutic role, not only can improve the spasm degree and the hemiplegic degree in patients, but also can promote recovery of limb function and activities of daily living, and it’s clinical efficacy is significantly superior to traditional acupuncture therapy. Therefore, this study shows that the treatment of tone-balance acupuncture is suitable for spastic hemiplegia after a stroke with qi-deficiency and blood-stasis, and is worthy of clinical application.更多还原