【作者】 韩德雄；

【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】 研究目的：探讨靳三针疗法为主,结合康复训练对缺血性卒中偏瘫患者神经功能缺损、综合功能、肢体活动能力、日常生活能力的影响,评价靳三针疗法对于缺血性卒中偏瘫的疗效,对靳三针疗法关于缺血性卒中偏瘫治疗的取穴、针刺角度、深度、刺激方法进行量化,规范靳三针疗法治疗缺血性卒中偏瘫的操作,使其具有可重复性,并进一步推广。方法：1、病例选择：选择254例符合研究标准、发病在2周-3个月内的偏瘫患者,按照1：1：1的比例,随机分为靳三针组83例、康复组84例和靳三针结合康复组87例。2、基础治疗：三组患者的基础药物治疗均参照《中国脑血管病防治指南》的方案控制血压、血糖,调节血脂,并给予抗血小板聚集,营养神经,以及对症治疗、防治并发症等。3、治疗方法：①弛缓瘫：靳三针组：取穴：主穴：颞三针、四神针、手三针、足三针。随症配穴：口角歪斜加口三针；语言不利、吞咽困难加舌三针。辨证配穴：肝阳暴亢加太冲；风痰阻络加丰隆；气虚血瘀加健侧足三里；阴虚风动加太溪。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。康复组：康复训练方案主要依据人民卫生出版社卫生部规划教材《康复医学》第三版制定。操作包括：床上良肢位摆放,关节被动活动,防止关节挛缩和变形,床上活动,起坐训练,桥式运动,兴奋性促进手法如利用联合反应、共同运动,感觉刺激(拍打、挤压等)诱发主动运动。靳三针加康复组：其治疗方案为靳三针疗法结合加康复训练,具体方法同上述。②痉挛瘫：靳三针组：取穴：颞三针、四神针、上肢挛三针、下肢挛三针。随症配穴：失语加舌三针；口角歪斜加口三针；腕关节严重痉挛加腕三针；踝关节内翻加踝三针；上下肢痉挛无法伸展加开三针；指趾浮肿加八邪、八风。辨证配穴同弛缓瘫。所有穴位均规范针刺方法、针刺深度、针刺角度、行针次数等参数。康复组：操作包括：缓解肌张力,坐位平衡训练,坐站转换,立位平衡训练,步行训练,上肢控制能力训练。靳三针加康复组其治疗方案为靳三针疗法结合加康复训练,具体方法同上述。4、疗程：各组疗程均为28天,康复训练和针刺治疗共进行20次,每周5次,休息2天后继续治疗,共治疗4周；基础药物治疗为28天。疗效评定：对每组入组患者进行治疗前、治疗14天后,治疗28天后神经功能评定,量表包括：临床神经功能缺损程度评分(NDS):Brunnstrom运动功能评价、四肢简化Fugl-Meyer运动功能评分、日常生活活动能力(Barthel指数)(ADL)、肢体功能综合评定(FCA)五个方面。结果：1、组内比较：三组病例经过14天、28天的治疗后,与治疗前比较,均有统计学差异(p<0.05),评分改善程度有统计学意义；治疗28天后与治疗14天后比较,亦有统计学差异(p<0.05)。2、组间比较：①NDS的变化：治疗14天、28天后靳三针组和康复组、结合组之间均无统计学差异,结合组与康复组之间均有统计学意义(p<0.05)。②ADL的变化：治疗14天、28天后靳三针组和康复组、结合组之间均无统计学差异(p>0.05),结合组与康复组之间均有统计学差异(p<0.05)。③上肢Fugl-Meyer评分的变化：治疗14天后三组之间比较疗效无统计学差异(p>0.05)。治疗28天后：靳三针组和康复组比较,差异无统计学意义；结合组和靳三针组、康复组分别比较,均有统计学差异(p<0.05)。④下肢Fugl-Meyer评分的变化：治疗14天后靳三针组与康复组、结合组之间均无统计学差异,结合组和康复组比较有统计学意义(p<0.05)。治疗28天后：靳三针组和康复组比较差异无统计学意义(p>0.05)；结合组和靳三针组、康复组分别比较,均有统计学差异(p<0.05)。⑤四肢Fugl-Meyer评分的变化：治疗14天后三组之间比较差异无统计学意义(p>0.05)；治疗28天后：靳三针组和康复组比较无统计学差异,结合组和靳三针组、康复组比较均有统计学差异(p<0.05)。⑥FCA的变化：治疗14天、28天后,靳三针组和康复组比较均无统计学差异(p>0.05)；结合组较靳三针组、康复组效佳,均有统计学差异(p<0.05)。结论：靳三针疗法和康复训练均能良好的改善缺血性卒中患者的偏瘫状态,两种疗法的效果之间比较无统计学差异,二者结合运用能够更好的促进缺血性卒中偏瘫患者肢体功能的恢复；该研究所使用的靳三针配穴方法、操作方法规范实用,切合临床实际,具有良好的推广意义。更多还原

【Abstract】 Objective:To observe therapeutic effect of Jin’s 3-needle manipulation combined with the rehabilitaion therapy on hemiplegia in patients with cerebral infarction.Methods:Two hundred and fifty-four patients who have hemiplegia of cerebral infarction in two weeks to three months, and consistent with clinical reasearch requirement were randomly divided into three groups according to the ratio of 1:1:1, which including Jin’s 3-needle manipulation group(Acunpuncture group,83cases), rehabilitaion group(84cases)and Jin’s 3-needle manipulation combined with the rehabilitaion group (combination group,87cases). Drugs using in this reasearch are based on "Guidelines on Cerebrovascular Disease Prevention and Control" which used to control blood pressure, cut down blood glucose, adjust lipid in blood, antiplatelet and trophic nerve, also symptomatic treatment to prevent complications.Concrete therapies:Flaccid paralysis:1) Acunpuncture group:the main points are the temporal 3-needle, hand 3-needle, foot 3-needle, and other pionts are added according to the symptoms.2) Rehabilitaion group:The rules of rehabilitaion are abide by "Rehabilitation medicine" which printed by People’s Medical Publishing House, including good pasture on bed, Bridge Movement, activities on bed, passive exercise on joints, and so on.3) Combination group:Methods in this group are acupuncture and rehabilitaion treatment which used in superior two groups. Spastic paralysis: 1) Acunpuncture group:The main points are the temporal 3-needle,3-needle in upper limb and lower limb on spasm, and other pionts are added according to the symptoms.2)Rehabilitaion group:The rules of rehabilitaion are abide by "Rehabilitation medicine" which printed by People’s Medical Publishing House, which include releasing muscle tension, balance training on sitting position, sitting position, controllability exercise, and so on.3) Combination group:Patients in this group accept two therapies including acupuncture and rehabilitaion measurements as above. Course of treatment:All patients will healed for 4 weeks, and every week researchers give them 5 times cure, the rest 2 days take a rest. Drugs also used 28 days.Evaluation:Patients are evaluated 3 times including before treatment, 2 weeks later, and the end of the reasearch, these measuring scale are Neuropathy Disability Score(NDS), Brunnstrom stage, Fugl-Meyer scores, Barthel Index, and Functional comprehensive assessment(FCA).Results:1) Comparison in group:After 14 days and 28 days therapies, compared with scores before the treatment, there were significant differences in all scales in three group.2) Comparison between groups:①Diversification in NDS:After 14 days and 28 days therapies, there were not signifcant difference between acunpuncture group and rehabilitaion group, also acunpuncture group and combination group, but the combination group is better than rehabilitaion group(p<0.05).②Diversification in ADL:There were not signifcant difference between acunpuncture group and rehabilitaion group after 14 days and 28 days therapies, also acunpuncture group and combination group, but the combination group is better than rehabilitaion group(p<0.05).③Diversification in Fugl-Meyer on Upper limb:There were not significant differences among three groups after 14 days treatments;After 28 days therapies, the acunpuncture group is similar to rehabilitaion group(p>0.05), but the combination group is better than the other two groups (p<0.05).④Diversification in Fugl-Meyer on Lower limb:There were not signifcant difference between acunpuncture group and rehabilitaion group after 14 days therapies, also acunpuncture group and combination group, but the combination group is better than rehabilitaion group(p<0.05);After 28 days therapies, the acunpuncture group is similar to rehabilitaion group(p>0.05), but the combination group is better than the other two groups (p<0.05).⑤Diversification in Fugl-Meyer on four limbs:There were not significant differences among three groups after 14 days treatments;After 28 days therapies, the acunpuncture group is similar to rehabilitaion group(p>0.05), but the combination group is better than the other two groups (p<0.05).⑥Diversification in FCA:The acunpuncture group is similar to rehabilitaion group(p>0.05), but the combination group is better than the other two groups (p<0.05) after 14 days and 28 days therapies.Conclusion:Jin’s 3-needle manipulation is useful to improve the function of hemiplegia in patients with cerebral infarction, and also rehabilitaion therapy, If we combine them thoughtfully, the effect must be better. And in this reasearch, the way to use acpoints dependent on symptoms, to operate the needles abide by rules, is valueable for clinical.更多还原