【作者】 石忠民；

【导师】 陈兴华；

【作者基本信息】 广州中医药大学 ， 针灸推拿学， 2010， 硕士

【摘要】 目的本研究采用临床随机对照方法,观察十二透穴法治疗中风后痉挛性瘫痪的临床疗效和安全性,并进行客观的疗效评价,期望进一步规范临床疗效,获得较好的社会效益。方法选取2009年2月至2009年12月期间在台湾卫民中医诊所治疗的,符合病例筛选标准的60例中风后肢体痉挛性瘫痪患者。随机分配到试验组(透刺组)和对照组(普通针刺组)两组,每组各有30例。隔日治疗1次,20次为1疗程,观察3个疗程。采用Fugl-meyer运动功能评分量表、日常生活活动能力评分量表(ADL)和肌张力Ashworth痉挛量表进行评定,观察其疗效,并进行安全性检测。用EPIDATA3.1软件建立数据库,用SPSS15.0软件进行统计分析。计量资料用均数±标准差(x±S)表示,计数资料用构成比(%)表示。计量资料组间比较采用t检验(方差不齐采用t’检验或秩和检验),自身前后比较用配对t检验或Wilcoxon配对秩和检验。分类资料组间比较采用χ2检验,等级资料组间比较采用Wilcoxon秩和检验。统计图形的制作采用软件Graph Pad Prism4.03完成。结果本研究共收到合格病例60例均为门诊病人。其中试验组30例,男21例,女9例,平均年龄61.19±8.24岁；对照组30例,男18例,女12例,平均年龄为59.27±9.09岁。试验组采用十二透六法针刺治疗,对照组采用针刺治疗,隔日一次,20天为一个疗程,观察三个疗程后的临床疗效。患者基线特征的可比性分析中,两组性别、年龄、病程、病变性质、偏瘫情况、治疗前Ashworth痉挛量表评分、Fugl-meyer运动功能评分、Barthel指数评分情况,经统计学分析均无统计学意义,说明组间均衡。十二透穴刺法在中风后偏瘫痉挛患者的Ashworth评分、Fugl-Meyer评分、上肢痉挛程度、Barthel指数评分等方面的改善,治疗前后差异显著。两组治疗前后血、尿、大便常规,肝、肾功能,心电图检测均无明显异常变化,表明灸法联合中药疗法安全有效,无毒副作用。结论十二透穴刺法与普通针刺法对中风后偏瘫痉挛状态的缓解治疗皆有作用。十二透穴刺法对中风后偏瘫痉挛状态的缓解优于普通针刺法。透刺组对脑卒中偏瘫肢体痉挛状态的改善效果比普通针刺组好,说明十二透穴刺法能改善患者痉挛程度及运动功能,并能够有效的提高患者的日常生活能力,从而提高了患者的生活质量。痉挛的改善有利于患者整体功能的恢复。而且该疗法安全可靠,值得临床进一步推广使用。更多还原

【Abstract】 ObjectiveIn this study, randomized controlled method was used to observe the safety and clinical effect of using 12 sets of acupoint to acupoint penetrative needling in the treatment of spastic paralysis after stroke.MethodIn the period of February to December in 2009 at the Taiwan Weimin TCM Clinic, 60 patients with spastic paralysis after stroke were qualified to be in the study. They were randomly divided into treatment (acupoint to acupoint penetration) and control (basic penetration) groups. Each group was composed of 30 patients. They were treated every other day,20 times equal one course of treatment, and they were observed for a full 3 courses of treatment. The patients were monitored via the Fugl-Meyer Assessment of motor recovery, the Activities of Daily Living Scale (ADL), and Modified Ashworth Scale (MSS) for spasticity.ResultsOf the 60 spastic paralytic patients,30 were in the treatment group, of which 21 were male and 9 were female, their average age was 61.19±8.24, the rest were in the control group, of which 18 were male and 12 were female, their average age was 59.27±9.09. The treatment group used the 12 sets of acupoint to acupoint penetrative needling, while the control group used basic needling. Both groups were treated every other day,20 days equal one course of treatment. They were to undergo a total of 3 courses of treatment.Before treatment, the comparability of the two groups regarding their sex, age, course and nature of disease, paralytic condition was assessed using the MSS, Fugl-Meyer Assessment of motor recovery, and Barthel Index. It was found that there was no significant difference between the two groups. After treatment, the effectiveness of the 12 set of acupoint to acupoint penetrative needling was assessed using the Modified Ashworth Scale, Fugl-Meyer Assessment, the spastic level of the upper limb, and Barthel Index.The lab tests (blood, urine, stool, liver and kidney function, and electrocardiogram) revealed no adverse effect after acupoint to acupoint needling treatment.Conclusion1. Both acupoint to acupoint penetrative needling and basic needling were effective in treating spastic paralysis after stroke.2. Acupoint to acupoint penetrative needling was more effective in treating spastic paralysis after stroke than basic needling.Acupoint to acupoint penetrative needling on the 12 sets of acupoints was more effective than basic needling. Patients had more mobility, less spasticity, and better quality of life after treatment. The method was not only effective but also resulted in no adverse reactions in the patients.更多还原