白脉软膏联合藏药浴治疗脑卒中后肢体痉挛的临床研究

发布时间：2018-01-10 04:11

本文关键词：白脉软膏联合藏药浴治疗脑卒中后肢体痉挛的临床研究　出处：《广州中医药大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:本研究通过观察白脉软膏结合五味甘露药浴对脑卒中后肢体痉挛的临床疗效,明确白脉软膏结合五味甘露药浴对缓解脑卒中后肢体痉挛的有效性,并观察此研究对患者肢体运动功能改善及日常生活能力提高的情况,为临床治疗脑卒中后肢体痉挛的研究提供安全有效的新疗法。方法:本研究为国家"十二五"科技支撑计划《脑卒中后痉挛的中医康复临床规范研究》的一部分,利用中心电脑随机分配的方法,将脑卒中后肢体痉挛患者随机分为A、B、C三组,本中心A组(现代康复组)25例,B组(白脉软膏组)29例,C组(白脉软膏+五味甘露药浴组)23例。A组病人给予基础治疗及现代康复训练,B组给予基础治疗、现代康复训练及白脉软膏涂擦,C组在B组基础上再加五味甘露药浴颗粒药浴,疗程为4周。分别在治疗前、治疗4周后对患者进行肢体功能状况评估,包括肢体痉挛程度(改良Ashworth量表MAS)、日常生活活动能力(改良Barthel指数MBI)及肢体运动功能(简易Fugl-Meyer评定量表FMA),收集各组数据,采用SPSS 21.0软件进行统计学分析,得出结论。结果:一、基线比较:A、B、C三组患者一般资料(包括年龄、性别、病程、病性)及治疗前MMSE、MAS、FMA及MBI评分之间比较差异无统计学意义(P0.05)。二、组内比较:治疗4周后,三组患者肢体痉挛程度MAS评分与治疗前比较均有下降,FMA及MBI评分均明显升高,与治疗前相比评分差异具有统计学意义(P0.05)。三、组间比较:治疗4周后,C组MAS评分及FMA评分较A组改善明显,且两组间疗效对比差异具有的统计学意义(P0.05);C组在MAS评分与B组MAS评分的差异具有统计学意义(P0.05),在FMA评分上差异无统计学意义(P0.05);B组FMA评分及MAS评分较A组升高明显,但两组间疗效差异没有统计学意义(P0.05);A、B、C三组治疗后MBI评分差异无统计学意义(P0.05)。四、分层比较,对病程、年龄分层分析统计结果显示,三组数据在年龄、病程分层研究中的差异没有统计学意义(P0.05)。五、研究过程中1例患者因发现肿瘤,终止试验研究。结论:一、三组治疗均可缓解脑卒中后肢体痉挛程度,C组患者疗效比A、B组显著,且其差异具有统计学意义;B组患者疗效比A组显著,其差异无统计学意义,可能是组间例数不等、治疗周期短或样本量少所致。二、三组治疗方案均对脑卒中后肢体痉挛患者的运动功能及日常生活活动能力具有改善作用,C组在FMA改善方面比A、B组显著;MBI评分前后差值高于A、B两组,但差异不具有统计学意义;B组在FMA及MBI前后差值高于A组,但差异没有统计学意义,阴性结果可能是组间例数不等、治疗周期短或样本量偏少所致。三、根据病程、年龄分层分析发现三组各项评分前后差值的差异无统计学意义,但由于样本量偏少,组内分层后人数不等,以及各种因素相互作用,试验结果可能为阴性,还需要增加样本量试验验证。四、该研究未出现不良反应,具有可靠的安全性。
[Abstract]:Objective: to observe the clinical effect of Baimai ointment combined with five kinds of mannu on limb spasm after stroke, and to clarify the effectiveness of Baimai ointment combined with Wuwei mannu medicine bath in relieving limb spasm after stroke. We also observed the improvement of motor function and daily living ability of patients in this study. To provide a safe and effective new therapy for the treatment of limb spasm after stroke. A part of the S & T support Program "Clinical norms of TCM Rehabilitation for Post-Stroke spasm". Patients with limb spasm after stroke were randomly divided into three groups: group A (25 cases of modern rehabilitation group) and group B (29 cases of Baimai ointment group). Group C (Baimai ointment, Wuwei mannu, 23 cases, group A) were given basic treatment and modern rehabilitation training. Group B was given basic treatment, modern rehabilitation training and Baimai ointment were smeared. Group C on the basis of B plus five kinds of mannose medicine bath, the course of treatment is 4 weeks. Before treatment, 4 weeks after treatment to evaluate the limb function of the patients. Including limb spasticity (modified Ashworth scale as). Activity of daily living (Barthel index) and limb motor function (Fugl-Meyer) were collected. The results were as follows: 1. Baseline comparison of general data (including age, sex, course of disease) of three groups of patients (including age, sex and course of disease) was made by using SPSS 21. 0 software. There was no significant difference in FMA and MBI scores between the two groups before and before treatment (P 0.05). Second, intragroup comparison: after 4 weeks of treatment. The MAS score of limb spasm degree in the three groups was significantly lower than that before treatment, and the scores of FMA and MBI were significantly higher than those before treatment (P 0.05). Comparison between groups: after 4 weeks of treatment, the scores of MAS and FMA in group C were significantly improved than those in group A, and the difference in curative effect between the two groups was statistically significant (P 0.05). The difference of MAS score between group C and group B was statistically significant (P 0.05), but there was no significant difference in FMA score between group C and group B (P 0.05). The scores of FMA and MAS in group B were significantly higher than those in group A, but there was no significant difference in curative effect between the two groups (P 0.05). There was no significant difference in MBI scores among the three groups after treatment (P 0.05). Fourth, the statistical results of the course of disease and age stratification analysis showed that the three groups of data were in the age. There was no significant difference in the course of the disease in the stratification study P0.05. 5. During the course of the study, one patient terminated the trial because of the discovery of the tumor. Conclusion: 1. The curative effect of group C was better than that of group A B, and the difference was statistically significant. The curative effect of group B was more significant than that of group A, and the difference was not statistically significant. It may be due to the difference in the number of cases between groups, the short period of treatment or the small sample size. 2. All the three treatments improved motor function and activity of daily living (ADL) of patients with limb spasm after stroke. The improvement of FMA in group C was significantly higher than that in group A (n = 5). The difference before and after MBI score was higher than that in group A and B, but the difference was not statistically significant. The difference before and after FMA and MBI in group B was higher than that in group A, but the difference was not statistically significant. The negative results may be caused by different cases, short treatment period or small sample size. Third, according to the course of disease. Age stratification analysis found that there was no significant difference between the three groups before and after scoring, but due to the small sample size, the number of people in the group after stratification, as well as the interaction of various factors, the test results may be negative. It also needs to increase sample size test verification. 4, this study has no adverse reactions, and has reliable safety.
【学位授予单位】：广州中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R277.7

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