“补肾健脑针法”对痉挛型脑瘫患儿日常生活活动能力影响的研究

发布时间：2018-04-29 22:04

本文选题：“补肾健脑针法” + 康复训练　；参考：《南京中医药大学》2012年硕士论文

【摘要】：目的：观察治疗前后痉挛型脑瘫患儿修改的Ashworth痉挛量表(MAS)和脑瘫患儿日常生活能力评价表(ADL)积分的变化情况,探索“补肾健脑针法”结合康复训练治疗肝肾不足型痉挛型脑瘫患儿的有效性及起效时间规律。研究方法：采用随机化方法。借助SAS统计分析系统产生60例受试者接受处理的随机安排,即列出流水号为01-60所对应的治疗分配。分为治疗组30例、对照组30例,其中治疗组脱落1例,纳入统计的病例治疗组29例,对照组30例。治疗组为“补肾健脑针法”结合康复训练,对照组单纯采用康复训练,康复治疗方法同治疗组。分别于治疗前、1个月后、2个月后、3个月后运用修改的Ashworth痉挛评定量表及日常生活能力评价表(ADL),观察两组患儿痉挛状态和日常生活能力改善的差异以及起效时间规律。结果：(1)根据治疗前后MAS积分变化,治疗组与对照组有显著性差异(P0.01)；治疗组治疗前与2个月后比较无显著差异(P0.05)；治疗前与3个月比较,有显著差异(P0.01),对照组治疗前与2个月及3个月后比较均无显著差异(P0.05)。说明“补肾健脑针法”结合康复训练能改善脑瘫患儿的痉挛状态,比单纯康复训练更早更为有效。 (2)在日常生活能力方面,根据ADL量表积分变化,两组治疗均能改善脑瘫患儿的日常生活活动能力,但治疗组明显优于对照组(P0.01),能够明显改善脑瘫患儿的日常生活活动能力(P0.01),而且治疗组在第1个月积分即显示出统计学意义(P0.05),3个月后与2个月后积分具有明显差异(P0.05)。说明治疗组起效时间早于对照组,第3个月起效幅度较大。而且疗程越长,患儿的日常生活活动能力的改善效果越明显(P0.01)。根据两组之间每个月ADL各因子评分比较看,经2个月治疗后,治疗组对粗大运动的改善与对照组比较有显著性差异(P0.05),经3个月治疗后,治疗组对粗大运动、附加功能的改善与对照组比较有显著性差异(P0.01),说明治疗组对粗大运动治疗效果较好。 (3)两组临床疗效比较,治疗组总有效率为100%,总显效率是72.41%；对照组总有效率为83.33%,总显效率是43.33%。两组比较总有效率和总显效率均有显著性差异(P0.05)；说明“补肾健脑针法”结合康复训练比单纯康复训练更有效。两组总起效情况比较,与对照组相比,治疗组起效时间较早,大多数在第1个月起效；粗大运动及附加功能起效时间早于对照组(P0.05),多数在第1个月起效；治疗组在站、步行、上下台阶、理解、步行能力及站立平衡起效月份早于对照组,站、步行、上下台阶多为第1个月开始起效；理解、步行能力及站立平衡多在2、3月后起效。治疗3个月后治疗组ADL单项评分因子(爬、站、转移、步行、理解、表达、步行能力)方面治愈率优于对照组。结论：“补肾健脑针法”结合康复训练对于痉挛性脑瘫患儿的治疗临床疗效肯定,能显著较早的地改善患儿的痉挛状态,提高患儿的日常生活能力,尤其是粗大运动能力,从而提高患儿的生活质量,减轻家长的负担。“补肾健脑针法”结合康复训练对痉挛型脑瘫患儿的痉挛状态和日常生活活动能力的改善具有起效早,疗效显著、安全等优势。避免了药物的副作用,价格相对便宜,故值得临床推广。
[Abstract]:Objective: To observe the changes of the modified Ashworth spasmodic scale (MAS) and the daily living ability assessment table (ADL) score of children with spastic cerebral palsy before and after treatment, and to explore the effectiveness and the onset time of the "tonifying kidney and brain acupuncture" combined with rehabilitation training for children with spastic cerebral palsy with deficiency of liver and kidney type.
Study method: using the randomization method, with the help of the SAS statistical analysis system, 60 subjects were treated randomly, that is to list the treatment allocation corresponding to the flow number 01-60, divided into 30 cases in the treatment group and 30 cases in the control group, including 1 cases of the treatment group, 29 cases in the statistical case treatment group and 30 in the control group. Combined with rehabilitation training, the control group was treated with rehabilitation training, rehabilitation therapy and treatment group. Before treatment, 1 months later, 2 months later, 3 months later, the modified Ashworth spasticity assessment scale and daily living ability assessment table (ADL) were used to observe the difference of spastic state and improvement of daily living ability in the two groups. The law of the starting time.
Results: (1) according to the changes of MAS scores before and after treatment, there was significant difference between the treatment group and the control group (P0.01); there was no significant difference between the treatment group before and after 2 months (P0.05); there was significant difference between before and 3 months (P0.01), and there was no significant difference between the control group before and after 2 months and 3 months (P0.05). Brain acupuncture combined with rehabilitation training can improve the spasticity of children with cerebral palsy, which is more effective than simple rehabilitation training earlier.
(2) in daily living ability, according to the ADL scale integral change, the two groups of treatment can improve the daily living ability of the children with cerebral palsy, but the treatment group is obviously better than the control group (P0.01). It can obviously improve the daily living ability of the children with cerebral palsy (P0.01), and the treatment group is statistically significant (P0.05) in first months' score (P0.05). There was a significant difference between 2 months after 2 months. It showed that the onset time of the treatment group was earlier than that of the control group, and the effect of the third months was greater. And the longer the course of treatment, the more obvious the improvement effect of the daily living ability of the children (P0.01). According to the comparison of the ADL factors of each month between the two groups, the treatment group was treated after 2 months of treatment. The improvement of gross exercise was significantly different from that of the control group (P0.05). After 3 months of treatment, the treatment group was significantly different from the control group (P0.01). The effect of the treatment group was better than that of the control group (P0.01).
(3) the total effective rate of the two groups was 100%, the total effective rate was 72.41%, the total effective rate of the control group was 83.33%, the total effective rate was significant difference between the 43.33%. two group and the total effective rate (P0.05). It showed that the "kidney tonifying brain acupuncture method" combined with the rehabilitation training was more effective than the simple rehabilitation training. The two groups had a total effect. Compared with the control group, the onset time of the treatment group was earlier than that of the control group, most of the effective time was first months. The onset time of the gross exercise and additional function was earlier than the control group (P0.05), most of which took effect in first months. The treatment group was standing, walking, walking up and down the steps, understanding, walking energy and standing balance were earlier than the control group, station, walking, up and down. More than first months began to start. Understanding, walking ability and standing balance were more effective after 2,3 months. After 3 months of treatment, the cure rate of the ADL single score factor (climbing, station, transfer, walking, understanding, expression, walking ability) in the treatment group was better than that of the control group.
Conclusion: the therapeutic effect of "invigorating kidney and invigorating the brain" combined with rehabilitation training in the treatment of children with spastic cerebral palsy is positive. It can significantly improve children's spasticity and improve the daily living ability of the children, especially the gross motor ability, so as to improve the quality of life and reduce the burden of the parents. Combined with rehabilitation training, the treatment of spastic cerebral palsy has the advantages of early effect, significant effect and safety. It avoids the side effects and the price is relatively cheap, so it is worthy of clinical promotion.

【学位授予单位】：南京中医药大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R246.6;R742.3

【参考文献】