体针联合本体感觉强化训练治疗卒中偏瘫上肢的疗效观察
发布时间：2018-08-01 10:37
【摘要】：目的:观察体针联合本体感觉强化训练治疗卒中偏瘫上肢功能障碍的临床疗效,探讨两者结合治疗卒中后患者偏瘫上肢功能及提高日常生活活动能力的有效性和临床推广价值,优化卒中偏瘫上肢运动障碍恢复的治疗方案,为临床上治疗卒中后偏瘫上肢功能障碍寻求一种更为有效的中西医结合康复干预方法,并提供循证医学证据。方法:采用单盲法随机对照试验研究方案,将符合纳入诊断标准的60例首次卒中且病程小于3个月的存在上肢功能障碍的患者按病人就诊先后顺序编号利用随机数字表法分成治疗组和对照组两组,每组各30例。两组受试者均予神经内科基础药物治疗和常规康复训练。对照组采取偏瘫侧上肢体针治疗,若患者处于弛缓期上肢选穴则以屈肌群穴位即阴经穴为主,如内关、曲泽、青灵、尺泽、极泉等,若患者处于痉挛期则取患侧上肢伸肌群穴位即阳经穴为主如外关、支正、曲池、臂佈、肩毭等,针刺得气后留针20分钟(同时在疗程中根据患者的康复进程和中医的辨证分型不同对穴位做适当调整以适应病情发展和减少穴位耐受现象)。治疗组则在对照组的治疗基础上加用本体感觉强化训练,治疗30min/天。所有受试者在纳入研究后给予治疗1次/天,周日休息,前后共治疗8周,共治疗48次,疗程56天。并在治疗前、治疗后(8 周)使用简化 Fugl-Mayer 运动功能量表(Fugl-Mayer assessment scale,FMA)评估上肢运动功能,改良Barthel指数(the modified barthel index,MBI)进行日常生活活动能力(ADL)评定,分别进行组内比较和组间比较以评价疗效。统计学分析:使用Excel表格统一录入并保存数据,结果均以均数士标准差(x±s),应用SPSS19.0软件进行分析:两组独立样本组间比较,如为计量资料,服从正态分布且方差齐性相等,则采用成组t检验,反之采用四格表资料的卡方检验;治疗前后组内比较,如为计量资料,服从正态分布且方差齐性相等,则采用配对t检验,反之采用四格表资料的卡方检验。各检验过程均以P0.05表示具有统计学意义。结果:FMA评分(上肢部分)结果分析。①组内比较:治疗组患者在治疗8周后的FMA评分较治疗前有明显增加,差异具有统计学意义(P0.01);对照组患者在治疗8周后的FMA评分较治疗前亦有所增加,差异具有统计学意义(P0.01)。②组间比较:两组治疗前FMA评分比较无统计学意义(P0.05);两组治疗8周后FMA评分具有差异性(P0.05),且治疗组FMA评分较对照组增加明显,两组FMA评分差值具有显著统计学意义(P0.01)。MBI指数评分结果分析。①组内比较:治疗组患者在治疗8周后的MBI指数较治(?)疗前有明显增加,差异具有统计学意义(P0.01);对照组患者在治疗8周后的MBI指数较治疗前亦有所增加,差异具有统计学意义(P0.01)。②组间比较:两组治疗前MBI指数比较无统计学意义(P0.05);两组治疗8周后MBI指数具有差异性(P0.05),且治疗组MBI指数较对照组增加明显,两组MBI指数差值具有显著统计学意义(P0.01)。结论:(1)表明体针治疗与本体感觉强化训练在促进偏瘫上肢功能恢复的疗效优于对照组即体针治疗。(2)表明体针治疗与本体感觉强化训练相联合的治疗方法可以有效改善脑卒中后患者上肢的日常生活能力,且疗效显著于体针组。
[Abstract]:Objective: To observe the clinical effect of body acupuncture combined with proprioceptive intensive training in the treatment of stroke hemiplegia upper limb dysfunction, to explore the effectiveness and clinical popularization value of combined treatment of hemiplegic upper limb function and daily living ability after stroke, and to optimize the treatment plan for the recovery of hemiplegia Upper Limb Dyskinesia for clinical treatment. A more effective method of combining traditional Chinese and Western medicine was sought after stroke, and evidence based evidence-based medical evidence was provided. Method: a single blind randomized controlled trial was used in 60 patients with upper limb dysfunction which were in accordance with the diagnostic criteria for the first stroke and the course of the disease was less than 3 months. The sequence number was divided into two groups, the treatment group and the control group, with 30 cases in each group. The two groups were all given the basic medicine treatment and routine rehabilitation training in the neurology department. The control group took the hemiplegia side upper limb needle treatment, if the patient was in the relaxation period, the main points were the flexor group acupoints, such as the Neiguan and the zanze. If the patient is in spasticity, the acupoints of the extensor group of the upper limb, that is, the Yang Meridian Acupoints, such as the external customs, the support, the Chi Chi, the arm cloth and the shoulder, are taken for 20 minutes (and the acupuncture points are adjusted to adapt to the development and reduction of the acupoints according to the patients' rehabilitation process and the TCM syndrome differentiation. " The treatment group was treated with proprioceptive intensive training on the basis of the treatment of the control group on the basis of the treatment of 30min/ days. All the subjects were given treatment 1 times / day, Sunday rest and 8 weeks before and after treatment, 48 times and 56 days of treatment. And before treatment, after treatment (8 weeks), the simplified Fugl-Mayer exercise function was used. The table (Fugl-Mayer assessment scale, FMA) evaluated the upper limb motor function, improved the Barthel index (the modified Barthel index, MBI) for daily living activity (ADL) evaluation, compared the intra group comparison with the group to evaluate the curative effect respectively. Difference (x + s), using SPSS19.0 software to analyze: two groups of independent sample groups, for example, for measurement data, obey normal distribution and equal variance homogeneity, then adopt group t test and vice versa test of four lattice data; in group comparison before and after treatment, if the data, obey normal distribution and the homogeneity of variance is equal, then use paired t Test, on the other hand, we used the chi square test of four grid data. All the tests were statistically significant with P0.05. Results: FMA score (upper limb part) results analysis. (1) in group comparison: the FMA score of the treatment group was significantly increased after 8 weeks of treatment, and the difference was statistically significant (P0.01); the control group was treated for 8 weeks. After the treatment, the FMA score of the two groups was not statistically significant (P0.01). There was no significant difference between the two groups before treatment (P0.05); the FMA score in the two groups was different after 8 weeks of treatment (P0.05), and the FMA score in the treatment group was significantly higher than that in the control group, and the difference value of the FMA score in the two groups had significant statistical significance (P0.). 01).MBI index score analysis. (1) in group comparison: the MBI index in the treatment group was significantly increased after 8 weeks of treatment than before treatment (?), and the difference was statistically significant (P0.01); the MBI index in the control group was also increased after 8 weeks of treatment, and the difference was statistically significant (P0.01). (2) group comparison: two groups before treatment (MBI). The index of the index was not statistically significant (P0.05); the MBI index in the two groups was different after 8 weeks (P0.05), and the MBI index in the treatment group was significantly higher than that in the control group. The difference between the two groups was statistically significant (P0.01). Conclusion: (1) the effect of the body acupuncture therapy and the proprioceptive intensive training on the recovery of the hemiplegia upper limb was better than that of the pair. (2) it shows that the combined treatment of body acupuncture and proprioception can effectively improve the daily living ability of the upper limbs of the patients after stroke, and the curative effect is significant in the body acupuncture group.
【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】：R743.3
本文编号：2157298
[Abstract]:Objective: To observe the clinical effect of body acupuncture combined with proprioceptive intensive training in the treatment of stroke hemiplegia upper limb dysfunction, to explore the effectiveness and clinical popularization value of combined treatment of hemiplegic upper limb function and daily living ability after stroke, and to optimize the treatment plan for the recovery of hemiplegia Upper Limb Dyskinesia for clinical treatment. A more effective method of combining traditional Chinese and Western medicine was sought after stroke, and evidence based evidence-based medical evidence was provided. Method: a single blind randomized controlled trial was used in 60 patients with upper limb dysfunction which were in accordance with the diagnostic criteria for the first stroke and the course of the disease was less than 3 months. The sequence number was divided into two groups, the treatment group and the control group, with 30 cases in each group. The two groups were all given the basic medicine treatment and routine rehabilitation training in the neurology department. The control group took the hemiplegia side upper limb needle treatment, if the patient was in the relaxation period, the main points were the flexor group acupoints, such as the Neiguan and the zanze. If the patient is in spasticity, the acupoints of the extensor group of the upper limb, that is, the Yang Meridian Acupoints, such as the external customs, the support, the Chi Chi, the arm cloth and the shoulder, are taken for 20 minutes (and the acupuncture points are adjusted to adapt to the development and reduction of the acupoints according to the patients' rehabilitation process and the TCM syndrome differentiation. " The treatment group was treated with proprioceptive intensive training on the basis of the treatment of the control group on the basis of the treatment of 30min/ days. All the subjects were given treatment 1 times / day, Sunday rest and 8 weeks before and after treatment, 48 times and 56 days of treatment. And before treatment, after treatment (8 weeks), the simplified Fugl-Mayer exercise function was used. The table (Fugl-Mayer assessment scale, FMA) evaluated the upper limb motor function, improved the Barthel index (the modified Barthel index, MBI) for daily living activity (ADL) evaluation, compared the intra group comparison with the group to evaluate the curative effect respectively. Difference (x + s), using SPSS19.0 software to analyze: two groups of independent sample groups, for example, for measurement data, obey normal distribution and equal variance homogeneity, then adopt group t test and vice versa test of four lattice data; in group comparison before and after treatment, if the data, obey normal distribution and the homogeneity of variance is equal, then use paired t Test, on the other hand, we used the chi square test of four grid data. All the tests were statistically significant with P0.05. Results: FMA score (upper limb part) results analysis. (1) in group comparison: the FMA score of the treatment group was significantly increased after 8 weeks of treatment, and the difference was statistically significant (P0.01); the control group was treated for 8 weeks. After the treatment, the FMA score of the two groups was not statistically significant (P0.01). There was no significant difference between the two groups before treatment (P0.05); the FMA score in the two groups was different after 8 weeks of treatment (P0.05), and the FMA score in the treatment group was significantly higher than that in the control group, and the difference value of the FMA score in the two groups had significant statistical significance (P0.). 01).MBI index score analysis. (1) in group comparison: the MBI index in the treatment group was significantly increased after 8 weeks of treatment than before treatment (?), and the difference was statistically significant (P0.01); the MBI index in the control group was also increased after 8 weeks of treatment, and the difference was statistically significant (P0.01). (2) group comparison: two groups before treatment (MBI). The index of the index was not statistically significant (P0.05); the MBI index in the two groups was different after 8 weeks (P0.05), and the MBI index in the treatment group was significantly higher than that in the control group. The difference between the two groups was statistically significant (P0.01). Conclusion: (1) the effect of the body acupuncture therapy and the proprioceptive intensive training on the recovery of the hemiplegia upper limb was better than that of the pair. (2) it shows that the combined treatment of body acupuncture and proprioception can effectively improve the daily living ability of the upper limbs of the patients after stroke, and the curative effect is significant in the body acupuncture group.
【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】：R743.3
【参考文献】
相关期刊论文 前10条
1 肖洪波;朱宗俊;陈瑞全;邵俊;蔡润;罗金发;;任务导向性训练联合肉毒素对脑卒中后上肢痉挛患者功能恢复的影响[J];中国临床保健杂志;2015年01期
2 王维;马跃文;杨巍;;镜像疗法对脑卒中偏瘫患者上肢功能和手功能的影响[J];大连医科大学学报;2013年06期
3 庄卫生;钱宝延;曹留拴;邹丽丽;;基于镜像神经元的动作观察疗法在运动功能康复中的应用[J];中国康复;2013年05期
4 王秋纯;陈红霞;;任务导向性训练对脑卒中患者上肢功能的疗效观察[J];中国康复;2013年04期
5 方向延;王南;赵建华;李志强;黄艳萍;;本体感觉强化训练对脑卒中恢复期患者偏瘫功能的疗效分析[J];现代诊断与治疗;2013年10期
6 吕静;李鑫铭;;“醒脑开窍”针刺法治疗中风后上肢痉挛性瘫痪30例[J];湖南中医杂志;2013年06期
7 宋如敏;李和平;;脑卒中后手功能障碍针灸治疗的研究进展[J];光明中医;2013年05期
8 赵嘉诚;邓昌明;;针刺配合康复训练治疗缺血性中风患者运动功能障碍42例[J];湖南中医杂志;2013年03期
9 薛晴;崔仁爱;邢艳丽;;运动想象疗法结合针康法治疗脑卒中后上肢功能障碍的临床疗效观察[J];针灸临床杂志;2012年09期
10 倪欢欢;崔晓;胡永善;吴毅;黄德权;瞿佩育;汪军;吴佶;史骏超;;针刺十宣、小海穴配合功能训练治疗中风后手功能障碍疗效观察[J];上海针灸杂志;2012年05期
相关硕士学位论文 前1条
1 冯丽媛;合谷刺电针动法对脑卒中后腕背伸功能恢复的临床研究[D];黑龙江中医药大学;2010年
，本文编号：2157298
本文链接：https://www.wllwen.com/yixuelunwen/shenjingyixue/2157298.html
最近更新
教材专著
