中西医结合个性化康复方案对缺血性中风病运动功能障碍的临床观察

发布时间：2018-04-09 23:14

本文选题：中西医结合　切入点：缺血性　出处：《河北医科大学》2016年硕士论文

【摘要】：目的:通过选择我院康复科缺血性中风病病人,按照中风病诊疗规范,给予常规药物以及康复训练等综合治疗的基础上,同时配合音乐、针灸、中药、熏蒸等个性化方案,观察中西医结合个性化康复方案对缺血性中风病运动功能障碍的影响,评价中西医个性化康复方案对缺血性中风病病人的治疗效果,评价其治疗作用及安全性。方法:根据选取标准,选择2014年9月-2015年9月邢台市人民医院康复科缺血性中风病伴有运动功能障碍的病人60例,按照单纯随机抽样分组的原则分为对照组和治疗组,两个组均给予常规内科治疗,治疗组再给予中西医结合个性化康复方案(中医治疗方法+西医治疗方法),对照组给予西医康复治疗方案。西医康复方案:基础康复治疗。中医康复方案包括:中医音乐疗法:根据中医“五型人”分类方法,对病人给予不同类型的音乐治疗,每日2小时,分为早:8:00-9:00;下午15:00-16:00。中药内服:每天一剂,一次100毫升,早晚各一次。针灸:选取肩井穴、肩隅穴、曲池穴、合谷穴、伏兔穴、昆仑穴、太冲穴、足三里穴、阳陵泉穴、委中穴。病人姿势:嘱咐病人尽量采取仰卧位,对病人采纳常规针灸手法(提插捻转),得气后留针30分钟,注意避免晕针、断针等反应。中药熏蒸:独活15克,桑寄生15克,羌活15克,秦艽15克,薄荷10克,藏红花10克,檀香15克,五味子10克,细辛6克。将上述药物煎液后用于治疗有功能障碍的一侧,在药液温度较高时利用蒸汽熏蒸患侧,待中药药液温度降低之45℃左右时,用药液将患侧热擦25分钟,每日进行1-2次。每组的治疗与训练时间为周一至周五(不包括药物治疗),疗程为1个月。病人入院时予康复评定一次,治疗一个月后进行第二次评定。评定结果纳入统计分析。康复训练期间,观察病人的训练态度,生活习惯,尽量减少干扰。根据治疗前后两组FMA评定法、美国国立卫生院脑卒中评定表(NIHSS)和日常生活能力评定(BI)结果的统计分析,来观察中西医结合个性化康复方案对缺血性中风病运动功能障碍的疗效及实用性。结果:1两组病人,在经过中西医结合个性化方案和单纯西医治疗方案的治疗后,肢体运动功能(FMA)均有显著的改善,治疗组优于对照组,组间差异有统计学意义(P0.01)。2两组病人,在经过中西医结合个性化方案和单纯西医治疗方案的治疗后,日常生活能力评定(BI)均有显著的改善,治疗组优于对照组,组间差异有统计学意义(P0.01)。3两组病人,在经过中西医结合个性化方案和单纯西医治疗方案的治疗后,脑卒中评定(NIHSS)均有显著的改善,治疗组优于对照组,组间差异有统计学意义(P0.01)。康复治疗过程中未见病人不良反应,此项治疗具有相对的安全性。结论:1缺血性中风病偏瘫病人,在给予常规康复训练基础上,配合中西医结合个性化康复治疗方案,增强病人训练积极性,可有效提高病人康复效率。2与单独的使用西医康复手段相比,中西医结合个性化康复方案治疗缺血性中风病偏瘫病人,康复效果更加明显,可以有效缩短病人康复治疗时间,提升康复治疗水平。3中西医结合个性化康复方案安全性较高,无明显不良反应,是一种安全可靠的康复手段。这为临床康复提供了新的手段和方法,适合一般病人的康复需求,有利于病人回归社会,具有一定的临床发展前景,符合我国医疗发展的趋势。4中医传统康复手段结合西医康复方法,能够更好的提高康复效果,发挥各自的优势,减少病人及家属的家庭和社会负担。中西医结合个性化康复方案,能够推动康复医疗技术的进步,进而推动传统中医走向世界,与世界先进的康复技术相接轨。这不仅使我国的康复医疗水平得到提高,也减少了国家的经济损失,促进了社会的和谐发展。
[Abstract]:Objective: through the selection of our hospital rehabilitation of ischemic stroke patients, according to the standard of diagnosis and treatment of stroke, given routine medicine and rehabilitation training on the comprehensive treatment, at the same time with the music, acupuncture, Chinese medicine fumigation, personalized programs, combined with individualized rehabilitation program observation effect on ischemic stroke movement dysfunction of traditional Chinese medicine and Western medicine treatment effect evaluation Chinese and Western medicine individualized rehabilitation scheme on ischemic stroke patients, to evaluate the curative effect and safety. Methods: according to the selection criteria, 60 cases of September 2014 -2015 year in September the rehabilitation department of Xingtai People's Hospital with motor dysfunction of ischemic stroke patients, according to the principle of random sampling in the group divided into treatment group and control group, two groups the treatment group received routine medical treatment and individualized rehabilitation program combining traditional Chinese and Western Medicine (TCM treatment plus Western medicine treatment Method), the control group received rehabilitation treatment. Western medicine Western medicine: basic rehabilitation. Including the rehabilitation scheme of traditional Chinese medicine: Chinese music therapy: according to the classification of traditional Chinese medicine "five type" method, given different types of music therapy for patients, 2 hours a day, divided into early: 8: 00-9:00; 15:00-16:00. p.m. every day: Chinese medicine an agent, a 100 ml, sooner or later each time. Acupuncture: select Jianjing, shoulder corner point, Quchi, Hegu, down the rabbit hole, Kunlun cave, Taichong, Zusanli, Yanglingquan, Weizhong. Patient posture: patient supine position to take charge of the patient, adopt routine acupuncture (lifting thrusting twirling), have left 30 minutes, avoid fainting, breakage and other reactions. Traditional Chinese medicine fumigation: Angelica 15 grams, 15 grams of 15 grams Loranthaceae, notopterygium, Gentiana 15 grams, 10 grams of mint, saffron 10 grams, 15 grams of sandalwood, Schisandra 10 grams, 6 grams of Asarum. The medicine decoction after use In the treatment of dysfunctional side, the use of steam fumigation affected side in the liquid when the temperature is higher, the traditional Chinese medicine liquid temperature decreased 45 degrees Celsius, liquid medicine will ipsilateral hot rub for 25 minutes, 1-2 times a day. The treatment and training time each Monday to Friday (not including drug therapy, treatment for 1) months. Patients on admission to rehabilitation evaluation once a month after treatment. Results the second evaluation included in the statistical analysis. The patients were observed during rehabilitation training, training attitude, habits, try to reduce interference. According to the two groups before and after treatment FMA assessment method, National Institutes of Health Stroke scale (NIHSS) and ADL (BI) the results of the statistical analysis, to observe the curative effect and practicability of combining traditional Chinese and Western medicine individualized rehabilitation scheme on ischemic stroke movement dysfunction. Results: 1 patients in the two groups, through the combination of traditional Chinese and Western medicine personality The treatment scheme and pure western medicine treatment, limb motor function (FMA) were significantly improved in treatment group than the control group, there was significant difference between the groups (P0.01.2) two groups of patients, after treatment of traditional Chinese and Western medicine and simple western medicine personalized program scheme, ADL (BI) were significantly improved in treatment group than the control group, there was significant difference between the groups (P0.01.3) two groups of patients, after treatment of traditional Chinese and Western medicine and simple western medicine treatment individualized after stroke assessment (NIHSS) were significantly improved in treatment group than the control group, there was statistical significance between the groups the difference (P0.01). No adverse reactions during the treatment of rehabilitation of patients, is relatively safe in the treatment. Conclusion: 1 ischemic stroke hemiplegia patients received routine rehabilitation training, on the basis, combined with the character of traditional Chinese medicine and Western Medicine Rehabilitation treatment, strengthen the patient training initiative, can effectively improve the efficiency of rehabilitation of patients with.2 compared with the use of Western medicine rehabilitation therapy alone, individualized rehabilitation regimen in the treatment of ischemic stroke patients with hemiplegia rehabilitation of traditional Chinese and Western medicine, the effect is more obvious, can effectively shorten the time of rehabilitation patients, enhance the combination of personalized rehabilitation scheme with high security level of rehabilitation the.3 of traditional Chinese medicine and Western medicine, no obvious adverse reactions, is a safe and reliable means of rehabilitation. This provides new means and methods for clinical rehabilitation, rehabilitation needs for patients, help patients return to society, has certain clinical development prospects, in line with the trend of.4 Chinese traditional Chinese medical development means of rehabilitation combined with western medicine rehabilitation methods, can improve the rehabilitation effect better, play their respective advantages, reduce patient and family burden of family and society in traditional Chinese and Western medicine. With personalized rehabilitation, rehabilitation can promote the progress of medical technology, and promote the traditional Chinese medicine to the world, combined with the rehabilitation of the world advanced technology. It not only improve the rehabilitation level of our country, but also to reduce the economic loss, and promote the harmonious development of the society.

【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R743

【参考文献】