醒脑通督针法治疗缺血性中风后偏瘫痉挛状态的临床观察

发布时间：2018-03-18 19:24

本文选题：缺血性中风　切入点：醒脑通督　出处：《山西中医学院》2016年硕士论文　论文类型：学位论文

【摘要】：目的本研究将醒脑通督针法用于缺血性中风后偏瘫痉挛状态的治疗,观察其临床疗效,从而探讨醒脑通督针法治疗该病的机理,进一步规范化操作,为该针法广泛地运用于临床提供理论依据和实践基础。方法本研究设立醒脑通督针法组为治疗组,常规针法组为对照组,患者随机入组后都按缺血性中风病诊疗常规给予西医基础治疗和康复训练,并在此基础上接受针刺治疗。醒脑通督针法组取穴:百会、四神聪、风府、风池、华佗夹脊穴(蛇形刺)、陶道、长强。常规针法组参考2010年出版的《针灸治疗学》(作者:王启才)取穴:肩毭、臂佈、曲池、手三里、合谷、环跳、风市、阳陵泉、足三里、绝骨、丘墟、解溪、太溪。两组均每日针刺1次,每次留针30分钟,每治疗10次后休息2天,共30次。观察指标采用CSS量表(评定神经功能缺损程度)、MAS量表(评定肢体痉挛程度)、FMA量表(评定运动功能)、ADL指数(评定日常生活能力),采用盲法评价,于治疗前、后对所有患者进行测评,通过比较患者治疗前后及两组之间各指标的变化,观察两种针法对患者上述四种功能障碍的影响,并据此来对比出两种针法对缺血性中风后偏瘫痉挛状态治疗效果的优劣。结果1.两种针法对临床神经功能缺损程度的影响治疗前两组患者CSS量表评分经软件分析,P0.05,认为两组患者神经功能缺损程度齐同,可以进行对比研究;治疗后测评,两组患者所得的评分与治疗前自身对照均降低,P0.05,差异均不具有统计学意义。2.两种针法对患肢痉挛程度的影响治疗前两组患者MAS量表评分经软件分析,P0.05,认为两组患者患肢痉挛程度齐同,可以进行对比研究。治疗后测评,两组患者上下肢痉挛程度评分与治疗前自身对照明显降低,P0.05,差异有统计学意义;治疗后与常规针刺组比较,上肢P0.05,差异无统计学意义,说明醒脑通督组上肢评分降低程度不明显;下肢P0.05,差异有统计学意义,说明醒脑通督组下肢评分降低明显。3.两种针法对患肢运动能力的影响治疗前两组患者FMA量表评分经软件分析,P0.05,认为两组患者患肢运动能力齐同,可以进行对比研究。治疗后测评,两组患者与治疗前自身对照评分均有明显升高,P0.05,差异有统计学意义;治疗后与常规针刺组比较,P0.05,差异有统计学意义,醒脑通督组评分升高明显。4.两种针法对患者日常生活能力的影响治疗前两组患者ADL评分经统计软件分析,P0.05,认为两组日常生活能力齐同,可以进行对比研究。治疗后测评,两组患者与治疗前自身对照评分均有所升高,P0.05,差异有统计学意义;治疗后与常规针刺组比较,P0.05,差异无统计学意义,说明醒脑通督组评分升高不明显。5.两种针法对总体有效率的影响醒脑通督针法组治疗后总有效27例,占87.1%,常规针法组总有效为19例,占63.3%,两组疗效相比较,P0.05,差异有统计学意义。结论1.醒脑通督针法与常规针法对于研究期间患者神经功能缺损程度的改善均没有明显疗效。2.醒脑通督针法与常规针法均能改善患者肢体的痉挛程度,醒脑通督针法改善下肢痉挛程度优于常规针刺组,对于上肢两种方法疗效相当。3.醒脑通督针法与常规针法对于提高患者的运动能力均有确切疗效,醒脑通督针法更为明显。4.醒脑通督针法与常规针法对于改善患者的日常生活能力均有效,且两种方法疗效相当,不能说明哪一种方法对于改善患者日常生活能力更有效。本研究结果显示醒脑通督针法的疗效主要体现在改善患者患肢痉挛程度以及提高患肢运动能力,对日常生活能力的提高与常规针刺法相当,短时期内对于神经功能缺损程度的改善并不明显。醒脑通督针法组总有效率为87.1%,常规针刺组总有效率为63.3%,差异具有统计学意义,可以认为醒脑通督针法治疗该病总体疗效优于常规针刺法。
[Abstract]:The purpose of this study will Xingnao unblocking acupuncture for the treatment of spastic hemiplegia after ischemic stroke, to observe its clinical curative effect, so as to explore the mechanism of Xingnao unblocking acupuncture treatment of the disease, to further standardize the operation, the method is widely used to provide theoretical basis and practical basis for clinical. Methods in this study the establishment of Xingnao unblocking acupuncture group for the treatment group, conventional acupuncture group as the control group, patients were randomized into group according to diagnosis and treatment of ischemic stroke treated with western medicine foundation treatment and rehabilitation training, and on the basis of received acupuncture treatment. Xingnao unblocking acupuncture group acupoints: Baihui, Sishencong, Fengchi, Fengfu, Hua Tuo Jiaji (snake thorn), Taodao, long strong. > conventional acupuncture group acupuncture treatment reference published in 2010 "(author: Wang Qicai) acupoints: Dou shoulder, arm, hand three years, Quchi, Hegu, ring jump, wind city, Yang Ling Quan, Zusanli and juegu, Qiuxu, JieXi, too Xi. Two groups of acupuncture 1 times a day, each time the needle for 30 minutes, every 10 days after treatment 2 days off, a total of 30 times. The observation indexes by CSS scale (assessment of the degree of neural function defect scale (MAS), assessment of spasticity degree scale (FMA), assessment of motor function, ADL (index) the assessment of the ability of daily life), evaluated by blind method before treatment, after evaluation of all patients, through the comparison between changes in patients before and after treatment, two groups of each index, to observe the effect of acupuncture on two patients with the four kinds of dysfunction, and to compare the advantages and disadvantages of the two kinds of needle method for treatment of hemiplegia spasticity after ischemic stroke. Results 1. of two kinds of acupuncture effect on clinical neurological impairment of the two groups before treatment CSS score through the analysis of the software P0.05, that two groups of patients with neurological deficits can be compared with Qi, study after treatment evaluation, two groups; The score and treatment of patients with the control were lower, P0.05, the difference was not statistically significant.2. two stitches on the score by the software analysis, affected limb spasticity in the two groups before treatment MAS scale P0.05, two group patients with limb spasticity with Qi, can be treated to conduct a comparative study. After the evaluation of lower limb spasticity score before treatment were significantly decreased, P0.05 patients were divided into two groups, the difference was statistically significant; after treatment compared with the routine acupuncture group of upper limb P0.05, the difference was not statistically significant, indicating Xingnao unblocking group on limb score decreased not obviously; lower extremity P0.05, the difference was statistically significant, indicating Xingnao unblocking group of lower extremity score decreased signiifcantly.3. two kinds of acupuncture on limb movement ability of the two groups before treatment FMA score through the analysis of the software P0.05, two group patients with limb movement ability with Qi, can Comparative study. After treatment evaluation, two groups of patients before treatment and control scores were significantly increased, P0.05, the difference was statistically significant; after treatment compared with the conventional acupuncture group P0.05, the difference was statistically significant, Xingnao unblocking score of group.4. increased significantly two kinds of acupuncture effect on daily life ability of patients before treatment, two ADL score of group analysis by statistical software P0.05, two group together with the ability of daily life, can carry out comparative study. After treatment evaluation, two groups of patients before treatment and control scores were increased, P0.05, the difference was statistically significant; after treatment compared with the conventional acupuncture group P0.05, the difference was not statistically significant. Description of Xingnao unblocking group were increased significantly.5. two effect of Xingnao acupuncture methods on the overall efficiency of unblocking acupuncture group after treatment, the total effective 27 cases, accounting for 87.1%, a conventional acupuncture group total effective 19 cases, accounting for 63.3%, two Results compared to P0.05, the difference was statistically significant. Conclusion 1. Xingnao unblocking acupuncture and conventional acupuncture for spasm during the study period in patients with neurological deficits were improved without obvious curative effect.2. Xingnao unblocking acupuncture and conventional acupuncture can improve the patients' limbs, awake brain unblocking acupuncture improve lower limb spasticity is superior to conventional acupuncture for the group, with two methods of upper limb rather.3. Xingnao unblocking acupuncture and conventional acupuncture in improving exercise capacity have definite curative effect in patients, Xingnao unblocking acupuncture is more obvious.4. Xingnao unblocking acupuncture and conventional acupuncture are effective to improve the ability of daily life of patients, and the curative effect of two kinds of methods, can not explain what kind of a more effective method for improving the ability of daily life of patients. The results of this study showed that effect of Xingnao unblocking acupuncture mainly in patients with limb spasticity and Improve the limb movement ability, is to improve the ability of daily life and routine acupuncture method, a short period of time for the improvement of nerve function defect degree is not obvious. Xingnao unblocking acupuncture group total effective rate was 87.1%, conventional acupuncture group, the total effective rate was 63.3%, the difference has statistical significance, can think of Xingnao unblocking acupuncture treatment the overall effect is better than conventional acupuncture.

【学位授予单位】：山西中医学院
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R246.6

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