经皮刮拭上肢阴阳经治疗中风后上肢痉挛临床疗效观察

发布时间：2018-06-01 17:55

本文选题：中风 + 上肢　；参考：《福建中医药大学》2016年硕士论文

【摘要】：目的：观察经皮刮拭法治疗中风后上肢痉挛临床疗效。方法：符合中风西医诊断标准及纳入标准,并完成规定治疗疗程的89例患者,其中治疗1组29例,治疗2组30例,对照组30例。分组情况：三组治疗在康复训练、普通针刺治疗及内科疾病基础治疗的基础上,对照组配合口服巴氯芬控制肌张力(巴氯芬每日最高剂量不得超过80mg)。治疗组配合经皮刮拭法控制肌张力,其中治疗1组选取患侧上肢阴经部位及阳经部位进行分段刮拭治疗,治疗2组选取患侧上肢阳经部位进行分段刮拭治疗。每日1次,W1-6,持续治疗4周。观察指标：1、三组患者于治疗前1天、治疗2周及治疗结束后1天对患者上肢进行改良Ashworth张力评分。2、治疗组患者在第6、12、18、24次治疗时,施术者记录患者刮拭前及刮拭后4小时内每隔60min患侧上肢肌张力情况,以计算患侧上肢治疗后松弛时间。3、依据简化Fugl-Meyer上肢运动功能评分量表,对三组受试者治疗前1天及治疗结束后1天患侧上肢进行功能评分。采用SPSS20.0统计软件包对数据统计分析。结果：改良Ashworth张力评分：经治疗4周后,三组患者痉挛程度较治疗前均有改变,三组患者进行相应治疗2周及4周后,组间改良Ashworth张力评分比较提示P值均小于0.05,具有统计学差异,分别对三组治疗前后改良Ashworth张力评分变化程度进行统计学比较,P值均小于0.05,提示三组治疗前后均具有统计学差异。治疗组于第6、12、18、24次刮拭治疗后患侧上肢松弛时间以分类资料记录,经4周治疗后,治疗组患者上肢松弛时间较治疗前均有不同程度延长,分别对4次记录进行组间比较,P值均小于0.05,具有统计学差异,对治疗组第6次及第24次治疗时的患侧上肢松弛时间变化程度比较,提示P值均小于0.05,具有统计学差异。简化Fugl-Meyer运动功能评分：经治疗4周后,三组患者患侧简化Fug-Meyer上肢运动功能评分较治疗前均有不同程度的提高,对治疗4周后三组的简化Fugl-Meyer上肢运动功能评分进行统计学处理,组间比较提示P大于0.05,无统计学差异,对各组治疗前及治疗后简化Fugl-Meyer上肢运动功能评分进行组内比较,P值均小于0.05,具有统计学差异。结论：经皮刮拭上肢经脉及口服巴氯芬均可改善中风后上肢痉挛情况；在延长患者上肢松弛时间方面刮拭上肢阴、阳经方法疗效较佳,可为中风患者上肢康复训练提供有效的治疗时间窗,以期提高康复疗效。在改善上肢运动功能方面三组无明显差异,目前尚不能明确经皮刮拭对患侧上肢功能恢复的作用。
[Abstract]:Objective: to observe the clinical effect of percutaneous wiping on upper limb spasm after stroke. Methods: 89 patients who met the criteria of western medicine diagnosis and inclusion of apoplexy and completed the prescribed course of treatment were divided into treatment group (n = 29), treatment group (n = 30) and control group (n = 30). Grouping: on the basis of rehabilitation training, general acupuncture treatment and basic treatment of internal diseases, the control group combined with oral baclofen to control muscle tension (the maximum daily dose of baclofen should not exceed 80 mg / g). The treatment group combined with percutaneous wiping method to control muscle tension, treatment group 1 selected the upper side of the upper limb Yin meridian and Yang meridian part of the curettage treatment, treatment group 2 selected the affected side of the upper limb with the positive part of scraping treatment. W1-6, once a day, for 4 weeks. Outcome measures: 1: one, the patients in the three groups were given modified Ashworth tension score of the upper extremities at 1 day before treatment, 2 weeks after treatment and 1 day after treatment. The patients in treatment group were treated with modified Ashworth tension score. The muscle tension of the affected upper extremities was recorded before and 4 hours after the operation in order to calculate the relaxation time of the affected upper extremities. According to the simplified Fugl-Meyer motor function scale, the muscle tension of the affected upper extremities was calculated. The upper limbs of the three groups were evaluated one day before treatment and one day after treatment. The data were analyzed by SPSS20.0 software package. Results: the modified Ashworth tension score: after 4 weeks of treatment, the spasm degree of the three groups was changed compared with that before treatment, and the patients in the three groups were given corresponding treatment for 2 weeks and 4 weeks. The comparison of modified Ashworth tension score between the three groups showed that P value was less than 0.05, and there was statistical difference. The change degree of modified Ashworth tension score before and after treatment in the three groups were all less than 0.05, indicating that the three groups had statistical difference before and after treatment. In the treatment group, the relaxation time of the affected upper limb was recorded as classified data after 24 times of scrape treatment. After 4 weeks of treatment, the relaxation time of the upper limb in the treatment group was prolonged to some extent than that before treatment. The P values of the four records were all less than 0.05, which had statistical difference. The changes of relaxation time of the affected upper extremities in the treatment group at the 6th and 24th times showed that the P values were all less than 0.05, which had statistical difference. Simplified Fugl-Meyer motor function score: after 4 weeks of treatment, the motor function score of affected side simplified Fug-Meyer upper limb in the three groups was improved in varying degrees compared with that before treatment. The simplified Fugl-Meyer motor function score of the three groups was statistically analyzed after 4 weeks of treatment. The comparison between groups showed that P > 0.05, there was no statistical difference. The scores of simplified Fugl-Meyer motor function of upper limb before and after treatment were all less than 0.05, which had statistical difference. Conclusion: percutaneous wiping of upper limb meridians and oral baclofen can improve the condition of upper limb spasm after stroke, and the effect of yang meridian method is better in prolonging the relaxation time of upper limb. It can provide an effective time window for upper limb rehabilitation training of stroke patients in order to improve the curative effect. There was no significant difference among the three groups in improving the motor function of the upper limb, and it was not clear at present that the effect of percutaneous wiping on the recovery of the upper limb function of the affected side.
【学位授予单位】：福建中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R246.6

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