醒脑开窍针法联合运动疗法对脑卒中患者偏瘫肢体功能及SEP的影响

发布时间：2018-06-15 19:00

本文选题：醒脑开窍”针法 + 运动疗法　；参考：《湖北中医药大学》2017年硕士论文

【摘要】：目的:脑卒中有发病率高、致残率高的特点,卒中后肢体运动功能障碍不仅严重影响患者日常生活,而且给家庭乃至社会带来了沉重的经济负担。因此,如何提高康复疗效,降低致残率已经成为脑卒中康复热点问题。目前,针灸结合运动疗法是脑卒中后的主要康复治疗手段,是卒中单元的重要内容。传统针灸在我国古代就应用于脑卒中康复治疗,到了现代,石学敏院士创立了“醒脑开窍”针法,该针法是一种特殊的针刺方法,其要求针刺时手法的量学规范,成熟应用于脑卒中康复治疗。目前针灸结合康复治疗能够改善脑卒中患者运动功能已被证实,“醒脑开窍”针法对脑卒中患者的运动功能有确切的治疗作用,且其机制也逐步走向成熟。为进一步研究“醒脑开窍”针法结合运动疗法对脑卒中患者的康复机制,本课题借助SEP来观察治疗前后患者功能变化,为后期脑卒中康复治疗提供科学参考,促进康复治疗精准化。同时对患者日常生活活动能力、肢体运动功能变化进行观察,进一步分析SEP与BMI、FMA分值之间的相关性。方法:按照纳入及排除标准将30例脑卒中患者按照随机数表法分为治疗组(“醒脑开窍”针法联合运动疗法)和对照组(运动疗法),每组各15例。两组组内根据Brunnstrom分期进行分层。在治疗前、治疗后4周、治疗后8周分别进行患侧肢体运动功能评定(FMA)、日常生活活动能力(MBI)评定,在治疗前与治疗8周后分别行SEP检测。治疗第3、6个月做好随访工作。结果:两组患者治疗4周、8周后,患侧肢体FMA评分均较治疗前提高,差异具有统计学意义(P0.05);治疗4周后两组患者FMA评分无明显差异(P0.05),治疗8周后联合治疗组评分明显优于对照组(P0.05);两组患者治疗4周、8周后,MBI评分均较治疗前提高(P0.05),两组患者治疗8周较治疗4周后MBI评分差异不显著(P0.05),治疗4周及8周后治疗组MBI提高值与对照组MBI提高值对比无显著差异(P0.05);两组患者治疗8周后患侧肢体N20、P40潜伏期均较治疗前缩短,波幅较均较治疗前升高(P0.05),治疗8周后治疗组患侧肢体N20、P40潜伏期缩短数值及波幅升高数值明显大于对照组(P0.05)。结论:醒脑开窍针法联合运动疗法能够改善脑卒中患者偏瘫肢体运动功能及日常生活能力,能够促进中枢神可塑性的发生,从而提高康复疗效。该联合治疗法能够有效缩短患侧SEP潜伏期,升高其波幅,其康复疗效较单纯运动疗法好。脑卒中患者SEP潜伏期及波幅的变化与其FMA评分及MIB评分呈正相关。
[Abstract]:Objective: stroke has the characteristics of high incidence and high disability rate. Limb motor dysfunction after stroke not only seriously affects patients' daily life, but also brings heavy economic burden to family and society. Therefore, how to improve rehabilitation efficacy and reduce disability rate has become a hot issue in stroke rehabilitation. At present, acupuncture combined with exercise therapy is the main rehabilitation method after stroke and an important part of stroke unit. The traditional acupuncture and moxibustion was used in the rehabilitation treatment of stroke in ancient China. In modern times, academician Shi Xuemin established the acupuncture method, which is a special acupuncture method, which requires the quantitative standard of acupuncture manipulation. Mature treatment is applied to stroke rehabilitation. At present, it has been proved that acupuncture combined with rehabilitation therapy can improve motor function of stroke patients. The acupuncture method of "refreshing brain and opening resuscitation" has definite therapeutic effect on motor function of stroke patients, and its mechanism is gradually maturing. In order to further study the mechanism of rehabilitation of stroke patients by acupuncture therapy combined with exercise therapy, the purpose of this study was to observe the functional changes of stroke patients before and after treatment by means of SEP, and to provide a scientific reference for the rehabilitation treatment of stroke in the later stage. Promote the precision of rehabilitation therapy. At the same time, the changes of activity of daily living and motor function of limbs were observed, and the correlation between SEP and BMI-FMA score was analyzed. Methods: according to the criteria of inclusion and exclusion, 30 patients with stroke were divided into two groups: treatment group (combined with acupuncture and exercise therapy) and control group (15 cases in each group). Stratification was performed according to Brunnstrom stage in both groups. Before treatment, 4 weeks after treatment, 8 weeks after treatment, the motor function of the affected limbs was assessed with FMAA, and the activity of daily living (ADL) was assessed by MBI. SEP was measured before and after 8 weeks of treatment. Follow-up work was done in the 3rd and 6th month of treatment. Results: after 4 weeks and 8 weeks of treatment, the FMA scores of the affected limbs in both groups were higher than those before treatment. There was no significant difference in FMA scores between the two groups after 4 weeks of treatment, but the scores in the combined treatment group were significantly better than those in the control group after 8 weeks of treatment, and the MBI scores in the two groups were significantly higher than those in the control group after 4 weeks and 8 weeks of treatment. There was no significant difference in MBI scores between the two groups after 8 weeks of treatment and 4 weeks after treatment, but there was no significant difference in MBI enhancement values between the treatment group and the control group after 4 weeks and 8 weeks of treatment, and there was no significant difference between the two groups after 8 weeks of treatment. The duration of treatment was shorter than that before treatment. After 8 weeks of treatment, the N20P40 latency and amplitude of the affected limbs in the treatment group were significantly higher than those in the control group (P 0.05). Conclusion: the combination of activating brain and resuscitation acupuncture combined with exercise therapy can improve the motor function and daily living ability of hemiplegic limbs, promote the occurrence of central nervous plasticity, and improve the curative effect of rehabilitation. The combined therapy can effectively shorten the latent period and increase the amplitude of SEP in the affected side, and its rehabilitation effect is better than that of simple exercise therapy. The changes of SEP latency and amplitude were positively correlated with FMA score and MIB score.
【学位授予单位】：湖北中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R246.6

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