针刺配合现代康复治疗对中风恢复期上肢痉挛的临床观察

发布时间：2018-07-26 18:21

【摘要】：目的为了探求更加科学的脑卒中的诊疗方案,本课题采用针刺配合现代康复治疗中风恢复期上肢痉挛,研究从多个方面及不同角度观察其临床治疗效果,探讨并分析该治疗方案的基本作用原理,通过研究该治疗方案为本病在今后的临床诊疗中提供参考。方法选取2015年1月至2016年12月就诊于黄石市中心医院康复医学科的符合条件的中风恢复期患者60人,研究方法分为两组,针刺现代康复组采取针刺(包括体针和头针)配合现代康复治疗(包括肌肉牵伸技术、作业疗法、电子生物反馈疗法),现代康复组则采用单纯现代康复治疗(包括肌肉牵伸技术、作业疗法、电子生物反馈疗法),各30例。在针刺治疗时要求整个疗程中操作手法及选穴处方一致,治疗的时间均为8周。所有参与实验的患者在疗程中按照治疗处方治疗,不得接受除治疗处方之外其他任何形式的治疗。观察开始时、观察中期和观察结束时,为其临床疗效做出评价,并观察临床神经功能缺损程度(CSS)分数来评估患者神经功能条件;观察改良的Ashworth肌张力评估量,来测定上肢肌肉痉挛程度;通过Fugl-Meyer(FMA)评定量表观察结果,来表明患者上肢的功能状况;评估巴氏指数(BI),从而测定患者的日常生活活动能力(ADL);并综合的比较与分析两组,对本观察的临床疗效采取相应的统计学数据分析。结果1.CSS结果比较:两组患者的CSS,在经过相应治疗后均有改善,通过统计学分析显示,差异有显著性(P0.O5)。表示两组患者都明显的改善了体征和临床症状。从分析可以看出,针刺现代康复组的治疗效果更加突出,优于现代康复组。2.改良的Ashworth肌张力的分级对比:两组患者在通过治疗后,上肢的肌张力都出现下降,前后对照针刺现代康复组的肌张力,提示差异具备极显著意义(P0.01);同样现代康复组肌张力前后对照,其差别亦有明显的对比意义(P0.05)。再对两组患者治疗后的肌张力进行比较,差异显示出极显著性意义(P0.01)。该数据表明针刺现代康复组可以明显降低中风恢复期患者的上肢屈肌肌张力,其疗效优于现代康复组。3.Fugl-Meyer(FMA)评分对比:两组患者经治疗后,上肢的功能均出现提高,针刺现代康复组FMA得分前后对照,差异具备极明显的对比意义(P0.01);前后比较现代康复组的FMA得分,差别有明显的对比意义(P0.05)。两组患者在诊治后FMA的得分相对比,差别表现出极明显的对比意义(P0.01)。故针刺现代康复组的治疗效果优于现代康复组,针刺现代康复组可明显提高中风恢复期患者上肢的功能。4.两组病人BI相较:经相关诊治后,两组病人的ADL都呈现变好趋势,前后比较针刺现代康复组的BI,表示差别具备极明显的对比意义(P0.01);先后比较现代康复组的BI,差别具有明显的对比意义(P0.05)。两组病人诊治后BI得分比对,差别具有极明显的对比意义(P0.01)。表明针刺现代康复组可以极大改善中风恢复期患者的日常生活能力,其治疗效果优于现代康复组。5.临床治疗效果相对比:针刺现代康复组30例,其中基本痊愈4例,显效18例,好转5例,无效3例,总的有效率为90%;现代康复组观察例数也是30例,其中0例是基本痊愈,8例为显效、10例是好转,无效的有12例,其总的有效率为60%。经统计学检测,两组总的有效率相对照,差异具有显著性意义(P0.O5),我们可以看出,针刺现代康复组的治疗效果优于现代康复组。结论临床观察结果表示针刺配合现代康复治疗中风恢复期上肢痉挛的患者,治疗效果显著,中风患者在恢复期时CSS可得到有效的提高,患者上肢的肌张力也可以有效的降低,能明显提高中风恢复期上肢痉挛患者的上肢功能,提高患者的ADL,综合疗效优于单纯现代康复治疗,是一种,值得临床上去推广,值得人们进一步深入研究的治疗效果明确的治疗方法。
[Abstract]:Objective to explore a more scientific diagnosis and treatment scheme for stroke, this subject uses acupuncture combined with modern rehabilitation to treat the upper limb spasticity in the recovery period of apoplexy. The study has been studied from many aspects and different angles to observe its clinical therapeutic effect, and to explore and analyze the basic principle of the treatment scheme, and to study the treatment scheme for the future. Methods 60 patients were selected from January 2015 to December 2016 in the rehabilitation medical department of Huangshi Central Hospital. The methods were divided into two groups. The modern rehabilitation group was treated with acupuncture (including body acupuncture and head needle) combined with modern rehabilitation therapy (including muscle drafting and operation therapy). In the modern rehabilitation group, the modern rehabilitation group was treated with simple modern rehabilitation (including muscle drafting, occupational therapy, and electronic biofeedback therapy) in 30 cases. In the treatment of acupuncture, the operation technique and the prescription of the selection were consistent in the whole course of treatment, and the time of treatment was 8 weeks. All the patients who participated in the experiment were treated in the course of treatment. Prescription treatment is not acceptable to any other form of treatment except for the treatment prescription. Observation start, observation at the mid-term and the end of observation, evaluate the clinical efficacy, and observe the clinical nerve function defect (CSS) score to evaluate the patient's neurological condition; observe the improved Ashworth muscle tension assessment to determine the upper limb muscles. The degree of spasm; the results were observed by the Fugl-Meyer (FMA) assessment scale to indicate the functional status of the upper limbs of the patients; to evaluate the pasteurized index (BI) and to determine the patient's daily living ability (ADL); and a comprehensive comparison and analysis of the two groups, and to analyze the clinical efficacy of this observation. Results the results of 1.CSS were compared: two groups. The CSS of the patient was improved after the corresponding treatment. Statistical analysis showed that the difference was significant (P0.O5). It indicated that the two groups were obviously improved the physical signs and clinical symptoms. It can be seen from the analysis that the therapeutic effect of the modern rehabilitation group was more prominent than that of the modern rehabilitation group, which was better than the classification of the Ashworth muscle tone improved by the modern rehabilitation group.2.. Ratio: after the two groups of patients, the muscle tension of the upper extremities decreased and the muscle tension of the modern rehabilitation group was compared with those of the modern rehabilitation group (P0.01), and the difference was also significant (P0.05) in the modern convalescence group before and after the muscle tension. The muscle tension of the two groups was compared. The difference showed significant significance (P0.01). The data showed that the acupuncture modern rehabilitation group could obviously reduce the flexor muscle tension of the upper limb in the stroke recovery period, and the effect was better than the modern rehabilitation group.3.Fugl-Meyer (FMA) score comparison: after the treatment, the function of the upper limbs increased and the FMA score of the modern rehabilitation group was compared before and after the score of the two groups. The difference has a very obvious contrast significance (P0.01); compared with the FMA score of the modern rehabilitation group, the difference has obvious contrast significance (P0.05). The difference between the two groups of patients after the diagnosis and treatment of FMA is very significant (P0.01). Therefore, the therapeutic effect of the acupuncture modern rehabilitation group is better than the modern rehabilitation group, and the modern rehabilitation group is needled. The BI of the functional.4. two groups of the upper limb of the patients with apoplexy can be significantly improved. After the diagnosis and treatment, the ADL of the two groups of patients showed a trend of better, compared with the BI in the modern rehabilitation group before and after the acupuncture, indicating that the difference had a significant contrast significance (P0.01), and the difference of BI in the modern rehabilitation group had a significant contrast significance (P0.05). The difference of BI score comparison between the two groups was very significant (P0.01). It showed that the acupuncture modern rehabilitation group could greatly improve the daily living ability of the patients in the recovery period of apoplexy. The treatment effect was better than that of the modern rehabilitation group.5. clinical treatment effect: 30 cases of the acupuncture at the present rehabilitation group, of which 4 cases were cured and 18 were markedly effective. 5 cases were improved, 3 cases were invalid, the total effective rate was 90%, and the number of cases observed in the modern rehabilitation group was 30 cases, of which 0 cases were basically healed, 8 were developed, 10 were improved, and 12 were ineffective. The total effective rate was 60%., the total efficiency of the two group was relative, and the difference was significant (P0.O5). We can see that acupuncture is modern. The curative effect of the rehabilitation group is better than that of the modern rehabilitation group. Conclusion the results of clinical observation indicate that the effect of acupuncture combined with the modern rehabilitation treatment for the upper limb spasticity in the recovery period of the stroke is remarkable. The CSS can be effectively improved during the recovery period, the muscle tension of the upper limb can also be effectively reduced, and it can obviously improve the recovery period of the stroke. The upper limb function of the patients with limb spasm, improving the patient's ADL, is better than the simple modern rehabilitation therapy. It is one kind, worthy of clinical promotion and worthy of further study.
【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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