头皮针徐疾补泻法结合康复训练对缺血性脑卒中恢复期患者神经功能缺损及临床结局影响的研究
发布时间：2018-12-15 03:19
【摘要】：目的：观察头皮针徐疾补泻法结合康复训练综合治疗方案对缺血性脑卒中恢复期患者神经功能缺损及临床结局的影响及安全性。方法：将符合纳入标准60例恢复期缺血性脑卒中患者,按简单随机法分为治疗组和对照组,每组各30例。两组均在西医常规内科治疗基础上进行研究,对照组运用单纯西医康复治疗,治疗组在对照组基础上加用头皮针治疗,共治疗6周。在治疗前及治疗第2周、4周、6周后通过美国国立卫生研究院神经功能缺损量表(NIHSS)、Fugl-Meyer运动评分量表(Fugl-Meyer assessmend scale, FMA)及基于中风病患者报告的临床结局评价量表(PRO)评价患者神经功能缺损程度及临床结局改善情况,治疗结束3个月后随访PRO评分以评价远期临床结局疗效。结果：治疗前：两组一般情况及以NIHSS评分、FMA评分及PRO评分相比较,差异无统计学意义(P0.05),说明基线状况良好,具有可比性。疗效结果：(1)上述三个量表评分组内比较：两组分别在治疗2周、4周、6周与治疗前一阶段(治疗2周较治疗前、治疗4周后较治疗2周、治疗6周较治疗4周)比较中差异有统计学意义(P0.05),提示两组评分结果较治疗前一阶段均有改善。(2)治疗结束后组间比较：两组患者治疗6周后与治疗前三个量表评分差值进行组间比较,差异均具有统计学意义(P0.05),提示治疗组在治疗前后NIHSS、FMA及PRO评分变化程度大于对照组。(3)治疗不同时点组间比较：治疗2周时两组NIHSS、FMA、PRO评分组间比较无显著差异(P0.05),2周治疗前后NIHSS、PRO评分的差值比较无统计学差异(P0.05)；但2周治疗前后FMA评分比较有统计学差异(P0.05),治疗组优于对照组；治疗4周及6周时,治疗组NIHSS、FMA及PRO评分优于对照组(P0.05)。(4)随访时PRO评分组内比较提示3个月后两组临床结局积分较前无明显差异(P0.05)。两组组间评分比较,治疗组评分明显优于对照组(P0.05)。综上提示两种治疗方案疗效相对稳定,均有着较好的远期临床疗效,治疗组的综合方案的远期疗效优势仍然显著。结论：恢复期缺血性脑卒中患者,在西医常规治疗上,加用头皮针徐疾补泻法结合康复综合治疗,对改善患者神经功能缺损及临床结局的趋势及程度优于单纯康复治疗组。头皮针徐疾补泻法结合康复综合治疗方案疗效确切、安全性可靠,在临床运用中实用性较高,依从性较好,值得社区广泛推广。
[Abstract]:Objective: to observe the effect and safety of scalp acupuncture and xuji tonifying and reducing therapy combined with rehabilitation training on neurological function defect and clinical outcome of patients with ischemic stroke in convalescent stage. Methods: 60 patients with convalescent ischemic stroke were randomly divided into treatment group (n = 30) and control group (n = 30). Both groups were studied on the basis of routine medical treatment of western medicine. The control group was treated with simple western medicine rehabilitation, the treatment group was treated with scalp acupuncture on the basis of control group, and the treatment group was treated for 6 weeks. Before and after 2 weeks, 4 weeks and 6 weeks of treatment, the National Institutes of Health (NIH) Neurologic impairment scale (Fugl-Meyer assessmend scale,) was adopted. FMA) and (PRO) were used to evaluate the degree of neurological deficit and the improvement of clinical outcome. PRO scores were followed up 3 months after treatment to evaluate the long-term clinical outcome. Results: before treatment, there was no significant difference between the two groups in general and in terms of NIHSS score, FMA score and PRO score (P0.05), indicating that the baseline condition was good and comparable. Results: (1) Intra-group comparison of the above three scales: the two groups were treated for 2 weeks, 4 weeks, 6 weeks and the first stage before treatment (2 weeks compared with before treatment, 4 weeks after treatment and 2 weeks after treatment, respectively). There was significant difference between 6 weeks of treatment and 4 weeks of treatment (P0.05). The results indicated that the scores of the two groups were improved compared with those before treatment. (2) comparison between the two groups after the end of treatment: the difference between the two groups after 6 weeks of treatment and the three scales before treatment was statistically significant (P0.05). It was suggested that the changes of NIHSS,FMA and PRO scores in the treatment group were greater than those in the control group before and after treatment. (3) there was no significant difference in the NIHSS,FMA,PRO score between the two groups at 2 weeks after treatment (P0.05). The difference of NIHSS,PRO score before and after 2 weeks treatment had no statistical difference (P0.05). But before and after 2 weeks of treatment, FMA scores were significantly different (P0.05), the treatment group was better than the control group; At 4 and 6 weeks of treatment, the scores of NIHSS,FMA and PRO in the treatment group were better than those in the control group (P0.05). (4). The results showed that there was no significant difference in the scores of clinical outcome between the two groups after 3 months (P0.05). The scores of the treatment group were significantly better than that of the control group (P0.05). The results indicated that the therapeutic effects of the two treatment schemes were relatively stable and had good long-term clinical effects. The advantages of the comprehensive regimen in the treatment group were still significant. Conclusion: in convalescent ischemic stroke patients, the combination of scalp acupuncture and xuji tonifying and reducing therapy combined with rehabilitation comprehensive treatment is better than the simple rehabilitation treatment group in improving the neurological function defect and clinical outcome of the patients. The combination of scalp acupuncture and xuji reinforcing and reducing method combined with rehabilitation comprehensive therapy is effective, safe and reliable, and has high practicability and good compliance in clinical application. It is worth popularizing widely in the community.
【学位授予单位】：成都中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R246.6
[Abstract]:Objective: to observe the effect and safety of scalp acupuncture and xuji tonifying and reducing therapy combined with rehabilitation training on neurological function defect and clinical outcome of patients with ischemic stroke in convalescent stage. Methods: 60 patients with convalescent ischemic stroke were randomly divided into treatment group (n = 30) and control group (n = 30). Both groups were studied on the basis of routine medical treatment of western medicine. The control group was treated with simple western medicine rehabilitation, the treatment group was treated with scalp acupuncture on the basis of control group, and the treatment group was treated for 6 weeks. Before and after 2 weeks, 4 weeks and 6 weeks of treatment, the National Institutes of Health (NIH) Neurologic impairment scale (Fugl-Meyer assessmend scale,) was adopted. FMA) and (PRO) were used to evaluate the degree of neurological deficit and the improvement of clinical outcome. PRO scores were followed up 3 months after treatment to evaluate the long-term clinical outcome. Results: before treatment, there was no significant difference between the two groups in general and in terms of NIHSS score, FMA score and PRO score (P0.05), indicating that the baseline condition was good and comparable. Results: (1) Intra-group comparison of the above three scales: the two groups were treated for 2 weeks, 4 weeks, 6 weeks and the first stage before treatment (2 weeks compared with before treatment, 4 weeks after treatment and 2 weeks after treatment, respectively). There was significant difference between 6 weeks of treatment and 4 weeks of treatment (P0.05). The results indicated that the scores of the two groups were improved compared with those before treatment. (2) comparison between the two groups after the end of treatment: the difference between the two groups after 6 weeks of treatment and the three scales before treatment was statistically significant (P0.05). It was suggested that the changes of NIHSS,FMA and PRO scores in the treatment group were greater than those in the control group before and after treatment. (3) there was no significant difference in the NIHSS,FMA,PRO score between the two groups at 2 weeks after treatment (P0.05). The difference of NIHSS,PRO score before and after 2 weeks treatment had no statistical difference (P0.05). But before and after 2 weeks of treatment, FMA scores were significantly different (P0.05), the treatment group was better than the control group; At 4 and 6 weeks of treatment, the scores of NIHSS,FMA and PRO in the treatment group were better than those in the control group (P0.05). (4). The results showed that there was no significant difference in the scores of clinical outcome between the two groups after 3 months (P0.05). The scores of the treatment group were significantly better than that of the control group (P0.05). The results indicated that the therapeutic effects of the two treatment schemes were relatively stable and had good long-term clinical effects. The advantages of the comprehensive regimen in the treatment group were still significant. Conclusion: in convalescent ischemic stroke patients, the combination of scalp acupuncture and xuji tonifying and reducing therapy combined with rehabilitation comprehensive treatment is better than the simple rehabilitation treatment group in improving the neurological function defect and clinical outcome of the patients. The combination of scalp acupuncture and xuji reinforcing and reducing method combined with rehabilitation comprehensive therapy is effective, safe and reliable, and has high practicability and good compliance in clinical application. It is worth popularizing widely in the community.
【学位授予单位】：成都中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R246.6
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