巨刺配合常规针刺治疗脑梗塞后痉挛性偏瘫疗效观察
发布时间：2019-06-13 19:11
【摘要】：研究目的：通过在观察巨刺配合常规针刺与单纯常规针刺治疗脑梗塞后痉挛性偏瘫疗效,探讨巨刺法疗效的产生机制,为临床治疗脑梗塞后痉挛性偏瘫针刺方法的选择提供参考。研究方法：将符合纳入标准的60例脑梗塞后痉挛性偏瘫患者随机分为两组,具体研究方法为：1、治疗组在康复治疗基础上采用巨刺法配合常规针刺治疗,患侧按常规操作取提插泻法,健侧按常规操作取提插补法,治疗时先针健侧,后针患侧,每穴操作约30s,留针30min,每日治疗1次,每周5次,两周为1个疗程。2、康复训练按照《中国脑卒中康复治疗指南(2011完全版)》对患者进行运动功能评估并制定相应的康复方案,每日治疗1次,每周5次,两周为1个疗程。3、对照组在康复治疗基础上采用单纯常规针刺治疗,针刺方法与治疗组患侧主穴、配穴的取穴和操作方法相同,康复训练内容同治疗组。4、治疗前进行基线和各观察指标的比较,治疗中注意观察安全性,经过两周治疗后以简化Fugl-Meyer评分评定患侧运动功能恢复情况,改良Barthel指数(MBI)量表评定患者日常生活能力改善情况,临床神经功能缺损程度评分评定患者神经功能恢复情况,中风病疗效评定标准评定临床症状改善情况。研究结果：1、基线及安全性评价：本研究纳入60例合格受试对象均顺利完成研究,未发生脱落及剔除,无针刺不良反应发生。两组病例在性别、年龄、病程、肌张力分级等方面基线可比,治疗前组间比较简化Fugl-Meyer运动功能评分、改良Barthel指数(MBI)评定量表、脑卒中患者临床神经功能缺损程度评分差异均无统计学意义。2、简化Fugl-Meyer评分比较：治疗前后治疗组评分分别为35.48±20.95、42.03±23.43；治疗前后对照组评分分别为35.19±24.86、42.58±26.06；治疗后组间比较差异无统计学意义(P0.05),但治疗组和对照组治疗后评分均较治疗前明显提高(P0.05)。3、改良Barthel指数(MBI)量表比较：治疗前后治疗组评分分别为29.59±26.42、40.34±32.63；治疗前后对照组评分分别为33.84±32.72、41.03±33.84；治疗后组间比较差异无统计学意义(P0.05),但治疗组和对照组治疗后评分均较治疗前明显提高(P0.05)。4、临床神经功能缺损程度评分比较：治疗前后治疗组评分分别为19.21±8.30、16.07±8.87；治疗前后对照组评分分别为18.84±9.57、15.77±9.46；治疗后组间比较差异无统计学意义(P0.05),但治疗组和对照组治疗后评分均较治疗前明显提高(P0.05)。5、中风病临床疗效评定标准比较：治疗前后治疗组评分分别为18.76±8.74、15.31±9.34；治疗前后对照组评分分别为18.13±9.30、15.23±9.49；治疗后组间比较差异无统计学意义(P0.05),但治疗组和对照组治疗后评分均较治疗前明显提高(P0.05),治疗组有效率65.52%；对照组有效率61.29%,两组有效率比较差异无统计学意义(P0.05)。研究结论：在康复训练基础上的巨刺配合常规针刺与单纯常规针刺在改善脑梗塞后痉挛性偏瘫患者肢体运动功能、日常生活能力、神经功能缺损程度和中风病临床症状方面差异无显著性,但巨刺法用于脑梗塞后痉挛性偏瘫已有中医学和现代医学理论及实践的支撑,本研究也暴露出病例数少、观察时间短、指标不够客观等不足,因此,本研究认为脑梗塞后痉挛性偏瘫可以采用“补健侧、泻患侧”的方法,应该完善进一步研究。
[Abstract]:Objective: To explore the mechanism of the treatment of spastic hemiplegia after the treatment of cerebral infarction with the conventional acupuncture combined with conventional acupuncture and conventional acupuncture, and to provide a reference for the selection of the method for the treatment of spastic hemiplegia after cerebral infarction. Methods:60 patients with spastic hemiplegia after cerebral infarction were randomly divided into two groups. The health-care side is used for extracting and inserting by the conventional operation, the needle-forming side and the back-needle affected side are arranged at the time of treatment, the operation for each point is about 30s, the needle is left for 30 minutes, once a day,5 times a week, and the two-week period is 1 treatment course. The rehabilitation training is carried out according to the guidelines for rehabilitation of stroke in China (2011 complete edition)> to evaluate the exercise function of the patient and to develop the corresponding rehabilitation program, once a day,5 times a week and 1 course of treatment for two weeks.3. The control group is treated with simple conventional acupuncture on the basis of rehabilitation therapy. the acupuncture method is the same as that of the main point in the affected side of the treatment group, the points of the acupuncture point and the operation method, the rehabilitation training content is the same as the treatment group,4, the baseline and the observation indexes are compared before the treatment, and the safety is observed in the treatment, After two weeks of treatment, the functional recovery of the affected side was assessed by the simplified Fugl-Meyer score, the improvement of the daily life of the patient was assessed by the modified Barthel index (MBI) scale, and the neurological function recovery of the patient was assessed according to the clinical neurological deficit score. To assess the improvement of the clinical symptoms in the evaluation of the curative effect of apoplexy. The results of the study:1. Baseline and safety evaluation: The study included 60 eligible subjects successfully completed the study, no drop-off and elimination, no needle-punched side effects occurred. There was no statistical significance between the two groups in terms of sex, age, course of disease, and grading of muscle tone, and the scores of the Fugl-Meyer exercise function and the improved Barthel index (MBI) scale were compared between the two groups. The scores of the treatment group before and after treatment were 35.48, 20.95, 42.03 and 23.43, respectively. The scores of the control group and the control group were 35.19, 24.86, 42.58 and 26.06, respectively. The scores of the modified Barthel index (MBI) were 29.59, 26.42, 40.34 and 32.63, respectively. The scores of the control group and the control group were 33.84, 32.72, 41.03 and 33.84, respectively. In the treatment group and the control group, the scores of the treatment group and the control group were significantly improved (P0.05).4. The score of clinical nerve function defect was compared with that of the treatment group before and after treatment: 19.21, 8.30, 16.07 and 8.87, respectively. The scores of the control group before and after treatment were 18.84, 9.57, 15.77 and 9.46, respectively. There was no significant difference between the treatment group and the control group (P0.05). However, the post-treatment scores of the treatment group and the control group were significantly improved (P0.05). The standard of the clinical curative effect of the apoplexy was compared with that of the treatment group before and after treatment: 18.76-8.74, 15.31-9.34, respectively. The scores of the control group and the control group were 18.13, 9.30, 15.23 and 9.49, respectively. There was no significant difference between the treatment group and the control group (P0.05). The effective rate of the treatment group was 65.52%, and the effective rate of the control group was 61.29%. There was no significant difference between the two groups (P0.05). The results of the study showed that the conventional acupuncture combined with conventional acupuncture and conventional acupuncture on the basis of rehabilitation training had no significant difference in the function of limb movement, the ability of daily life, the degree of neurological function and the clinical symptoms of stroke in the patients with spastic hemiplegia after cerebral infarction. But the giant needling method is used in the treatment of spastic hemiplegia after cerebral infarction, and the support of the theory and practice of modern medicine. The study also shows that the number of cases is small, the observation time is short, and the index is not objective and so on. Therefore, the present study is of the opinion that after the cerebral infarction, the spastic hemiplegia can adopt the "Complementing the side and the affected side" method, Further research should be done.
【学位授予单位】：广州中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R246.6
[Abstract]:Objective: To explore the mechanism of the treatment of spastic hemiplegia after the treatment of cerebral infarction with the conventional acupuncture combined with conventional acupuncture and conventional acupuncture, and to provide a reference for the selection of the method for the treatment of spastic hemiplegia after cerebral infarction. Methods:60 patients with spastic hemiplegia after cerebral infarction were randomly divided into two groups. The health-care side is used for extracting and inserting by the conventional operation, the needle-forming side and the back-needle affected side are arranged at the time of treatment, the operation for each point is about 30s, the needle is left for 30 minutes, once a day,5 times a week, and the two-week period is 1 treatment course. The rehabilitation training is carried out according to the guidelines for rehabilitation of stroke in China (2011 complete edition)> to evaluate the exercise function of the patient and to develop the corresponding rehabilitation program, once a day,5 times a week and 1 course of treatment for two weeks.3. The control group is treated with simple conventional acupuncture on the basis of rehabilitation therapy. the acupuncture method is the same as that of the main point in the affected side of the treatment group, the points of the acupuncture point and the operation method, the rehabilitation training content is the same as the treatment group,4, the baseline and the observation indexes are compared before the treatment, and the safety is observed in the treatment, After two weeks of treatment, the functional recovery of the affected side was assessed by the simplified Fugl-Meyer score, the improvement of the daily life of the patient was assessed by the modified Barthel index (MBI) scale, and the neurological function recovery of the patient was assessed according to the clinical neurological deficit score. To assess the improvement of the clinical symptoms in the evaluation of the curative effect of apoplexy. The results of the study:1. Baseline and safety evaluation: The study included 60 eligible subjects successfully completed the study, no drop-off and elimination, no needle-punched side effects occurred. There was no statistical significance between the two groups in terms of sex, age, course of disease, and grading of muscle tone, and the scores of the Fugl-Meyer exercise function and the improved Barthel index (MBI) scale were compared between the two groups. The scores of the treatment group before and after treatment were 35.48, 20.95, 42.03 and 23.43, respectively. The scores of the control group and the control group were 35.19, 24.86, 42.58 and 26.06, respectively. The scores of the modified Barthel index (MBI) were 29.59, 26.42, 40.34 and 32.63, respectively. The scores of the control group and the control group were 33.84, 32.72, 41.03 and 33.84, respectively. In the treatment group and the control group, the scores of the treatment group and the control group were significantly improved (P0.05).4. The score of clinical nerve function defect was compared with that of the treatment group before and after treatment: 19.21, 8.30, 16.07 and 8.87, respectively. The scores of the control group before and after treatment were 18.84, 9.57, 15.77 and 9.46, respectively. There was no significant difference between the treatment group and the control group (P0.05). However, the post-treatment scores of the treatment group and the control group were significantly improved (P0.05). The standard of the clinical curative effect of the apoplexy was compared with that of the treatment group before and after treatment: 18.76-8.74, 15.31-9.34, respectively. The scores of the control group and the control group were 18.13, 9.30, 15.23 and 9.49, respectively. There was no significant difference between the treatment group and the control group (P0.05). The effective rate of the treatment group was 65.52%, and the effective rate of the control group was 61.29%. There was no significant difference between the two groups (P0.05). The results of the study showed that the conventional acupuncture combined with conventional acupuncture and conventional acupuncture on the basis of rehabilitation training had no significant difference in the function of limb movement, the ability of daily life, the degree of neurological function and the clinical symptoms of stroke in the patients with spastic hemiplegia after cerebral infarction. But the giant needling method is used in the treatment of spastic hemiplegia after cerebral infarction, and the support of the theory and practice of modern medicine. The study also shows that the number of cases is small, the observation time is short, and the index is not objective and so on. Therefore, the present study is of the opinion that after the cerebral infarction, the spastic hemiplegia can adopt the "Complementing the side and the affected side" method, Further research should be done.
【学位授予单位】：广州中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R246.6
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