目的:探讨头针联合运动疗法治疗脑梗死偏瘫患者下肢运动功能障碍的临床疗效。方法:回顾性分析本院收治的脑梗死偏瘫患者60例。根据是否联合使用头针治疗将入选患者分成治疗组30例与对照组30例。所有患者均接受常规治疗,对照组患者接受运动疗法,治疗组先接受头针治疗,并携头针进行运动疗法训练。于治疗前和治疗4周、8周后采用简式Fugl-Meyer下肢运动功能评分(FMA-LE)和Holden步行功能、日常生活活动能力(Barthel index, BI)进行评定。结果:治疗4周、8周后两组患者FMA-LE评分、Holden步行能力评定及BI评分均较治疗前明显提高(P < 0.05);治疗4周后,两组患者上述指标的差异无统计学意义(P > 0.05);治疗8周后治疗组患者上述指标均显著优于对照组水平(P < 0.05)。结论:头针联合运动疗法可改善脑梗死患者下肢运动功能。
Objective: To investigate the clinical effect of scalp acupuncture and exercise therapy on lower limb motor function in patients with cerebral infraction. Methods: 60 patients recovering from cerebral infarction were retrospective analyzed. According to whether or not they were treated with scalp acupuncture, the patients were divided into treatment group (30 cases) and control group (30 cases). All patients received routine treatment. Patients in control group were only given exercise therapy in activities of the lower limb. Patients in treatment group were given scalp acupuncture and followed by exercise therapy with scalp acupuncture. They were assessed with Fugl-Meyer Assessments of lower extremity (FMA-LE) and Holden walking ability and Activity of daily living (Barthel index) before and at the 4 weeks and 8 weeks over the treatment. Results: FMA-LE, Holden walking ability and Barthel index were improved in all groups after the treatment (P < 0.05). At the 4 weeks of treatment, all indices were not statistically different among two groups (P > 0.05); At the 8 weeks of treatment, treatment group exhibited significantly higher scores for all indices compared with control group (P < 0.05). Conclusion: scalp acupuncture and exercise therapy can improve the lower limb motor function recovery of patients with cerebral infarction.
头针,运动治疗,脑梗死,运动功能, Scalp Acupuncture Exercise Therapy Cerebral Infarction Motor Function头针联合运动疗法对脑梗死偏瘫患者下肢运动功能恢复的效果分析
采用SPSS26.0软件分析数据。符合正态分布的计量资料用均数 ± 标准差( x ¯ ± s )表示;非正态分布资料采用四分位数法表示。组内治疗前后比较采用配对样本t检验或配对样本非参数检验(Wilcoxon Test);组间比较采用独立样本t检验或非参数检验(Mann-Whitney U Test);计数资料比较采用卡方检验。P < 0.05为差异具有统计学意义。
周 洲,刘慧子,张东宁,胡 月,王信亭,朱崇田. 头针联合运动疗法对脑梗死偏瘫患者下肢运动功能恢复的效果分析Effect of Scalp Acupuncture Combined with Exercise Therapy on Lower Limb Motor Function Recovery in Patients with Hemiplegia Caused by Cerebral Infraction[J]. 临床医学进展, 2020, 10(08): 1810-1816. https://doi.org/10.12677/ACM.2020.108272
参考文献ReferencesWang, W., Jiang, B., Sun, H., et al. (2017) Prevalence, Incidence, and Mortality of Stroke in China: Results from a Nationwide Population-Based Survey of 480687 Adults. Circulation, 135, 759-771.
<br>https://doi.org/10.1161/CIRCULATIONAHA.116.025250唐萍萍, 许骞, 陈栋, 等. 头针刺激层次影响大脑皮层功能的机制探讨[J]. 针刺研究, 2020, 45(6): 504-507.母晓明, 吕晓玲, 王晓琴, 等. 运动疗法在脑梗死患者中后期康复中的应用效果[J]. 中国医学物理学杂志, 2018, 35(6): 724-728.全国第四届脑血管病学术会议. 各类脑血管病诊断要点及脑卒中患者临床神经功能缺损程度评分标准(1995) [J]. 中华神经科杂志, 1996, 29(6): 379-383.陆寿康, 孔尧其. 实用头针大全[M]. 上海: 上海科学技术出版社, 1993.Gladstone, D.J., Danells, C.J. and Black, S.E. (2002) The Fugl-Meyer Assessment of Motor Recovery after Stroke: A Critical Review of Its Measurement Properties. Neurorehabilitation and Neural Repair, 16, 232-240.
<br>https://doi.org/10.1177/154596802401105171叶祥明. 康复医学科管理及诊疗规范[M]. 浙江: 浙江大学出版社, 2014.Taghizadeh, G., Martinez-Martin, P., Meimandi, M., et al. (2019) Barthel Index and Modified Rankin Scale: Psychometric Properties during Medication Phases in Idiopathic Parkinson Disease. Annals of Physical & Rehabilitation Medicine. <br>https://doi.org/10.1016/j.rehab.2019.08.006刘罡, 吴毅, 吴军发. 脑卒中后大脑可塑性的研究进展[J]. 中国康复医学杂志, 2008, 23(1): 87-90.Mello, E.A., Cohen, L.G., Monteiro Dos Anjos, S., et al. (2015) Increase in Short-Interval Intracortical Facilitation of the Motor Cortex after Low-Frequency Repetitive Magnetic Stimulation of the Unaffected Hemisphere in the Subacute Phase after Stroke. Neural Plasticity, 2015, Article ID: 407320.Trinh, T., Scheuer, S.E., Thompson-Butel, A.G., et al. (2016) Cardiovascular Fitness Is Improved Post-Stroke with Upper-Limb Wii-Based Movement Therapy But Not Dose-Matched Constraint Therapy. Topics in Stroke Rehabilitation, 23, 208-216. <br>https://doi.org/10.1080/10749357.2016.1138672Periard, J.D., Travers, G.J.S., Racinais, S., et al. (2016) Cardiovascular Adaptations Supporting Human Exercise-Heat Acclimation. Autonomic Neuroscience, 196, 52-62. <br>https://doi.org/10.1016/j.autneu.2016.02.002周士枋. 脑卒中后大脑可塑性研究及康复进展[J]. 中华物理医学与康复杂志, 2002, 24(7): 437-439.甄君, 林子玲, 孔梅, 等. 运动疗法对脑梗死患者血流变学和运动功能恢复的影响[J]. 中国实用神经疾病杂志, 2011, 14(16): 18-19.王占想, 林艳, 毕俊忠, 等. 运动疗法对急性脑梗死远期功能预后的影响[J]. 山西医药杂志, 2016, 9(45): 999-1002.Wu, B. (2014) Acupuncture plus Chinese Medicinal Fumigation and Washing for Edema of the Stroke-Affected Limb. Journal of Acupuncture and Tuina Science, 12, 278-281.王琼, 邢海娇, 鲍娜, 等. 基于数据挖掘的头针疗法临床应用特点研究[J]. 针刺研究, 2018, 43(3): 199-203.刘建峰, 樊晓红, 焦黎明. 头针联合疏血通注射液治疗急性脑梗死疗效观察[J]. 山西医药杂志, 2017, 46(19): 2366-2368.张丽华, 张姝, 张爱玲, 等. 头针与康复训练同步治疗对脑梗死急性期患者上肢肌张力的影响[J]. 辽宁中医杂志, 2014, 41(12): 2676-2678.胡晓丽, 李元婧. 头针治疗脑梗死临床研究进展[J]. 辽宁中医药大学学报, 2018, 20(8): 145-148.代杰, 项容, 陈勇, 等. 头针结合康复治疗急性脑梗死的最佳时间窗研究[J]. 现代中西医结合杂志, 2014, 23(13): 1381-1383.包永珍, 曾明, 吴华, 等. 高压氧联合上肢康复机器人训练对脑卒中偏瘫上肢运动功能的影响[J]. 中华物理医学与康复杂志, 2015, 37(1): 35-37.张丽华, 王艳君, 张姝, 等. 双侧头针与康复训练同步治疗对脑梗死急性期患者运动功能的影响[J]. 四川中医, 2014, 32(9): 152-154.