目的:探究急性脑出血患者采用多效经穴激活治疗仪联合针刺疗法对偏瘫肢体运动功能恢复的临床疗效。方法:回顾性分析本院收入病房的108例脑出血偏瘫患者,根据患者治疗方法不同分为A组33例,B组37例,C组38例。A组接受常规康复科治疗,B组在A组基础上接受多效经穴激活治疗仪治疗,C组在A组的基础上接受针刺治疗联合多效经穴激活治疗仪。评估患者治疗前、治疗一月后肢体运动功能,评定方法参照简式Fugl-Meyer运动功能评分(FMA)、日常生活活动能力(Barthel index, BI)、Holden步行功能以评定治疗结果。结果:治疗一月后三组患者患侧肢运动功能评分FMA、BI、Holden步行能力均较治疗前明显提高(P < 0.05),C组与A组B组FMA、BI、Holden步行能力治疗效果比较均有统计学意义(P < 0.05)。结论:多效经穴激活治疗仪联合针刺疗法可有效改善脑出血患者偏瘫侧肢体运动功能。 Objective: To explore the clinical effect of multi-effect meridian point activation therapy combined with acupuncture therapy on the recovery of hemiplegic limb motor function in patients with acute cerebral hemorrhage. Methods: 108 patients with cerebral hemorrhage and hemiplegia in inwards of our hospital were retrospectively analyzed and divided into Group A (33 cases), Group B (37 cases) and Group C (38 cases) according to different treatment methods. Group A received conventional rehabilitation treatment, Group B received multi-effect meridian acupoint activation therapy on the basis of Group A, and Group C received acupuncture treatment combined with multi-effect meridian acupoint activation therapy on the basis of Group A. The patients’ motor function was evaluated before and after treatment for one month. The results were evaluated by referring to the simple Fugl-Meyer motor function score (FMA), Barthel Index (BI) and Holden walking function. Results: After 1 month of treatment, FMA, BI and Holden walking ability of the affected limb in the three groups were significantly improved compared with those before treatment (P < 0.05), and there were statistically significant differences in FMA, BI and Holden walking ability between Group C and Group A and Group B (P < 0.05). Conclusion: Multi-effect meridian acupoint activating instrument combined with acupuncture therapy can effectively improve the limb motor function of hemiplegic patients with cerebral hemorrhage.
目的:探究急性脑出血患者采用多效经穴激活治疗仪联合针刺疗法对偏瘫肢体运动功能恢复的临床疗效。方法:回顾性分析本院收入病房的108例脑出血偏瘫患者,根据患者治疗方法不同分为A组33例,B组37例,C组38例。A组接受常规康复科治疗,B组在A组基础上接受多效经穴激活治疗仪治疗,C组在A组的基础上接受针刺治疗联合多效经穴激活治疗仪。评估患者治疗前、治疗一月后肢体运动功能,评定方法参照简式Fugl-Meyer运动功能评分(FMA)、日常生活活动能力(Barthel index, BI)、Holden步行功能以评定治疗结果。结果:治疗一月后三组患者患侧肢运动功能评分FMA、BI、Holden步行能力均较治疗前明显提高(P < 0.05),C组与A组B组FMA、BI、Holden步行能力治疗效果比较均有统计学意义(P < 0.05)。结论:多效经穴激活治疗仪联合针刺疗法可有效改善脑出血患者偏瘫侧肢体运动功能。
脑出血,偏瘫,针刺疗法,多效经穴激活治疗仪
Yue Hu1*, Xinting Wang1, Chongtian Zhu2#
1The 11th Clinical Medical College of Qingdao University, Qingdao Shandong
2Linyi People’s Hospital, Linyi Shandong
Received: Oct. 5th, 2021; accepted: Nov. 3rd, 2021; published: Nov. 10th, 2021
Objective: To explore the clinical effect of multi-effect meridian point activation therapy combined with acupuncture therapy on the recovery of hemiplegic limb motor function in patients with acute cerebral hemorrhage. Methods: 108 patients with cerebral hemorrhage and hemiplegia in inwards of our hospital were retrospectively analyzed and divided into Group A (33 cases), Group B (37 cases) and Group C (38 cases) according to different treatment methods. Group A received conventional rehabilitation treatment, Group B received multi-effect meridian acupoint activation therapy on the basis of Group A, and Group C received acupuncture treatment combined with multi-effect meridian acupoint activation therapy on the basis of Group A. The patients’ motor function was evaluated before and after treatment for one month. The results were evaluated by referring to the simple Fugl-Meyer motor function score (FMA), Barthel Index (BI) and Holden walking function. Results: After 1 month of treatment, FMA, BI and Holden walking ability of the affected limb in the three groups were significantly improved compared with those before treatment (P < 0.05), and there were statistically significant differences in FMA, BI and Holden walking ability between Group C and Group A and Group B (P < 0.05). Conclusion: Multi-effect meridian acupoint activating instrument combined with acupuncture therapy can effectively improve the limb motor function of hemiplegic patients with cerebral hemorrhage.
Keywords:Cerebral Hemorrhage, Hemiplegia, Acupuncture, Multi-Effect Meridian Acupoint Activation Therapeutic Instrument
Copyright © 2021 by author(s) and Hans Publishers Inc.
This work is licensed under the Creative Commons Attribution International License (CC BY 4.0).
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脑出血是指排除外伤性原因而引起的脑实质出血,占脑卒中患者的15%~20%,发病率约为(12~15)/10万人年 [
选取2019年9月至2020年11月期间我院康复科收治的脑出血患者,单侧上下肢功能障碍的患者108例,根据患者治疗方式分为A组、B组和C组三组。三组患者一般资料(性别、年龄、病程、偏瘫部位等)比较,差异无统计学意义(P > 0.05),见表1。
组别 | 例数 | 性别(男/女) | 年龄(岁, x ¯ ± S ) | 病程(天, x ¯ ± S ) | 患侧(左侧/右侧) |
---|---|---|---|---|---|
A组 | 33 | 21/12 | 55.00 ± 11.35 | 14.33 ± 6.37 | 16/17 |
B组 | 37 | 18/19 | 56.19 ± 11.70 | 14.16 ± 5.18 | 15/22 |
C组 | 38 | 21/17 | 55.92 ± 10.85 | 12.76 ± 5.22 | 19/19 |
χ2/t | 0.616 | 0.105 | 0.29 | 0.766 | |
P值 | 0.735 | 0.901 | 0.42 | 0.682 |
表1. 两组患者的一般资料比较
① 经CT或MRI检查确诊符合脑卒中的诊断标准;
② 符合《中国各类主要脑血管病诊断要点2019》中脑卒中诊断 [
③ 生命体征平稳,意识清楚,可以配合检查和治疗;
④ 初次、单侧发病或虽既往有发作但未遗留有神经功能障碍;
⑤ 年龄 ≤ 70岁。
① 有癫痫发作病史、一级亲属中有特发性癫痫病史及使用致痫药物;
② 合并脑外伤、脑血管瘤等其他脑血管疾病;
③ 心、肺、肝、肾等重要脏器功能减退或衰竭;
④ 认知功能障碍或交流障碍,不能配合治疗;
⑤ 主要运动皮质区的直接损伤。
三组患者均接受神经内科的常规治疗,如改善颅脑微循环、控制血压、脱水降颅压、营养脑血管神经等 [
根据患者偏瘫程度,由康复医师及康复治疗师系统评估制定针对性康复训练方案,训练目标包括预防脑出血后可能形成对的各种并发症 [
B组在A组的基础上辅以多效经穴激活治疗仪(河南易奇生物科技有限公司,型号YQ-D505),治疗波为正向单向脉冲矩形波,脉冲频率400 Hz,脉冲宽度140 μs。患者取平卧位或侧卧位,酒精消毒皮肤后将成组治疗电极片贴于患者上下肢穴位处,上肢贴4组,第一组贴于肩髃、肩髎,第二组贴于曲池、手三里,第三组贴于内关、外关,第四组贴于合谷、劳宫。下肢贴5组,第一组贴于秩边、环跳,第二组贴于承扶、殷门,第三组贴于足三里、阴陵泉,第四组贴于绝骨、三阴交,第五组贴于涌泉、太冲。开始时用低强度电流,随着患者耐受程度提高逐渐调大电流至患者最大耐受强度。每周治疗5次,每次治疗30分钟。
在B组的基础上,C组患者辅以针灸疗法。患者取平卧位或侧卧位,选用一次性针灸针(头体针:规格0.30 mm × 40 mm腰臀针:0.3 mm × 80 mm):
醒脑开窍双侧取穴:人中、下极泉、尺泽、内关、委中、三阴交、太溪。活血通经患侧取穴:风池、肩髃、肩髎、臂臑、曲池、手三里、四读、合谷、后溪、环跳、丰市、足三里、阳陵泉、绝骨、昆仑、解溪。口眼歪斜取穴:下关、颊车透地仓,太阳。言语不清取穴:承浆、廉泉、天突、通里、哑门。认知障碍与头痛头晕双侧取穴:百合、太阳、太冲、合谷。根据患者病情酌情取穴,每周针灸5次,每次留针30 min。
治疗前、治疗后一个月对三组患者偏瘫侧肢体进行功能评定。主要的评定指标为:① 简式Fugl-Meyer运动功能评分(FMA) [
采用SPSS21.0软件,计量资料采用( x ¯ ± S )表示、组内比较采用两配对样本t检验,组间比较采用单因素方差分析,等级资料采用秩和检验,P < 0.05为差异具有统计学意义。
治疗前,三组患者上下肢FMA评分组间差异均无统计学意义(P > 0.05)。治疗4周后,三组患肢FMA评分均较组内治疗前显著提高(P < 0.05),组间差异有统计学意义(P < 0.05),见表2。
组别 | 治疗前 | 治疗一月 | P |
---|---|---|---|
A组 | 40.64 ± 6.53 | 54.30 ± 6.00a | <0.05 |
B组 | 39.32 ± 6.94 | 61.11 ± 8.22ab | <0.05 |
C组 | 39.89 ± 5.70 | 66.71 ± 8.63abc | <0.05 |
F | 0.367 | 22.53 | |
P | P > 0.05 | P < 0.05 |
表2. 两组患者治疗前与治疗后的FMA评分比较
注:与治疗前相比Pa < 0.05;与A组相比,Pb < 0.05;与AB组相比,Pc < 0.05。
治疗前,三组患者Holden步行能力分级评分组间差异均无统计学意义(P > 0.05)。治疗4周后,三组患者Holden步行能力分级评分均较组内治疗前显著提高(P < 0.05),组间差异有统计学意义(P < 0.05),见表3。
组别 | 治疗前 | 治疗一月 | P |
---|---|---|---|
A组 | 0.00 (0.00~3.00) | 2.00 (0.00~3.00)a | <0.05 |
B组 | 0.00 (0.00~3.00) | 2.00 (0.00~4.00)ab | <0.05 |
C组 | 0.00 (0.00~3.00) | 2.00 (0.00~4.00)abc | <0.05 |
Z | 1.328 | 7.589 | |
P | 0.515 | 0.022 |
表3. 两组患者治疗前与治疗后的Holden步行能力分级评分比较
注:与治疗前相比Pa < 0.05;与A组相比,Pb < 0.05;与AB组相比,Pc < 0.05。
治疗前,三组患者BI指数评分组间差异均无统计学意义(P > 0.05)。治疗4周后,三组患者BI指数评分均较组内治疗前显著提高(P < 0.05),组间差异有统计学意义(P < 0.05),见表4。
组别 | 治疗前 | 治疗一月 | P |
---|---|---|---|
A组 | 45.03 ± 8.53 | 56.06 ± 7.37a | <0.05 |
B组 | 45.27 ± 7.91 | 62.84 ± 10.11ab | <0.05 |
C组 | 46.05 ± 9.46 | 72.11 ± 9.84abc | <0.05 |
F | 0.59 | 3.16 | |
P | 0.55 | 0.047 |
表4. 两组患者治疗前与治疗后的BI指数评分比较
注:与治疗前相比Pa < 0.05;与A组相比,Pb < 0.05;与AB组相比,Pc < 0.05。
脑出血偏瘫患者的肢体功能恢复一直是康复科讨论的热点话题。患者瘫痪后严重影响运动功能,长期卧床患者易发生肺炎褥疮等并发症,生活不能自理,对他人严重依赖,也对患者的心理产生极大的冲击。研究表明,大脑的皮质代表区可因日常活动而发生改变,当神经系统因环境变化而发生适应性变化被称为大脑的可塑性,这是脑卒中患者康复的基础 [
多效经穴激活治疗仪是将传统神经肌肉电刺激与中医经络学相结合的一种新型治疗方式,其操作简单,安全有效,近年来被广泛应用于脑卒中患者的康复治疗,特别适用于对针刺疗法恐惧的患者。临床多选用低频脉冲电刺激,但该方法不能模拟针灸对穴位的刺激,产生推拿按摩等功效,易产生不适感。本研究上肢肩髃、曲池、手三里、合谷取穴手阳明大肠经,外关取穴手少阳三焦经为八脉交会穴,下肢足三里取足阳明胃经,阴陵泉、三阴交取穴足太阴脾经,调节体内经气,是中医治疗痿痹不遂的常用穴位 [
本研究表明,治疗一月后三组患者FMA、BI、Holden步行能力均较治疗前明显改善,差异具有统计学意义,与本组治疗前相比,三组患者FMA、BI、Holden步行能力均明显提高,且C组提高水平较A组、B组更显著,这表明常规康复训练、多效经穴激活治疗仪、与针刺治疗均能促进患者肢体运动功能的恢复,但常规康复治疗联合多效经穴激活治疗仪与针刺治疗则更能进一步改善患者肢体功能,提高患者日常生活自理能力,有助于提高患者生活质量,早日回归社区家庭。
虽然针刺疗法对脑出血患者的偏瘫功能恢复已有广泛文献报道,但针刺与多效经穴激活治疗仪联合治疗的文章却不多见。本研究表明,C组与A组B组FMA、BI、Holden步行能力治疗效果比较均有统计学意义(P < 0.05),证明将针刺疗法与多效经穴激活治疗仪结合,可有效促进脑卒中患者偏瘫侧肢体功能的改善,是一种行之有效的治疗方式,值得临床推广。
山东省中医药科技发展计划项目(2019-0862)。
胡 月,王信亭,朱崇田. 多效经穴激活治疗仪联合针刺疗法对脑出血患者偏瘫肢体运动功能的影响Effect of Multi-Effect Acupoint Activating Instrument Combined with Acupuncture Therapy on Motor Function of Hemiplegic Limbs in Patients with Cerebral Hemorrhage[J]. 临床医学进展, 2021, 11(11): 4964-4970. https://doi.org/10.12677/ACM.2021.1111729