调督针法对脑梗死运动功能障碍患者下肢肌张力的影响

Effects of Tiaodu Acupuncture on Muscle Tension of Lower Extremities in Patients with Motor Dysfunction after Cerebral Infarction

目的:观察调督针法与传统针法对脑梗死后运动功能障碍患者下肢肌张力的疗效。方法:70例脑梗死患者随机分为两组,每组35例,调督组采用调督针法结合康复训练,对照组采用传统针刺结合康复训练。均每日治疗1次,每周治疗5次,疗程4周。两组分别在治疗前、治疗2周后、治疗4周后采用修订的Ashworth痉挛评定量表、临床痉挛指数(CSI)进行痉挛程度评定,治疗前及治疗4周后采用Fugl-Meyer评分法(FMA)及改良的Barthel指数(MBI)进行运动功能评定。结果:(1)FMA评分和MBI评分:治疗4周后,两组FMA评分和MBI评分较治疗前均有显著提高(P<0.01),调督组两种评分均高于对照组(P<0.05)。(2)CSI评分:治疗2周及4周后,两组CSI评分均较治疗前显著增高(P<0.01),治疗4周后较治疗2周后均又下降(P<0.01)。治疗2周后两组CSI评分比较,差异无统计学意义(P>0.05),治疗4周后调督组CSI评分低于对照组(P<0.05)。(3)修订的Ashworth评分:治疗2周后两组处于痉挛期(≥Ⅰ级)的患者比例均明显高于治疗前,处于软瘫期(肌张力0级)的患者比例明显低于治疗前(P<0.01)。治疗4周后较之2周时两组处于痉挛期(≥Ⅰ级)的患者比例又逐步下降,肌张力0级患者比例又有所增多(P<0.01);组间比较,治疗2周后两组肌张力分布差异无统计学意义(P>0.05),治疗4周后调督组肌张力0级的患者比例高于对照组,处于痉挛期(≥Ⅰ级)的患者比例明显低于对照组(P<0.05)。结论:调督针法对脑梗死后运动功能障碍患者下肢肌张力及运动功能的改善明显优于传统针刺。

Objective： To compare therapeutic effects of Tiaodu acupuncture and traditional acupuncture on muscle tension of lower extremities in patients with motor dysfunction after cerebral infarction. Methods： A total of 70 patients with cerebral infarction were randomly divided into two groups, 35 patients in each group. The Tiaodu group received Tiaodu acupuncture combined with rehabilitation training, and the control group received traditional acupuncture combined with rehabilitation training, once daily, five times per week for four weeks. The Ashworth was evaluated by modified Ashworth Spasticity Scale （ASS） and Clinic Spasticity Index （CSI） before the treatment and two and four weeks after treatment in two groups. The motor function was evaluated by Fugl- Meyer Assessment Scale （FMA） and modified Barthel Index （MBI） before treatment and 4 weeks after treatment in two groups. Results： The scores of FMA and MBI were obviously increased in two groups four weeks after treatment （P〈0.01）, and Tiaodu group showed higher FMA and MBI scores than the control groups （P〈0.05）. TheCSI were obviously increased in two groups two and four weeks ＇after treatment （P〈0.01）, while the scores were decreased in two groups four weeks ＇after treatment （P〈O.01）. There were no statistical differences on CSI between two groups two weeks ＇after treatment （P〉0.05）, and the Tiaodu group showed lower CSI scores than the control group four weeks after treatment （P〈0.05）. The proportion of convulsion stage ≥grade I ） was obviously increased in two groups two weeks after treatment, and the proportion of flaccid paralysis period （level 0 of muscle ten- sion） was obviously decreased （P〈0.01）. The proportion of convulsion stage （≥grade I ） was decreased gradually four weeks after treatment, and the proportion of flaccid paralysis period was increased （P〈0.01）. There was no statistical difference on muscular tension between two groups two weeks after treatment （P〉0.05）. The Tiaodu group showed higher proportion of level 0 muscle tension than control group four weeks after treatment, and Tiaodu group showed less the proportion of convulsion stage （≥grade I） than the control group （P〈0.05）. Con- clusion： Tiaodu acupuncture shows better effects on the improvements of muscle tension of lower extremities and motor function than traditional acupuncture in patients with motor dysfunction after cerebral infarction.