针灸联合穴位贴敷治疗中风后遗症偏瘫的临床疗效研究

Clinical Effect of Acupuncture and Moxibustion Combined with Acupoint Application on Hemiplegia of Apoplectic Sequelae

目的探究针灸联合穴位贴敷治疗中风后遗症偏瘫的临床疗效,为该疾病的诊治提供临床依据。方法收集2016年2月—2017年10月期间本院神经内科收治的中风后遗症偏瘫患者共100例,采用随机数字表法将其随机分成对照组和观察组,每组50例。对照组采用常规康复联合针灸治疗,观察组在对照组治疗基础上加用穴位贴敷治疗,2组均治疗1个月后进行疗效评估,观察2组临床疗效以及治疗前后徒手肌力测定(MMT)和日常生活活动评分(Barthel指数)的改善情况,检测患者外周血中组织型纤溶酶原激活物(t-PA)、快速抑制酶-1(PAI-1)的水平并比较检测结果的差异情况与病情及疗效的关系。结果观察组治疗总有效率为88.0%,显著高于对照组的66.0%(P<0.05);与治疗前比较,治疗后2组的MMT评分、Barthel指数评分均显著提高(P<0.05),且观察组较对照组变化明显(P<0.05);治疗后2组患者PAI-1较治疗前均明显降低(P<0.05),t-PA含量较治疗前均明显升高(P<0.05),且观察组较对照组变化明显(P<0.05)。结论运用针灸联合穴位贴敷治疗中风后遗症偏瘫疗效明显,与常规康复治疗比较,其优势明显,值得临床推广应用;此外,临床工作中可以通过组织型纤溶酶原激活物(t-PA)、快速抑制酶-1(PAI-1)联合检测值的异常变化来预测中风后遗症偏瘫的病情严重程度及治疗效果。

Objective To explore the clinical effect of acupuncture and moxibustion combined with acupoint application in treating hemiplegia of apoplexy sequelae and to provide clinical basis for the diagnosis and treatment of apoplexy.Methods From February 2016 to October 2017,one hundred patients with hemiplegia of apoplexy sequelae were collected and randomly divided into control group and observation group with 50 cases in each group.The control group was treated with routine rehabilitation combined with acupuncture and moxibustion,and the observation group was treated with acupoint application on the basis of the control group,and the curative effect was evaluated after one month of treatment in both groups.The clinical efficacy and the improvement of MMT and Barthel index before and after treatment were observed.The levels of tissue plasminogen activator(t-PA)and rapid inhibitor of plasminogen activator-1(PAI-1)in peripheral blood were measured.Results The total effective rate of the observation group was 88.0%,which was significantly higher than 66.0%in the control group(P<0.05),and the MMT score and Barthel index of the observation group were significantly higher than those of the control group(P<0.05).After treatment,the level of PAI-1 in the two groups was significantly lower than that before treatment(P<0.05),and the content of t-PA in the observation group was significantly higher than that in the control group(P<0.05).Conclusion Acupuncture and moxibustion combined with acupoint application are effective in the treatment of hemiplegia of apoplexy sequelae.Compared with conventional rehabilitation therapy,it has obvious advantages and is worth popularizing in clinic.In addition,the abnormal changes of t-PA and PAI-1 can be used to predict the severity and therapeutic effect of hemiplegia of apoplectic sequelae.