分期针刺联合步行训练对脑梗死后下肢运动功能的影响

Effect of staged acupuncture combined with walking training on lower limb motor function after cerebral infarction

目的观察分期针刺联合步行训练对脑梗死后下肢运动功能以及血清鸢尾素(irisin)和小而密低密度脂蛋白(small dense low density lipoprotein,sdLDL)含量的影响。方法采用随机数字表法将90例脑梗死患者分为A组、B组和C组,每组30例。A组予分期针刺治疗,B组予步行训练,C组予分期针刺联合步行训练治疗。于治疗前后分别采用Fugl-Meyer运动功能评定量表(Fugl-Meyer assessment,FMA)、Berg平衡量表(Berg balance scale,BBS)和改良Barthel指数(modified Bobath index,MBI)评定患者下肢运动功能、平衡协调能力和日常生活活动能力。使用数字化跑台步态分析系统(walkerview)采集时空参数、运动学参数和对称性参数,比较两组治疗前后的变化。检测并比较两组治疗前后血清irisin和sdLDL含量。结果治疗后,3组时空参数、运动学参数、对称性参数、FMA评分、MBI评分、BBS评分以及血清irisin和sdLDL含量均较治疗前改善(P<0.05),且C组上述指标均显著优于A组和B组(P<0.05)。结论分期针刺联合步行训练能改善脑梗死患者的下肢运动能力和日常生活活动能力,提高平衡协调能力,改善步态,降低sdLDL含量,促进irisin生成,联合治疗的疗效优于单一治疗。

Objective To observe the effect of staged acupuncture combined with walking training on lower limb motor function and serum irisin and small dense low density lipoprotein(sdLDL)content after cerebral infarction.Method Ninety patients with cerebral infarction were randomly divided into group A,group B and group C,with 30 cases in each group.Group A was treated with acupuncture by stages,group B was treated with walking training,and group C was treated with staged acupuncture combined with walking training.The Fugl-Meyer assessment(FMA),Berg balance scale(BBS),modified Bothel index(MBI)were used before and after treatment to assess the motor function of lower limbs,balance and coordination ability and activities of daily living.The spatio-temporal parameters,kinematic parameters and symmetry parameters were collected by walker view gait analysis system,and the changes before and after treatment were compared between the two groups.The serum levels of irisin and sdLDL were detected and compared between the two groups before and after treatment.Result After treatment,the spatio-temporal parameters,kinematic parameters,symmetry parameters,FMA scores,MBI scores,BBS scores,and serum irisin and sdLDL contents were significantly improved in the three groups(P<0.05),and the above indexes in group C were significantly better than those in groups A and B(P<0.05).Conclusion Staged acupuncture combined with walking training can improve the lower limb motor ability and activities of daily living ability of patients with cerebral infarction,improve balance and coordination ability,improve gait,reduce sdLDL content,and promote irisin production.The efficacy of combination therapy is better than monotherapy.