脑卒中偏瘫4个月内对患者肢体痉挛的治疗:应用神经促通术配合低频脉冲电流的效果分析

Treatment of limb spasticity in hemiplegic patients within 4 months after stroke: curative effect of neural facilitation combined with low frequency pulse current

目的:观察分析神经促通术配合低频脉冲电流治疗病程4个月以内的脑卒中偏瘫肢体痉挛患者的效果及机制。方法:选择2001-01/2004-05住院的病程4个月以内的脑卒中偏瘫痉挛状态患者50例。Ashworth肌张力评定在Ⅰ～Ⅲ级。排除有意识/精神/智能障碍、患肢失认失用、帕金森综合征、癫痫;水电解质紊乱、戴心脏起搏器、严重营养不良、严重心肺系统疾病、不配合治疗者。随机分为治疗组25例和对照组25例。两组均采用常规药物治疗及基本康复训练,治疗组行神经促通术康复治疗4周,同时配合痉挛肌治疗仪治疗10d或20d,以简式Fugl-Meyer量表评分和Ashworthr分级分别评定两组治疗前后的运动功能和肢体痉挛程度,并进行组间比较。结果:治疗前两组的Fugl-Meyer评分和Ashworthr评级差异无显著意义(t=0.536,P>0.05和χ2=0.75,P>0.05),而治疗后两组间比较差异有显著意义(t=2.340,P<0.05和χ2=7.92P<0.05),即治疗组的疗效好于对照组。结论:神经促通术配合低频脉冲电流治疗可改善脑卒中偏瘫肢体的痉挛状态,有效提高患肢运动功能。

AIM:To observe and analyze the effect of neural facilitation combined with low frequency pulse current in treating the spasticity in hemiplegic patients within 4 months after the attack of stroke,and to explore its mechanism. METHODS:Fifty hemiplegic inpatients within 4 months after stroke,whose Ashworth muscular tone evaluation was during grade Ⅰ-Ⅲ.Patients with conscious/mental/intellectual disorder,agnosia and agraxia of the injured limb,Parkinson's syndrome,epilepsy,water electrolyte disturbance,carrying cardiac pacemaker,had severe malnutrition,severe cardiac and pulmonary diseases,and those who were incooperative with the treatment,were excluded.All the patients were randomly divided into treatment group(n=25) and control group(n=25).Patients in both groups received routine drug treatment and basic rehabilitative training,while those in the treatment group were treated with neural facilitation for 4 weeks combined with muscular spasm machine for 10 or 20 days.The motor function and spastic level of limbs were evaluated with simple Fugl-Meyer scale and Ashworthr grade respectively before and after treatment in both groups,and the results were compared between the two groups.RESULTS:There were insignificant differences in the scores of Fugl-Meyer scale and Ashworthr grade between the two groups before treatment(t=0.536,P >0.05;χ2=0.75, P >0.05),while the differences were significant after treatment between the two groups (t=2.340,P< 0.05; χ2=7.92,P< 0.05), that was to say the curative effect was better in the treatment group than in the control group.CONCLUSION:The treatment of neural facilitation combined with low frequency pulse current can ameliorate the spasticity of hemiplegic limbs after stroke, and effectively improve the motor function of the injured limbs.