按摩足反射区对脑卒中偏瘫患者运动功能及血液流变学的影响

Effect of massotherapy in reflex zone of feet on motor function and hemorrheological indexes of hemiplegic stroke patients

目的:观察足反射区按摩疗法对脑卒中偏瘫患者的治疗作用及对血液流变学的影响。方法:病例来源于2004-03/2005-05广西中医学院第一附属医院推拿科住院病房。将己确诊并符合纳入标准的出血性和缺血性脑卒中偏瘫早期患者106例等量随机地分成两组:观察组和对照组,每组53例。对照组只给予单纯常规中西药物治疗,观察组脑卒中偏瘫患者加用足反射区按摩疗法进行康复治疗,反射区的定位与选取:肾-输尿管-膀胱、头、额窦、小脑与脑干、脑垂体。患者取仰卧位。施术者以屈食指点、按法为主,并配合推、摩、掐、括等法刺激上述反射区。力度以患者出现较强的刺激感(酸、麻、胀、痛)但能忍受为度,心脏病患者及体质严重虚弱者力度宜轻。施术后患者尽可能多饮水。每足20min,双足全程约45min。7次为1个疗程,疗程间休息3d。共治疗3个疗程。以简式的Fugl-Meyer运动量表(Ⅰ级:严重运动障碍,运动功能积分<50分;Ⅱ级:明显运动障碍,运动功能积分50～84分;Ⅲ级:中度运动障碍,运动功能积分85～95分;Ⅳ级:轻度运动障碍,运动功能积分96～99分;Ⅴ级:正常,运动功能积分100分)和修订的Barthel指数(差:Barthel指数≤40分;中等:Barthel指数为41～60分;良好:Barthel指数>61分)为指标进行疗效评定。同时检测两组患者治疗前后的高切全血黏度、低切全血黏度、血浆黏度、红细胞压积及红细胞聚集指数等血液流变学指标。结果:对照组中有3例因要求实施针灸治疗而退出实验,进入结果分析50例,观察组53例全部进入结果分析。①两组患者治疗前后肢体运动功能比较:观察组治疗后的运动功能积分大于对照组(83.26±20.42,67.34±9.33);观察组治疗后运动功能Ⅳ级以上占有率高于对照组,差异有显著性意义(62%,30%,P<0.001)。②两组患者治疗前后日常生活活动能力比较:观察组治疗后的日常生活活动能力积分大于对照组(82.54±23.80,60.53±25.37);观察组治疗后日常生活活动能力达良好以上的占有率高于对照组,差异有显著性意义(72%,42%,P<0.05)。③两组治疗后血液流变学指标比较:观察组血液流变学各项指标与治疗前比较,均有改善,差异有显著性意义(P<0.05)。两组治疗后血液流变学指标比较,差异有显著性意义(P<0.05)。结论:按摩足反射区有利于血液流变学指标的改善,有利于脑卒中偏瘫患者运动功能和日常生活能力的恢复。

BACKGROUND： To observe effect of massotherapy in reflex zone of feet on motor function and hemorrheology of patients with stroke and hemiplegia. METHODS： Cases were selected from the Department of Massage of the First Hospital Affiliated to Guangxi College of Traditional Chinese Medicine from March 2004 to May 2005. Totally 106 hemorrhagic and ischemic patients with stroke and early hemiplegia were divided randomly into observational group and control group with 53 in each group. Patients in control group were treated with routine Chinese and western medicine, hut patients in observational group were treated with massotherapy in reflex zone of feet. Localization and selection of reflex zone： kidney-ureter- bladder, head, frontal sinus, cerebellum, brain stem and hypophysis. Patients were maintained at supine position. Reflex zones mentioned above were stimulated with pressing combined with pushing, rubbing and fingernail pressing manipulation. Stimulated degrees such as soreness, tingling sensation, distending pain and ache were observed on patients but all of them could be beard. Patients with cardiac disease and weak body mass had a little stimulated sensation. Patients drank water as much as possible after operation. Each foot was treated for 20 minutes, and two feet for 45 minutes. Seven times were regarded as 1 course and the intervals were 3 days. All patients were treated for 3 courses. Simple Fugl-Meyer motor scale： Grade Ⅰ ： severe motor disorder, scores of motor function 〈 50 points; Grade Ⅱ ： obvious motor disorder, scores of motor function=50-84 points; Grade Ⅲ： moderate motor disorder, scores of motor function=85-95 points; Grade Ⅳ： mild motor disorder, scores of motor function=96-99 points; Grade Ⅴ： normal, scores of motor function=100 points; Revised Barthel index： Poor： Barthel index ≤ 40 points; Moderate： Barthel imlex =41-60 points; Well： Barthel index 〉 61 points. Hemorheological indexes such as whole blood viscosity of high shear rates, whole blood viscosity of low shear rates, serum viscocity, hematocrit and erythrocyte aggregation index were measured before and after treatment in the two groups. RESULTS： Three cases in control group were lost because of acupuncture. Finally, 50 cases in control group and 53 in observational group entered the analysis. ① Comparisons of motor function of limbs before and after treatment： After treatment, scores of motor function in observational group were more than those in control group （83.26±20.42, 67,34±9.33）, and occupational rate above grade Ⅳ in observational group was significantly higher than that in control group （62%, 30%, P 〈 0.001）.② Comparisons of activities of daily living （ADL） before and after treatment： After treatment, scores of ADL in observational group were more than those in control group （82.54±23,80, 60.53±25.37）, and occupational rate above well degree in observational group was significantly higher than that in control group （72%, 42%, P 〈 0.05）.③ Comparisons of hemorheological indexes after treatment： Hemorheological indexes in observational group were improved remarkably, and there was significantly different from those before treatment （P 〈 0,05）. There were also significant differences between the two groups after treatment （P 〈 0,05）. CONCLUSION： Massotherapy in reflex zone of feet can improve hemorheological indexes and recovery motor function and ADL ability of patients with stroke and hemiplegia,