针刺加康复防治脑卒中异常运动模式的康复学评定

Rehabilitation evaluation on post-stroke abnormal movement pattern prevented and treated with acupuncture and rehabilitation

目的:探讨针刺与康复结合对脑卒中肢体运动异常模式的影响,并采用康复学方法进行评定。方法:将90例脑卒中肢体运动功能障碍患者随机分为针刺加康复训练组(针康组)、体针组和药物组,每组30例,药物组给予神经科常规药物治疗,针康组、体针组在药物组治疗之上分别加头穴(顶区、顶前区等)针刺配合康复训练及传统体针(肩髃、风市等)配合持续电针,共治疗8周。各组治疗前后分别采用临床疗效评价、Fugl-Meyer运动功能评分、改良的Ashworth痉挛量表、关节活动度(ROM)测量和肩部疼痛评分为观察指标进行康复学评定。结果:针康组有效率为93.1%(27/29),优于体针组的66.7%(20/30)与药物组的57.1%(16/28)(均P<0.01)。各组患者治疗后,Fugl-Meyer评分、肌张力Ashworth分级、下肢及肩关节ROM测量和肩部疼痛评分(除药物组)较治疗前均有明显改善(均P<0.01)。针康组在Fugl-Meyer评分、肌张力Ashworth分级、上肢ROM测量和肩部疼痛评分改善方面显著优于体针组及药物组(P<0.05,P<0.01)。结论:针刺加康复与传统体针方法对脑卒中患者运动功能障碍有明显的改善作用,针刺加康复明显优于传统体针方法,能够有效防治脑卒中患者异常模式的产生,对提高患者生存质量具有重要意义。

Objective To explore the impacts of acupuncture and rehabilitation on post-stroke abnormal patterns of limb movement and evaluate them via rehabilitation method. Methods Ninety cases of post-stroke movement disorder were randomly divided into an acupuncture-rehabilitation group, a body acupuncture group and a medication group, 30 cases in each group. In medication group, the conventional medication in neurological depart- ment was administered. In acupuncture-rehabilitation group and body acupuncture group, on the basis of the therapy as medication group, scalp acupuncture （such as parietal area and anterior parietal area, etc. ）, rehahilitation training and traditional body acupuncture [such as Jianyu （LI 15） and Fengshi （GB 31）, etc. ] were supplemented. The continuous electric stimulation was applied in body acupuncture group. The treatment lasted for 8 weeks. The assessment of clinical efficacy, Fugl-Meyer score, Modified Ashworth scale （MAS）, range of motion （ROM） and shoulder pain score were taken as observation indices for rehabilitation evaluation before and after treatment in each group. Results The effective rate was 93.1% （27/29） in acupuncture rehabilitation group, which was superior to 66.7% （20/30） in body acupuncture group and 57.1% （16/28） in control group （both P〈0.01） separately. After treatment, Fugl-Meyer score, MAS, ROM of the lower limbs and shoulder joint and shoulder pain score （except medication group） were all remarkably improved as compared with those before treatment in each group （all P〈0.01）. The improvements in Fugl-Meyer score, MAS, ROM of the upper limbs and shoulder pain score in acupuncture-rehabilitation group were significantly superior to those in body acupuncture group and medication group （P〈0.05, P〈 0; 01）. Conclusion Acupuncture and rehabilitation therapy and traditional body acupuncture remarkably improve in post-stroke movement disorder. But acupuncture and rehabilitation therapy is apparently superior to traditional body acupuncture. This therapy can effectively prevent and treat post-stroke abnormal patterns and it is greatly significant in the improvement of survival quality for the patients.