针刺结合运动再学习早期干预对脑梗死患者肌张力及其运动功能的影响

The effect of a motor relearning programme combined acupuncture on muscle tension and motor function recovery after cerebral infarction

目的观察不同针刺方法结合运动再学习法（MRP）早期干预对脑梗死患者肌张力及功能恢复的疗效差异。方法符合纳入标准的脑梗死患者90例按随机数字表法分成阳明经针刺加MRP组（A组）、防痉挛针刺加MRP组（B组）和单纯MRP组（c组），每组患者30例。3组患者均采用相同方案的药物治疗和MRP训练。A组患者在药物治疗和MRP训练的基础上，增加阳明经针刺法；B组在药物治疗和MRP训练的基础上，增加防痉挛针刺法；C组患者不增加任何方法治疗。3组患者均于在治疗前及治疗4周后（治疗后）采用美国国立卫生研究院脑卒中量表（NIHSS）、简式Fugl-Meyer运动功能评定量表（FMA）、Fugl-Meyer平衡量表（FM-B）、综合痉挛量表（css）以及改良的Barthel指数（MBI），分别评估其神经功能缺损程度、运动功能、平衡功能、肌张力、日常生活活动（ADL）能力。结果治疗后，3组患者各项评分与组内治疗前比较，差异均有统计学意义（P〈0．05）。B组治疗后仅NIHSS评分与c组治疗后的差异有统计学意义（P〈0．05），其FMA评分、FM—B评分、CSS评分、MBI评分方面与C组治疗后比较，差异均无统计学意义（P〉0．05）。A组患者治疗后，除FM—B评分与C组治疗后比较差异无统计学意义（P〉0．05），其余各项评分与C组治疗后比较，差异均有统计学意义（P〈0．05），且A组治疗后的FMA和CSS评分与B组治疗后比较，差异亦有统计学意义（P〈0．05）。A组患者治疗前后的NIHSS、FMA、CSS和MBI评分差值与B组和C组的比较，差异均有统计学意义（P〈0．05）；B组仅NIHSS、FMA的评分差值与C组的比较，差异有统计学意义（P〈0．05）。结论针刺结合MRP法早期干预能有效地改善脑梗死患者的运动功能和肌张力，不同的针刺方法其疗效存在差别，而防痉挛针刺在改善运动功能的同时，可有效地控制肌张力，有利于MRP训练。

Objective To observe the effects of a motor relearning programme （MRP） combined with different early acupuncture interventions on muscle tension and motor function recovery after cerebral infarction. Methods A total of 90 patients with cerebral infarction who met the inclusion criteria were divided into three groups at random： a YANGMING meridian acupuncture and MRP group （group A）, an anti-spasm acupuncture and MRP group （group B）, and an MRP group （group C）. All of the patients in all three groups were treated with routine medication. The National Institute of Health stroke scale （NIHSS）, the composite spasticity scale （CSS）, Fugl-Meyer assessment （FMA）, the Fugl-Meyer balance scale （FM-B） and the modified Barthel index （MBI） were used to measure performance before treatment and after 4 weeks of treatment. Another comparison was intra-group between before and after treatment. Results There were significant differences in the assessment results in all of the groups after treatment compared with those before treatment. After treatment, group B was superior to group C only in terms of NIHSS scores. There was no significant NIHSS score difference between groups A and C. The FMA, CSS and MBI results revealed significant differences among all three groups, with the scores of group A consistently the highest. The average FMA score in group B was significantly higher than in group C hut there was no statistically significant difference in FM-B scores among the three groups. Conclusion MRP therapy combined with early acupuncture in-tervention can improve motor function and muscular tension after cerebral infarction. Anti-spasm acupuncture can improve motor function and control muscular tension effectively at the same time, making it beneficial for MRP training.