针刺、推拿与超声波治疗脑梗死后上肢运动功能障碍的正交优选研究

Study on the Orthogonal Optimization of Acupuncture, Tuina and Ultrasonic Treatments for Upper Limb Motor Dysfunction after Cerebral Infarction

目的确定针刺、推拿和超声波治疗脑梗死后上肢运动功能障碍的优选康复方案。方法应用3因素(A因素为针刺,B因素为推拿,C因素为超声波)2水平正交设计法,将80例脑梗死伴上肢运动功能障碍患者随机分为8组,每组10例,治疗4星期后观察各组神经功能缺损程度评分(NIHSS)及简化Fugl-Meyer上肢运动功能评分(FMA)的变化。结果治疗前各组NIHSS、上肢FMA评分比较,差异均无统计学意义(P>0.05)。对NIHSS的改善方面,A、B2因素均为显著因素(均P<0.05),C因素2水平比较差异无统计学意义(P>0.05);对上肢FMA评分的改善方面,A、B、C 3因素均为显著因素(P<0.05,P<0.01,P<0.05);A2B1C1为最佳方案。结论结合针刺、推拿和超声波是治疗脑梗死后上肢运动功能障碍的优选,能有效改善上肢运动功能障碍。

Objective To develop a optimized rehabilitation protocol for acupuncture, Tuina and ultrasonic treatments of upper limb motor dysfunction after cerebral infarction.Methods An orthogonal design with three factors （acupuncture as factor A, Tuina as factor B and ultrasound as factor C） and two levels was used. Eighty cerebral infarction patients with upper limb motor dysfunction were randomly allocated to eight groups, 10 cases each. The National Institute of Health Stroke Scale （NIHSS） score and the simplified Fugl-Meyer Assessment （FMA） score for upper limb motor function were recorded after four weeks of treatment. Results There were no statistically significant pre-treatment differences in the NIHSS score and the FMA score for the upper limb between the groups （P〉0.05）. For an improvement in NIHSS, factors A and B were both significant （bothP〈0.05）; there was no statistically significant difference in factor C between the two levels （P〉0.05）. Factors A, B and C were all significant for an improvement in the FMA score for the upper limb （P〈0.05,P〈0.01,P〈0.05）. A2B1C1 was the optimal protocol.Conclusions A combination of bilateral acupuncture, Tuina and ultrasound is an optimized protocol for treating upper limb motor dysfunction after cerebral infarction. It can effectively reduce upper limb motor dysfunction.