针刺联合运动想象对脑卒中软瘫上肢精细动作的影响

Impacts on fine movement of upper extremity with flaccid paralysis in stroke treated with acupuncture combined with motor imagery

目的:探讨针刺联合运动想象对脑卒中软瘫上肢精细动作的影响。方法:将62例上肢处于软瘫期的脑卒中偏瘫患者随机分为观察组(30例)、对照组(32例)。对照组采用常规西药治疗及肢体被动运动基础上予头穴透刺(百会透太阳为主)加患肢局部透刺(肩髃透臂臑、曲池透少海、外关透内关等)治疗,留针30min;观察组在对照组治疗基础上针刺留针期间予运动想象疗法。两组均每天治疗1次,每周治疗5天,共治疗4周。分别于入组时、治疗2周、4周后,及第6周、8周、90天后随访记录上肢动作研究量表(ARAT)和改良Fugl-Meyer(FMA)评分。结果:1上肢ARAT评分:从第2周起,各时间点两组比较,观察组ARAT评分均较对照组有显著提高(均P<0.05)。观察组组内各时间点两两比较,评分均有显著性提高(均P<0.05);对照组组内各时间点两两比较,第2周与治疗前比较P>0.05,其余时间点评分均有显著提高(均P<0.05)。2上肢FMA评分:第2周、第90天时,观察组FMA评分显著高于对照组(均P<0.05)。观察组组内各时间点两两比较,评分均显著提高(均P<0.05);对照组组内各时间点两两比较,除第90天与第8周比较P>0.05外,其余时间点均P<0.05。结论:采用针刺联合运动想象疗法对脑卒中软瘫期早期干预能有效促进上肢协调功能和精细动作的恢复,尤其在改善精细动作方面,疗效优于单纯针刺治疗。

Objective To explore the impacts on the fine movement of upper extremity with flaccid paralysis in stroke treated with acupuncture and motor imagery.Methods Sixty-two cases of flaccid paralysis of upper extremity in stroke were randomized into an observation group（30 cases）and a control group（32 cases）.In the control group,the conventional western medication and the passive movement of the extremity were applied.Additionally,the penetrating needling technique was used at the head points[penetrating needling from Baihui（GV 20）to Taiyang（EX-HN 5）]and the local affected extremity[penetrating needling from Jianyu（LI 15）to Binao（LI14）,from Quchi（LI 11）to Shaohai（HT 3）,from Waiguan（TE 5）to Neiguan（PC 6）,etc].The needles were retained for 30 min.In the observation group,on the basic treatment as the control group,during the needle retaining,the motor imagery therapy was supplemented.The treatment was given once a day,5 treatments a week,for 4 weeks totally in the either group.The scores in the action research arm test（ARAT）and the modified FuglMeyer assessment（FMA）were recorded at the moment of enrollment,in 2 and 4 weeks of treatment,in the 6th and 8th weeks,as well as after 90 days separately.Results ① ARAT score：since the 2nd week,ARAT scores in the observation group were all improved significantly as compared with those in the control group at the each time points（all P〈0.05）.In the observation group,the scores were improved significantly in the pair comparison at the time points（all P〈0.05）.In the control group,the score in the 2nd week was not different significantly as compared with that before treatment（P〉0.05）,but the scores at the rest time points were improved significantly in the pair comparison（all P〈0.05）.②FMA score：in the 2nd week and on the 90 th day,FMA score in the observation group was higher significantly than those in the control group（both P〈0.05）.In the observation group,the scores were all improved significantly in the pair comparison at the time points（all P〈0.05）.In the control group,except that in comparison between the 90 th day and the 8th week（P〉0.05）,the results were all P〈0.05 at the rest time points.Conclusion The early intervention of the combined therapy of acupuncture and motor imagery effectively promotes the recovery of the coordination function and the fine movement of upper extremity,especially the improvements of the fine movement in stroke at flaccid paralysis stage.The efficacy is better than the single acupuncture treatment.