不同体位下指压不同穴位对脑卒中患者胫前肌和腓骨长、短肌的表面肌电影响

The effect of applyication of acupressure stimulation on different acupoints of stroke patients with different body postures on different s EMG signals of tibialis anterior muscle, fibula long muscle and fibula short muscle

目的:优化指压穴位刺激法在脑卒中偏瘫治疗中的应用。方法:30例偏瘫患者,分别在仰卧伸膝0°位和屈膝90°位下指压偏瘫侧足三里、足临泣穴,对比刺激即刻3s、停止刺激后第一个3s、第二个3s、第三个3s的胫前肌和腓骨长、短肌最大等长收缩的积分肌电值(i EMG)。结果:1刺激前后比较:两种体位下,指压两个穴位,刺激即刻的i EMG明显高于刺激前(P<0.05),停止刺激后的三个3s的i EMG呈逐渐下降趋势。2穴位间比较:两种体位下,均表现为指压足三里穴,胫前肌刺激即刻的i EMG、停止刺激后的三个3s的i EMG均明显高于足临泣穴(P<0.05);指压足临泣穴,腓骨长、短肌刺激即刻的i EMG、停止刺激后的三个3s的i EMG均明显高于足三里穴(P<0.05)。3体位间比较:仰卧屈膝90°位指压两个穴位,胫前肌刺激即刻、停止刺激后第一个3s的i EMG明显高于伸膝0°位(P<0.05);腓骨长、短肌刺激即刻的i EMG明显高于伸膝0°位(P<0.05)。结论:1指压刺激偏瘫侧足三里、足临泣穴均可诱发偏瘫侧胫前肌和腓骨长、短肌收缩,且即刻效应和延续效应良好。2指压足三里穴对诱发胫前肌收缩的即刻效应和延续效应优于足临泣穴;指压足临泣穴对诱发腓骨长、短肌收缩的即刻效应和延续效应优于足三里穴。3仰卧屈膝90°位,指压刺激足三里、足临泣穴对诱发胫前肌和腓骨长、短肌收缩的即刻效应明显优于伸膝0°位,延续效应无明显差异。

Objective： To optimize the use of acupressure acupoint stimulation in the treatment of hemiplegia patients after stroke.Method： Thirty stroke patients participated in this study. Acupressure acupoint stimulations were respectively applied on Zusanlipoint（ST36） and Zulinqipoint（GB41）. The s EMG signals were collected in patients with two different body postures：supine with straight knee and supine with 90° flexion. Integrated EMG（i EMG）of maximum isometric contractions of tibialis anterior muscle（TA）, fibula long muscle（FL）and fibula short muscle（FS）were collected at 5 different time phases： pre-stimulation 3s, the immediate 3s at stimulation, the 1st 3s after stimulation, the 2nd 3s after stimulation and the 3rd 3s after stimulation.Result：1The comparison between pre and post-stimulation： After the application of acupressure on the two acupoints of patients with two kinds of postures, i EMG of maximum isometric contraction of TA, FL and FS at the stimulation immediate 3s improved significantly compared with pre stimulation（P〈0.05）.The i EMGs gradually declined at the time phases of three 3s after stimulation. 2The comparison between the two acupoints ： after the application of acupressure on Zusanlipoint, the i EMG of TA at the immediate 3s at stimulation, the three 3s after stimulation were significantly higher than that on Zulinqipoint with two kinds of postures（P〈0.05）. After the application of acupressure on Zulinqipoint, the i EMG of FL and FS at the immediate 3s received stimulation, the three 3s after stimulation were significantly higher than that on Zusanlipoint with the two kinds of body postures（P〈0.05）. 3The comparison between the two kinds of body postures：after the application of acupressure to the two acupoints under supine with 90° knee flexion, the i EMG of TA at the immediate 3s at stimulation and the first 3s after stimulation were significantly higher than that under supine with straight knee（P〈0.05）. The i EMG of FL and FS at the immediate 3s at stimulation under supine with 90°knee flexion were significantly higher than that under supine with straight knee（P〈0.05）.Conclusion：1Acupressure stimulation applied on Zusanlipoint and Zulinqipoint of affected side in stroke patients could induce the contractions of TA, FL and FS. Also, it showed positive immediate effect and continued effect. 2 Applying acupressure stimulation on Zusanlipoint showed a significantly better immediate effect and continued effect on inducing the contraction of TA than that on Zulinqipoint. However, applying acupressure stimulation on Zulinqipoint showed a significantly better immediate effect and continued effect on inducing the contraction of FL and FS than that on Zusanlipoint.3Applying acupressure stimulation on Zusanlipoint and Zulinqipoint under supine with 90° knee flexion showed a significantly better immediate effect on inducing the contraction of TA, FL and FS than that under supine with straight knee, the continued effect showed no significant difference.