互动式头针结合作业疗法治疗脑卒中上肢运动功能障碍:随机对照研究

Interactive dynamic scalp acupuncture combined with occupational therapy for upper limb motor impairment in stroke:a randomized controlled trial

目的：比较互动式头针与传统头针治疗对脑卒中上肢运动功能障碍的临床疗效差异。方法：采用随机对照研究,利用MINIMIZE分层随机软件,将70例脑卒中后上肢Brunnstrom分级为Ⅲ~Ⅴ级的患者随机分为互动式头针组、传统头针组,每组35例。互动式头针组选取病灶同侧顶颞前斜线中2/5、顶颞后斜线中2/5、顶旁2线作为头针刺激区,且在实施头针治疗的过程中行康复训练;传统头针组头穴刺激区同互动式头针组,但头针治疗与康复训练分开实施,上午进行康复训练,下午行针刺治疗。于治疗前、治疗1、2个月比较两组Fugl-Meyer上肢运动功能评定量表（U-FMA）、Wolf运动功能测试量表（WMFT）及改良Barthel指数评定量表情况。结果：两组治疗后U-FMA积分、WMFT积分、改良Barthel指数积分均较治疗前明显改善（均P〈0.01）,互动式头针组治疗后U-FMA积分改善优于传统头针组（P〈0.05）,互动式头针组Brunnstrom分级Ⅳ~Ⅴ级患者治疗2个月后WMFT积分、治疗后Barthel指数积分均较传统头针组改善明显（P〈0.05,P〈0.01）;但互动式头针组Brunnstrom分级Ⅲ级的患者WMFT积分、改良Barthel指数积分的改善与传统头针比较差异无统计学意义（均P〉0.05）。结论：互动式头针对Brunnstrom分级Ⅳ~Ⅴ级的脑卒中患者上肢运动功能、日常生活自理能力的改善优于传统头针,治疗时间越长,上肢运动功能改善越明显;互动式头针对Brunnstrom分级Ⅲ级的脑卒中患者上肢运动功能障碍的改善与传统头针疗效相当。

Objective To compare the clinical efficacy on upper limb motor impairment in stroke between the interactive dynamic scalp acupuncture therapy and the traditional scalp acupuncture therapy.Methods The randomized controlled trial and MINIMIZE layering randomization software were adopted.Seventy patients of upper limb with ⅢtoⅤ grade in Brunnstrom scale after stroke were randomized into an interactive dynamic scalp acupuncture group and a traditional scalp acupuncture group,35 cases in each one.In the interactive dynamic scalp acupuncture group,the middle 2/5of Dingnieqianxiexian（anterior oblique line of vertex-temporal）,the middle2/5of Dingniehouxiexian（posterior oblique line of vertex-temporal）and Dingpangerxian（lateral line 2of vertex）on the affected side were selected as the stimulation areas.Additionally,the rehabilitation training was applied during scalp acupuncture treatment.In the traditional scalp acupuncture group,the scalp stimulation areas were same as the interactive dynamic scalp acupuncture group.But the rehabilitation training was applied separately.The rehabilitation training was applied in the morning and the scalp acupuncture was done in the afternoon.The results in Fugl-Meyer for the upper limb motor function（U-FMA）,the Wolf motor function measure scale（WMFT）and the modified Barthel index in the two groups were compared between the two groups before treatment and in 1and 2months of treatment,respectively.Results After treatment,the U-FMA score,WMFT score and the score of the modified Barthel index were all apparently improved as compared with those before treatment（all P〈0.01）.The improvement in the U-FMA score after treatment in the interactive dynamic scalp acupuncture group was better than that in the traditional scalp acupuncture group（P〈0.05）.For the patients of Ⅳ to Ⅴ grade in Brunnstrom scale,WMFT score in 2months of treatment and the score of Barthel index after treatment in the interactive dynamic scalp acupuncture group were improved apparently as compared with those in the traditional scalp acupuncture group（P〈0.05,P〈0.01）.But,for the patients of Ⅲ grade in Brunnstrom scale,WMFT score and the score of Barthel index after treatment in the interactive dynamic scalp acupuncture group were not different significantly as compared with those in the traditional scalp acupuncture group（both P〉0.05）.Conclusion For the patients of Ⅳ to Ⅴ grade in Brunnstrom scale in stroke,the interactive dynamic scalp acupuncture therapy achieves the superior improvements of the upper limb motor function and the activity of daily life as compared with the traditional scalp acupuncture therapy,and the longer the treatment lasts,the more apparent the improvements are.For the patients ofⅢ grade in Brunnstrom scale,the interactive dynamic scalp acupuncture therapy achieves the similar improvement in the upper limb motor impairment as compared with the traditional scalp acupuncture therapy.