体外反搏结合“醒脑开窍”针法对缺血性脑卒中恢复期下肢痉挛患者的临床疗效和肌电图分析

Clinically Therapeutic Effect and EMG Analysis on Stroke Patients with Lower-extremity Spasticity by External Counterpulsation Combined with“Xingnao-Kaiqiao”Acupuncture

目的:观察体外反搏结合"醒脑开窍"针法对缺血性脑卒中恢复期下肢痉挛患者的疗效。方法:123例缺血性脑卒中恢复期患者随机分为A组41例(基础治疗结合康复训练),B组41例(A组基础上配合常规针刺及常规理疗),C组41例(A组基础上配合体外反搏结合"醒脑开窍"针法),治疗前及疗程结束后运用临床痉挛指数、Fugl-Meyer评分比较3组患者治疗前后痉挛下肢的运动功能,并运用表面肌电图系统记录治疗前后主动肌及拮抗肌肌电活动差异。结果:1治疗结束后与治疗前比较3组患者主动肌(股二头肌和胫前肌)积分肌电值(integrated electromyography,IEMG)无显著性差异(P>0.05);拮抗肌(股直肌和腓肠肌内侧)IEMG明显降低(P<0.05),与A、B组治疗后比较C组拮抗肌治疗后IEMG的改变具有明显差异(P<0.05);2治疗结束后与治疗前比较3组患者患侧肢体膝屈曲、踝背屈协同收缩率(co-contraction ratio,CO)均明显降低(P<0.05),与A、B组比较C组降幅更加明显(P<0.05);3与治疗前相比3组患者临床痉挛指数、Fugl-Meyer评分均显著改善(P<0.01),且C组优于A、B组(P<0.05)。结论:体外反搏结合"醒脑开窍"针法能够有效改善缺血性脑卒中恢复期患者下肢肌肉电生理活动及临床痉挛症状,促进患者康复,值得临床推广。

Objective： To observe the clinically therapeutic ticity by external counterpulsation combined with＂ Xingnao effect on stroke patients with lower - extremity spas- - Kaiqiao＂ acupuncture. Methods： 123 cases with ischemic stroke at the recovery stage were randomly divided into group A,B and C. In each group it had 41 pa- tients. The group A was treated by basic therapy combined with rehabilitation training. The group B was treated based on the therapy in group A and additionally received conventional acupuncture and physical therapy. The group C was treated based on the therapy in group A and additionally received external counterpulsation com- bined with＂ Xingnao - Kaiqiao＂ acupuncture. Patients with lower limb motor function were assessed by Clinical Spasticity Index （CSI） and Fugl - Meyer assessment scale （FAS）. At the same time agonist and antagonist muscle integrated electromyography （IEMG）scores of the knee buckling and ankle dorsiflexion were recorded by surface EMG before and after treatment. Results：（1） muscles （biceps femoris muscle and pretibial muscle Compared with that before treatment, the IEMG of agonist ） in 3 groups had no significant difference （ P 〉 0.05 ）, but the IEMG of antagonist muscle （rectus muscle and gastrocnemius muscle） in 3 groups a had a significant de- cline （ P 〈 0. 05 ）. The IEMG of antagonist muscle of the group C had a significant difference compared with that in groups A and B （ P 〈 0.05 ）. （2）Compared with that before treatment, the co - contraction ratio （ CO ） of knee buckling and ankle dorsiflexion in 3 groups had a significant decline（ P 〈 0.05 ） ,and the CO of the group C had a significant difference compared with group A and group B （ P 〈 0.05 ）. （3）Compared with those before treat- ment the CSI and FAS were significantly improved （ P 〈 0.05 ） and the group C was significantly better than group A and group B （ P 〈 0.05 ）. Conclusion： External counterpulsation combined with＂ Xingnao - Kaiqiao＂ acupuncture can not only effectively improve the stroke patients with lower - extremity spasticity, but can also promote patients＇ recovery.