“国学点穴”联合姿势和运动控制治疗帕金森综合征随机平行对照研究

Random Parallel Control Study of "Guoxue Dianxue" combined Posture and Motion Control in the Treatment of Parkinson's Syndrome

[目的]观察“国学点穴”联合姿势和运动控制治疗帕金森综合征疗效。[方法]使用随机平行对照方法,将90例住院及门诊患者病志号抽签简单随机分为三组。A组30例姿势和运动控制,松弛、关节活动度、姿势、平衡、往复、步态训练,1次/d,40min/次;日常生活活动能力训练,1次/d,30min/次;语言训练,1次/d,30min/次;吞咽训练,1次/d,30min/次;松弛训练：缓慢前庭刺激松弛全身肌肉;关节活动度训练：主动或被动训练,牵拉缩短绷紧屈肌,防止挛缩发出,维持正常关节活动度;平衡训练：患者在坐直、跪直和站直体位下做前后、左右重心转移训练或在以上4个方向施加轻推或摇使其脱离平衡,让患者自己恢复平衡,逐渐增加活动复杂性,增加重心转移范围;往复运动：患者同时做双上肢或双下肢之间或上肢与下肢之间交互运动;步态训练：加快启动速度和步行速度,加大步幅及步伐基底宽度,确保躯干运动和摇动之间相互交替协调重心转移及步态中足跟—足趾顺序触地运动,按指令步行;日常生活训练：早期调整维持其粗大和精细协调运动、肌力、身体姿势和心理状态实现生活自理,后期最大程度维持其原有功能和活动能力,加强日常生活监督和安全性防护,提供简单、容易操作、省力的方法完成各项活动;语言训练：音量锻炼,舌、唇和上下颌练习,提高对呼吸肌肉活动控制能力及舌和唇部运动能力;吞咽刺激：感觉刺激,口颌功能训练,摄食训练,恢复和提高患者吞咽功能,增加进食安全,减少食物误咽吸入肺及吸入性肺炎等并发症发生。B组30例国学点穴结合推拿,点穴手法为主（含按揉、？法、拿法、弹拨等）;1次/d,6次/周,头颈肩部取百会、印堂、太阳、风池、颈夹脊、肩井等,患者仰卧位,医生以按揉、刮法放松面颈部肌肉2~3min,在上述穴位点法3~5min;颈椎摇、扳、牵伸3~5min;四肢及腹部取肩髎、肩前、曲池、手三里、外关、合谷、天枢、关元、肚角、梁丘、血海、阳陵泉、足三里、太冲等,患者仰卧位,对双上肢按揉、摇、牵伸、点5~8min,点天枢、关元、肚角各5min,双下肢关节牵伸、摇、牵伸、点5~7min;背腰部取华佗夹脊穴、环跳、委中、承山等,以点法、整脊为主,患者俯卧位,双手点华佗夹脊,整脊8~10min,胸腰椎牵伸、扳5min,点环跳、委中、承山2~3min。C组30例“国学点穴”联合姿势和运动控制;现代康复运动治疗技术（PT、OT、ST）、推拿,1次/d,6次/周。连续治疗2周为1疗程。观测临床症状、帕金森评定量表（UPDRS）、不良反应。治疗1疗程（2周）,判定疗效。[结果]A组显效0例,有效11例,无效19例,恶化0例,总有效率36.67%;B组显效0例,有效13例,无效17例,恶化0例,总有效率43.33%;C组显效0例,有效26例,无效4例,恶化0例,总有效率86.67%;临床疗效C组优于A、B组（P〈0.01）,A组与B组无显著差异（P〉0.05）。[结论]姿势和运动控制理论联合“国学点穴”联合现代康复运动技术治疗帕金森,疗效满意,无严重不良反应,值得推广。

[Objective] Observation of the effect of ＂Guoxue Dianxue＂ combined posture and motion control in the treatment of Parkinson＇s syndrome. [Methods] Using random parallel control method, 90 patients were randomly divided into three groups. A group of 30 cases of posture and movement control, relaxation, joint activity, posture, balance, reciprocating, gait training, 1 times/d, 40 min/times; activities of daily living training, 1 times/d, 30 min/times; language training, 1 times/d, 30 min/times; swallowing training, 1 times/d, 30 min/ times; relaxation training： slow vestibular stimulation to muscle relaxation; joint activity training： active or passive training, shorten the pull taut flexor, prevent contracture of a normal joint activity; balance training： patients in the sit straight, straight and stand straight kneeling under do before and after transfer of training or in the direction of more than 4 push or shake off the applied balance for patients to restore balance, gradually increase the complexity, increase the focus range; reciprocating motion： patients at the same time between upper limbs or lower limbs or upper and lower extremity. The interaction between sports; gait training： to speed up the startup speed and walking speed, stride length and increase the pace of base width, ensure the trunk movement and shaking between alternating shift and gait coordination with toe movement order midfoot touchdown, according to the instruction of walking; daily life training： early adjustment to maintain its coarse and fine coordinated movement, muscle strength, body posture and realize the psychological state of self-care, the late maximum maintain its original function and activity, strengthen the daily supervision and safety protection, provide a simple method and easy operation, and complete the training activities; words： volume exercise, tongue, lips and jaw exercises, improve the ability of tongue and lip motion control respiratory muscle activity; swallowing stimulation： sensory stimulation, jaw function training, feeding training, recovery and improve patient swallow Swallowing function, increase food safety, reduce the incidence of lung and aspiration pneumonia and other complieations.B group of 30 cases of ＂Guoxue Dianxue＂ combined with massage, acupuncture manipulations （including by kneading, roiling method, with method, plucked, etc.）; l/d,6 times/week; head and neck and Baihui, Yintang,Taiyang, Jingjiajian, Jianjing, the doctor to with, scraping method to relax the face and neck muscles 2-3 min, 3-5 rain in the acupuncture point method; cervical vertebra shake, pull, draft 3-5 min; Limbs and abdomen take Jianliao, Jianqian, Quchi, Shousanli, Waiguan, Waiguan, Hegu, Tianshu, Guanyuan, Dujiao, Liangqiu, Xuehai, Yanglingquan, Zuosanli, Taiehong, the patient supine, the double arm by rubbing, shaking, drafting, 5-8 rain, Tianshu, Guanyuan, Dujiao, 5 min each, drafting of the joints of lower limbs, shaking, drafting, point 5-7 rain; take back Huatuo Jiaji, Huantiao, Weizhong, Chengshan, by point method, chiropractic, patients prone position, hands Huatuo Jiaji, chiropractic 8~10rain, thoracolumbar draft, pull 5rain, point Huantiao, Chengshan 2-3 min.C group of 30 cases of ＂Guoxue Dianxue＂ joint posture and motion control; modem rehabilitation exercise therapy technology （PT, OT, ST）, massage, 1 times/d, 6 times/week. Continuous treatment for 2 weeks for 1 courses. Observation of clinical symptoms, Parkinson Rating Scale （UPDRS）, adverse reactions. Treatment of 1 courses （2 weeks）, to determine the efficacy. [Results] A group 0 eases, effective 11 cases, invalid 19 eases, worsened in 0 eases, the total efficiency of 36.67%; B group 0 eases, effective 13 eases, invalid 17 eases, worsened in 0 eases, the total efficiency of 43.33%; C group 0 cases, effective 26 eases, invalid 4 cases, worsened in 0 cases, the total efficiency of 86.67%; the clinical effect of C is better than that of group A and group B （P〈0.01）, A group and B group had no significant difference （P〉0.05）. [Conclusion] The effect of posture and movement control theory combined with the Ancient Chinese Literature Search acupuncture combined with modern rehabilitation exercise for Parkinson, with no serious adverse reactions, worthy of promotion.