头电针结合强制性运动对缺血性脑卒中患者上肢功能的影响

Effect of Scalp Electroacupuncture Combined Constraint-induced Movement Therapy on Movement Function of Ischemic Stroke Patients' Upper Limbs

目的观察头电针结合强制性运动对缺血性脑卒中患者上肢功能的影响。方法采用随机数字表法将80例脑卒中患者分为常规康复组、头电针组、强制运动组(constraint-induced movement therapy,CIMT)及综合干预组(头电针+CIMT),常规康复组采用神经发育疗法(Bobath技术为主,Brunnstrom技术为辅)强化患侧上肢训练;头电针组采用焦氏头针结合电刺激疗法;强制运动组限制健侧上肢,强化患肢训练;综合干预组采用头电针联合强制运动法进行治疗。分别在治疗前及治疗4、12周观察患者偏瘫上肢FuglMeyer运动功能评分(Fugl-Meyer assessment scale,FMA)、腕关节活动度及手功能分级。结果与本组治疗前比较,治疗4周后,各组患者偏瘫上肢FMA评分明显升高,腕关节活动度及手功能分级均明显改善(P<0.05,P<0.01);但除综合干预组偏瘫腕关节活动度在腕关节背伸及桡偏两个活动方向上较常规康复组明显改善(P<0.05)外,其他各组间FMA评分及手功能分级比较,差异均无统计学意义(P>0.05)。治疗12周后,与常规康复组比较,综合干预组FMA评分升高,偏瘫腕关节活动度及手功能分级均明显改善(P<0.05)。结论常规康复、头电针及强制性运动训练对缺血性脑卒中患者偏瘫上肢功能均有较好的康复效果,但头电针联合CIMT训练作用最为明显,且显效最早。

Objective To observe the effects of scalp electroacupuncture （SEA） combined constraint-induced movement therapy （ CIMT） on movement function of ischemic stroke patients＇ upper limbs. Methods Totally 80 stroke patients were assigned to four groups according to random digit table, i.e., the routine rehabilitation group, the SEA group, the CIMT group, and the comprehensive intervention group. Patients in the routine rehabilitation group strengthened the training of upper limbs on the affected side by Bobath dominated technology and Brunnstrom assisted technology. Patients in the SEA group re- ceived Jiao＇s SEA combined EA therapy. Those in the CIMT group restricted the upper limbs of the healthy side and strengthened training of the affected side. Those in the comprehensive intervention group used SEA combined CIMT treatment. Fugl-Meyer assessment scale （FMA）, grading of hand function and range of wrist movement were observed before intervention, at week 4 and 12 after intervention, respectively. Results Compared with before treatment in the same group, FMA scores of upper limbs significantly increased, grading of hand function, and range of wrist movement were obviously improved in the 4 groups after 4-week treatment （P 〈0.05, P 〈0.01 ）. There was no statistical difference in FMA scores of upper limbs or grading of hand function among the four groups. But dorsal expansion of wrist and radial deviation were more obviously improved in the comprehensive intervention group than in the routine rehabilitation group （P 〈0.05）. Compared with the routine rehabilitation group, FMA scores of up- per limbs increased, grading of hand function and range of wrist movement were obviously improved in the comprehensive intervention group （P 〈 0.05）. Conclusions Routine rehabilitation, SEA, and CIMT showed better rehabilitation effect on movement function of ischemic stroke patients＇ upper limbs. But ESA combined CIMT showed most obvious effect with earliest effect shown.