社区康复训练联合针刺治疗脑卒中后肢体功能障碍随机平行对照研究

Community Rehabilitation Training combined with Acupuncture for Treatment of Limb Dysfunction after Stroke Randomized Controlled Trial

[目的]观察社区康复训练联合针刺治疗脑卒中后肢体功能障碍疗效。[方法]使用随机平行对照方法,将84例患者按掷骰子方法简单随机分为两组。对照组42例体针:患侧风府、百会、肩髃、臂臑、曲池、手三里、合谷、环跳、髀关、伏兔、梁丘、足三里、丰隆、绝谷等穴,平补平泻,得气后留针20min;头针:对侧运动区、感觉区、平衡区、血管舒缩区,得气后留针1h,隔日1次。治疗组42例康复训练,肢体训练,上肢:患者坐位或站立位,指导患者握紧双手,拇指外展,向前伸双臂,用健侧手去拉动患侧上肢,医者对患者关节进行适当按摩;下肢:患者仰卧位,指导患者健康肢体手握住床架,辅助患者抬起患侧肢体,确保患肢可离开床面,双脚尽量并拢,双膝靠拢,膝关节呈90°屈曲,将腰部向上挺,尽量抬高;翻身训练:向左翻身,需指导患者左下肢在上方,在向右侧翻身,需确保右下肢在上方;吞咽训练:指导患者伸缩舌头、闭口等,以上训练3次/d,每次进行10次左右练习;吹气训练:指导患者闭口后确保气体充满双颊,鼓腮之后将气轻轻呼出,2次/d,每次进行5遍;棍棒操:避免出现肩关节活动障碍,选长1~1.2m,直径3~3.5cm棍棒,指导患者双手握住棍棒,比肩稍窄,用健康手带动患肢手,伸直两肘,做向前向上推举,直臂左右摆动,肩臂左右后伸,前臂旋前旋后,肩部内旋与外旋等训练,4次/d;针刺治疗同对照组。连续治疗10个月为1疗程。观测临床症状、肢体活动能力、生活能力评分、满意度、不良反应。治疗1疗程(10个月),判定疗效。[结果]治疗组显效22例,有效19例,无效1例,总有效率97.62%;对照组显效17例,有效16例,无效9例,总有效率78.57%;治疗组疗效优于对照组(P<0.01)。生活能力评分两组均有改善(P<0.01),治疗组改善优于对照组(P<0.01)。满意度治疗组优于对照组(P<0.05)。[结论]社区康复训练联合针刺治疗脑卒中后肢体功能障碍,疗效满意,无严重不良反应,值得推广。

[Objective] To observe the effect of community rehabilitation training combined with acupuncture on limb dysfunction after stroke. [Method] 84 patients were randomly divided into three groups according to the method of random dice by random parallel control method. The control group of 42 cases of acupuncture： suffering from erosswind palace, Baihui, Jianyu, binao, Quchi, Hegu, hand three years, huangtiao, biguan, futu, Liangqiu, Zusanli, Fenglong, great valley and other points, reinforcing reducing, after the gas needle 20min; scalp acupuncture： feeling contralateral movement district, district, district, balance of vasomotor area, after the gas for lh, 1 every other day. The treatment group of 42 cases of upper limb rehabilitation training, physical training, with a sitting or standing position, guide the patients to hold hands, thumb abduction, stretched out his arms, with the contralateral hand to pull the upper limb, medicine appropriate massage on patients with lower limb joint; patient supine, guiding patients with healthy limbs holding the bedstead. Assist patients to lift the affected limb, to ensure that the limb can leave the bed, feet to the knees close together, knees have 90 degrees of flexion, the waist up quite as high as; turn over training： left turn, left lower limb in the guide to the right side, in turn, to ensure that the right lower limb in above; swallowing training： guidingpatients with telescopic tongue, closed, more than 3 training/d, each of about 10 times the practice; to guide the patients after blowing training： closed to ensure gas fills the eheeks, cheeks after the drum The gas exhaled gently, 2 times/d, each 5 times; stick exercises： avoid shoulder joint movement, choose the length 1-1.2m, 3-3.5cm in diameter stieks, guide the patients to hold the sticks, par slightly narrow, with a healthy limb hand hand motion, straight forward to do two cubits, press, straight arm swing, arm around shoulder extension, forearm pronation and supination external rotation, rotation and training within 4/d shoulder, acupuncture treatment with the control group. Continuous treatment for 10 months for a course of 1. The clinical symptoms, physieal activity, life ability score, satisfaction and adverse reactions were observed. Treatment 1 course of treatment （for 10 months）, judge curative effect. [Result] In the treatment group, 22 eases were markedly effective, effective in 19 eases, ineffective in all eases, the total effective rate was 97.62%, the control group was markedly effective in 17 eases, effective in 16 eases, ineffective in 9 eases, the total effeetive rate was 78.57%; the treatment group was better than the eontrol group （P〈0.01）. Life ability score of the two groups were improved （P〈0.01）, the treatment group was better than the control group （P〈0.01）. Satisfaction with the treatment group was better than the eontrol group （P〈0.05）. [Conclusion] The community rehabilitation training combined acupuncture treatment of limb dysfunction after stroke, curative effeet is satisfied, no serious adverse reactions, worthy of promotion.