针刺结合康复训练治疗中风后肢体痉挛疗效观察

Acupuncture combined with rehabilitation training for the limb spasm after stroke

目的:观察针刺督脉和华佗夹脊穴为主结合康复训练与单纯针刺、单纯康复训练治疗中风后肢体痉挛的临床疗效差异。方法:将90例中风后肢体痉挛患者按入院先后顺序随机分为针刺康复组、针刺组及康复组,每组30例。针刺康复组采用针刺督脉和华佗夹脊穴为主结合康复训练进行治疗,针刺组采用与针刺康复组取穴一致的单纯针刺治疗;康复组采用与针刺康复组相同康复方式的单纯康复训练治疗,均每日治疗1次,10次为一疗程,疗程间隔1 d,共治疗4个疗程。观察治疗前后修订的Ashworth评分(MAS)、临床痉挛指数(CSI)评分、Fugl-Meyer评分(FMA)、Barthel指数(BI)评分,并比较各组临床疗效。结果:3组治疗后MAS、CSI评分均较治疗前降低(均P<0.05),FMA、BI评分均较治疗前升高(均P<0.05);治疗后针刺康复组MAS、CSI、FMA、BI各评分均较针刺组和康复组改善更明显(均P<0.05);针刺组和康复组之间各评分比较差异均无统计学意义(均P>0.05)。针刺康复组、针刺组和康复组的总有效率分别为90.0%(27/30)、76.7%(23/30)和73.3%(22/30),针刺康复组临床疗效优于针刺组和康复组(均P<0.05)。结论:针刺督脉和华佗夹脊穴为主结合康复训练在降低中风后肢体痉挛患者的肌张力方面,明显优于单纯康复训练和单纯针刺治疗,可更好地提高中风患者日常生活活动能力及运动功能。

Objective To observe the different clinical effects on the limb spasm after stroke among acupuncture mainly at governor vessel（GV） and Jiaji（EX-B 2） combined with rehabilitation training, simple acupuncture and simple rehabilitation training. Methods Ninety patients according to admission sequence were randomized into a combination group, an acupuncture group and a rehabilitation group, 30 cases in each one. The comprehensive treatment was applied in the combination group. The same acupuncture was used in the acupuncture group; the same rehabilitation was used in the rehabilitation group. All the treatment was given for 4 courses with 1 d between the two courses, 10 times as one course, once a day. The modified Ashworth score（MAS）, clinic spasticity index（CSI）, Fugl-Meyer assessment（FMA）,Barthel index（BI） were observed before and after treatment. The effects were compared among the three groups. Results After treatment, the MAS, CSI score of the three groups significantly decreased in comparison with those before treatment（all P〈0.05）, the FMA and BI score of the three groups increased in comparison with those before treatment（all P〈0.05）.The improvements for MAS, CSI, FMA and BI of the combination group were better than those of the acupuncture group and the rehabilitation group（all P〈0.05）. There were no statistical significance between the acupuncture group and the rehabilitation group（all P〈0.05）. The total effective rate of 90.0%（27/30） in the combination group was better than 76.7%（23/30） in the acupuncture group and 73.3%（22/30） in the rehabilitation group（both P〈0.05）. Conclusion Acupuncture mainly at GV and Jiaji（EX-B 2） combined with rehabilitation training are superior to simple acupuncture and simple rehabilitation training on reducing muscle tonus for stroke patients with limb spasm, which can more effectively improve the ability of daily life and motor function.