纳甲法选穴针刺治疗脑卒中下肢痉挛偏瘫的临床观察

Clinical Observation of Acupuncture at Acupoints Selected by Na Jia Method for Lower-limb Spastic Hemiplegia after Cerebral Stroke

目的观察周铭心教授研创的子午流注纳甲法取穴卡选穴针刺对脑卒中下肢痉挛偏瘫的改善情况。方法将84例脑卒中下肢痉挛偏瘫的患者采用随机数字表法分为治疗组、对照组和空白组,每组28例。空白组采用单纯的康复治疗;对照组在康复基础上加用普通针刺;治疗组在对照组基础上采用子午流注纳甲法选穴针刺。观察3组治疗前后Ashworth痉挛评定等级、Barthel指数及简化Fugl-Meyer下肢运动功能评分变化。结果3组治疗前后简化Fugl-Meyer下肢运动功能评分比较,差异有统计学意义(P<0.01)。3组治疗后简化Fugl-Meyer下肢运动功能评分比较,差异有统计学意义(P<0.01),治疗组优于对照组和空白组(P<0.01),对照组与空白组比较,无显著差异(P>0.05)。3组治疗前后Barthel指数评分、Ashworth肌痉挛评定比较,差异有统计学意义(P<0.01,P<0.05)。3组治疗后Barthel指数评分、Ashworth肌痉挛评定比较,差异具有统计学意义(P<0.01),治疗组疗效最优(P<0.01,P<0.05)。结论子午流注纳甲法选穴针刺配合普通针刺和康复治疗对改善肌张力、提升下肢运动功能和生活质量疗效肯定,此子午流注选穴卡操作运用简便,准确率高,可供临床医者拓展和运用。

Objective To observe the effect of acupuncture at acupoints selected by Zi Wu Liu Zhu Na Jia point-selection card invented by professor ZHOU Ming-xin method （midnight-noon ebb-flow） in improving lower-limb spastic hemiplegia after cerebral stroke. Method Eighty-four patients with lower-limb spastic hemiplegia after cerebral stroke were randomized into a treatment group, a control group, and a blank group by using random number table method, 28 cases in each group. The blank group was only given rehabilitation; the control group was treated with ordinary acupuncture in addition to rehabilitation; the treatment group was intervened by acupuncture at acupoints selected by Zi Wu Liu Zhu Na Jia method in addition to the intervention given to the control group. The Ashworth Scale, Activities of Daily Living （ADL） in Barthel Index （BI） and simplified Fugl-Meyer Assessment （FMA） of lower-limb function were observed before and after the intervention. Result After the treatment, the simplified FMA scores were changed significantly in the three groups （P〈0.01）. After the treatment, the between-group differences in comparing the simplified FMA score were statistically significant （P〈0.01）, and the treatment group was superior to both the control group and blank group （P〈0.01）, while the difference between the control group and blank group was statistically insignificant （P〉0.05）. The ADL from BI and Ashworth scores were significantly changed after the treatment in the three groups （P〈0.01, P〈0.05）. After the treatment, the between-group differences in comparing the ADL score and Ashworth grading were statistically significant （P〈0.01）, and the therapeutic efficacy was the best in the treatment group （P〈0.01,P〈0.05）. Conclusion Acupuncture at acupoints selected by Zi Wu Liu Zhu Na Jia method plus ordinary acupuncture and rehabilitation is effective in improving muscular tension, enhancing lower-limb motor function and the quality of life; the Zi Wu Liu Zhu point-selection card is easy-to-operate and has a high accuracy, thus suitable for application and promotion in clinic.