调神解痉针刺法治疗中风后上肢痉挛性瘫痪临床观察

Clinical Observation of Tiao Shen Jie Jing Needling in Treating Post-stroke Upper-limb Spastic Palsy

目的观察调神解痉针刺法治疗中风后上肢痉挛性瘫痪的临床疗效。方法将90例中风后上肢痉挛性瘫痪患者随机分为观察组和对照组,每组45例。观察组予调神解痉针刺法治疗,对照组予常规针刺治疗。观察记录治疗前、治疗2星期、治疗4星期和治疗后3个月改良Ashworth痉挛分级量表(MAS)、上肢运动功能简化Fugl-Meyer量表(SFMA)及日常生活能力Barthel指数评分,并于治疗前后测定患者血清?-氨基丁酸(GABA)浓度水平。结果观察组总有效率为83.3%,对照组总有效率为61.0%,观察组疗效优于对照组(P<0.05)。两组患者治疗后各项评分与同组治疗前比较均有改善(P<0.05),且观察组的改善更明显(P<0.05)。在随访时,观察组各项评分有持续改善,优于对照组(P<0.05);观察组治疗后GABA浓度水平高于对照组(P<0.05)。结论调神解痉针刺法可有效改善患者上肢痉挛状态,改善上肢运动功能,提高日常生活能力,并能够保持远期疗效,优于常规取穴治疗,其作用机制与调节血清GABA水平相关。

Objective To observe the clinical efficacy of Tiao Shen Jie Jing needling （regulating the mind and release spasm） in treating post-stroke upper-limb spastic palsy. Method Ninety patients with post-stroke upper-limb spastic palsy were randomized into an observation group and a control group, 45 cases each. The observation group was intervened by Tiao Shen Jie Jing needling, while the control group was given ordinary acupuncture. The Modified Ashworth Scale （MAS）, short-form Fugl-Meyer Assessment （SFMA） and Barthel Index （BI） were evaluated and recorded prior to the treatment, after 2-week and 4-week treatment and 3 months later after the intervention; the serum γ-aminobutyric acid （GABA） was detected before and after the treatment. Result The total effective rate was 83.3% in the observation group versus 61.0% in the control group, and the efficacy of the observation group was superior to that of the control group （P〈0.05）. The scores of each scale showed improvements after the treatment in both groups （P〈0.05）, and the improvements in the observation group were more significant （P 〈 0.05）. The follow-up showed continuing improvements in the scales in the observation group, which were superior to those in the control group （P〈0.05）; after the treatment, the content of GABA in the observation group was significantly higher than that in the control group （P〈0.05）. Conclusion Tiao Shen Jie Jing needling can effectively ameliorate the upper-limb spasm, as well as the motor function of the upper extremities, improve the activities of daily living and maintain a long-term efficacy, better than ordinary acupuncture. The action mechanism is related to the regulation of GABA content in serum.