基于德尔菲针刺方案改善卒中后平衡功能障碍的临床研究

Using a Delphi consensus process to develop an acupuncture treatment protocol for people with post-stroke balance dysfunction:A clinical research

目的:观察德尔菲针刺穴组方案对脑卒中平衡功能障碍患者的影响,为社区治疗脑卒中后平衡功能障碍提供有效、规范的针刺方案。方法:共招募105例脑卒中平衡功能障碍患者,随机分为3组,其中试验组35例,对照组36例,空白组34例。试验组接受德尔菲针刺治疗方案+基础治疗;对照组接受常规辨证取穴针刺治疗方案+基础治疗;空白组仅接受基础治疗。针刺治疗时间为30min/次,1次/d,6次/周,共4周。所有受试者均于治疗开始前和治疗结束后进行结局指标的评定。结果:(1)3组患者治疗前一般资料、结局指标表评分无明显差异;(2)干预结束后,3组患者的FMA-LE、BBS、MBI评分较治疗前提高(P<0.01);(3)干预结束后,3组患者的Ashworth评分较治疗前差异无统计学意义;(4)干预结束后,试验组及对照组患者的FMA-LE值、BBS值、MBI值的改善程度均优于空白组(P<0.05,P<0.01),但两组间比较差异无统计学意义。结论:德尔菲针刺穴组方案能够改善脑卒中患者平衡功能和日常生活活动能力。

Objective： To observe the effect of acupuncture point scheme on the balance dysfunction of stroke patients in order to provide an objective theoretical basis for promoting the formation of standardized acupuncture treatment program in the clinical practice. Methods： A multi-center randomized, single-blind, parallel-controlled trial was designed with a sample of 105 participants. All participants were randomly divided into 3 groups, including trial group（35 cases）, control group（36 cases） and blank group（34 cases）. Participants in trial group received 4-week Delphi acupuncture treatment plus basic treatment, which will under the professional acupuncture therapist, participants in control group received 4-week conventional dialectical acupuncture treatment plus basic treatment, while participants in blank group only received the basic treatment without acupuncture treatment. The time of acupuncture treatment was 30 min/time, 1 time/d, 6 times/week, and 4 weeks in total. Each participant＇s baseline information and indicators before trial starts were collected, and all outcome indicators were evaluated at 4 weeks. Results：（1）There were no significant differences in the general condition of patients between three groups before treatment, meanwhile, there was no statistical difference between three groups in the initial functional assessment score.（2）After treatment, the FMA-LE scores, BBS scores, MBI scores of three groups patients were significantly improved（P0.01）.（3）After treatment, the Ashworth score of three groups had no significant statistical difference compared with initial assessment score.（4）Compared with the blank group, the degree of FMA-LE, BBS, MBI scores in the trial group and control group significantly improved after treatment（P0.05, P0.01）. Compared with the control group, the degree of FMA-LE, BBS, MBI scores in the trial group had no significantly difference. Conclusion： Delphi acupuncture point scheme could improve the balance function and activities of daily living of patients with stroke.