当归四逆汤加减熏洗对痉挛型脑瘫患儿运动功能康复的疗效观察

Effect of Addition and Subtraction Treatment of Danggui Sinitang Combined with Fumigation and Washing with Medicinal Solution for Motor Function of Children with Spastic Cerebral Palsy

目的：观察当归四逆汤加减熏洗对痉挛型脑瘫患儿运动功能康复的疗效,对促-抗炎因子的调节作用和血液流变学的影响。方法：将108例患儿采用SAS软件生成,随机按1∶1比例分为对照组和观察组各54例。对照组参照《中国脑性瘫痪康复指南》以康复训练为主,采用Bohath疗法和Vojta疗法,40 min/次,1次/d,6次/周,休息1 d。观察组在对照组康复治疗的基础上,给予当归四逆汤加减熏洗,30 min/次,1次/d,6次/周,休息1 d。两组疗程均为连续治疗6周。进行治疗前后粗大运动功能测试（GMFM）和精细运动能力测试;痉挛程度采用改良Ashworth量表（MAS）和临床痉挛指数（CSI）,于治疗前后各评价1次;检测治疗前后肿瘤坏死因子-α（TNF-α）,白细胞介素-6（IL-6）和IL-10水平及血液流变学指标。结果：治疗后观察组患儿GMFM量表的A,B,C 3个功能区评分和GMFM总分均高于对照组（P〈0.01）;观察组患儿FMFM量表B,C,D,E功能区评分和FMFM分值均高于对照组（P〈0.01）;观察组患儿MAS分级轻于对照组（Z=2.465,P〈0.05）;观察组患儿CSI分级轻于对照组（Z=1.975,P〈0.05）;观察组患儿TNF-α,IL-6水平均低于对照组,IL-10水平高于对照组（P〈0.01）;观察组患儿全血黏度（高切、低切）、血浆黏度、纤维蛋白原、血小板聚集率均低于对照组（P〈0.01）。结论：在Bohath和Vojta康复技能训练的基础上,采用当归四逆汤加减熏洗治疗痉挛型脑瘫可进一步提高患儿的粗大运动功能和精细运动功能,提高肌力,减轻痉挛程度,并具有调节促-抗炎性反应体系和改善血液流变作用。

Objective： To observe the clinical efficacy of addition and subtraction treatment of Danggui Sinitang combined with fumigation and washing with medicinal solution for motor function of children with spastic cerebral palsy,and to investigate its＇ effect on pro-inflammatory factor,anti-inflammatory factor and hemorheology.Method： One hundred and eight patients were randomly divided into control group（54 cases） and observation group（54 cases） by random number table produced by SAS software at 1 ∶ 1. Patients in control group got rehabilitation training according to Guidelines for the Rehabilitation of Cerebral Palsy in China,accompanied by the treatment of Bohath and Vojta,40 min/time,1 time/day,6 times/week. Based on the treatment in control group,patients in observation got additional treatment of addition and subtraction of Danggui Sinitang combined with fumigation and washing with medicinal solution,30 min/time,1 time/day,6 times/week. The treatment course was 6 weeks in both groups. Before and after treatment,gross motor function measure（GMFM） and fine motor function measure（FMFM） were conducted; modified Ashworth scale（MAS） and clinic spasticity index（CSI）were evaluated both before and after treatment; and levels of tumor necrosis factor-α（TNF-α）,interleukin-6（IL-6）,IL-10 and hemorheological indexes were detected. Result： After treatment,scores of three functional areas of A,B,C of GMFM scale and the total score in observation group were higher than those in control group（P〈0. 01）. And the scores of functional areas of B,C,D,E of FMFM scale and the total score were also higher than those in control group（P〈0. 01）. Classifications of MAS and CSI in observation group were less than those in control group（Z = 2. 465,P〈0. 05 and Z = 1. 975,P〈0. 05）. Levels of TNF-α and IL-6 were lower than those in control group,and level of IL-10 was higher than that in control group（P〈0. 01）. The whole blood low and high shear viscosity,plasma viscosity,fibrinogen,and platelet aggregation rate were lower than those in control group（P〈0. 01）. Conclusion： Based on the treatment of Bohath and Vojta,treatment of addition and subtraction of Danggui Sinitang combined with fumigation and washing with medicinal solution can improve GMFM,FMFM and muscle strength,relieve the degree of spasm,and can regulate pro-inflammatory factor,anti-inflammatory factor and hemorheology.