指压穴位刺激对早期脑卒中偏瘫患者踝背屈功能的影响

The effects of acupressure acupoint stimulation on ankle dorsiflexion in stroke patients within early stage

目的:观察指压穴位刺激对早期脑卒中偏瘫患者踝背屈功能的影响。方法:45例偏瘫患者,随机分为指压穴位组、电针组和神经肌肉电刺激组各15例。3组在常规药物和物理治疗的基础上,指压穴位组增加前期系列研究制定的指压穴位刺激法提高偏瘫侧胫前肌、腓骨长短肌兴奋性的综合方案干预;电针组电针偏瘫侧足三里穴、足临泣穴;神经肌肉电刺激组电刺激偏瘫侧胫前肌、腓骨长短肌。3组踝关节干预时间均为每次10min,每天1次,每周5天,疗程8周。分别于治疗前、治疗4w后、治疗8w后,评估以下指标:患侧踝背屈协同收缩率(co-contraction ratio,CCR)、患侧踝背屈主动活动范围(active range of motion,AROM)、患侧简式Fugl-Meyer运动功能评分(踝关节运动控制部分)。结果:①3组治疗前后比较:3组的各项指标治疗前、治疗4w后、治疗8w后两两比较均有显著性差异(P<0.05),患侧踝背屈CCR逐步降低、患侧踝背屈AROM和简式Fugl-Meyer运动功能评分逐步增高;②3组间比较:患侧踝背屈CCR、AROM:3组间治疗前两两比较均无显著性差异(P>0.05);指压穴位组的治疗4w后、治疗8w后的患侧踝背屈CCR分别低于电针组、神经肌肉电刺激组,具有显著性差异(P<0.05),而AROM分别高于电针组、神经肌肉电刺激组,具有显著性差异(P<0.05);电针组较神经肌肉电刺激组的治疗4w后、治疗8w后均无显著性差异(P>0.05);简式Fugl-Meyer运动功能评分:3组间治疗前、治疗4w后、治疗8w后两两比较均无显著性差异(P>0.05)。结论:指压穴位刺激法可有效改善早期脑卒中偏瘫患者踝背屈功能。

Objective: To observe the effects of acupressure acupoint stimulation on ankle dorsiflexion in stroke patients within early stage.Method: Totally 45 hemiplegic patients were divided into 3 groups randomly: acupressure acupoint stimulation group(n=15), electroacupuncture group(n=15) and neuromuscular stimulation group(n=15). Three groups all accepted the traditional medication and physical treatment. Participants in acupressure acupoint stimulation group accepted integrated acupressure acupoint stimulation program which had been described in previous investigations to excite the tibialis anterior and fibula long, short muscle of affected side. Electroacupuncture was applied to Zusanli point(ST36) and Zulinqi point(GB41) of affected side in electroacupuncture group. Electrical stimulation was delivered to tibialis anterior and fibula long, short muscle of affected side in neuromuscular stimulation group. Each intervention lasted 10 minutes, once a day, 5 times per week for 8 weeks. Ankle dorsiflexion co-contraction ratio(CCR), active range of motion(AROM) of ankle dorsiflexion and ankle motor control on shorted Fugl-Meyer motor scale were accessed before, 4 and 8 weeks after intervention.Result:(1) The results between pre-,4 and 8 weeks after intervention showed significant difference(P<0.05).CCR of affected ankle decreased whereas AROM and shorted Fugl-Meyer motor function scale of affected ankle increased stage by stage.(2)CCR and AROM between 3 groups showed no significant differences before intervention(P>0.05). Compared to another two groups, CCR of affected ankle in acupressure acupoint stimulation group was lower at both 4 and 8 weeks after intervention(P<0.05) respectively. Furthermore, AROM of affected ankle in acupressure acupoint stimulation group was significantly higher compared to another two groups(P<0.05) respectively. There were no notable differences between electroacupuncture group and neuromuscular stimulation group at both 4 and 8 weeks after intervention(P>0.05). Referring to shorted Fugl-Meyer motor scale, no significant difference happened between 3 groups at any time nodes of assessment(P>0.05).Conclusion: Acupressure acupoint stimulation could significantly improve ankle dorsiflexion ability of affected side in hemiplegic patients within early stage.