加味栝楼桂枝汤药浴联合高压氧对中风痉挛性偏瘫患者肌张力及运动功能的影响

Effect of modified Gualou-Guizhi decoction combined with hyperbaric oxygen on muscle tension and motor function in stroke patients with spastic hemiplegia

目的探讨加味栝楼桂枝汤药浴联合高压氧对中风痉挛性偏瘫患者肌张力及运动功能的影响。方法将符合入选标准的70例中风痉挛性偏瘫患者按随机数字表法分为2组,每组35例。对照组在常规治疗基础上结合高压氧,观察组在对照组基础上结合加味栝楼桂枝汤药浴。采用Lindmark量表评估肢体运动功能,采用Fugl-Meyer运动功能量表(Fugl-Meyer Assessment Scale,FMA)评估肢体运动功能障碍程度,采用改良Ashworth肌力量表(Modified Ashworth Scale,MAS)评估肌张力,采用全自动肌电图仪检测股四头肌表面肌电图均方根值(root mean square,RMS)和中位频率(frequency median,FM),评价临床疗效。结果观察组总有效率为91.4%(32/35)、对照组为71.4%(25/35),2组比较差异有统计学意义(χ^2=4.629,P=0.0314)。治疗后,观察组运动协调能力和感觉功能评分均高于对照组(t值分别为5.936、5.182,P值均<0.05);上下肢FMA评分均高于对照组(t值分别为12.310、11.996,P值均<0.01);MAS评分低于对照组(t=5.083,P=0.031)。治疗后,观察组肌电图RMS[(79.13±7.02)比(68.45±7.01),t=5.697]、FM[(99.31±9.65)Hz比(90.73±9.49)Hz,t=5.382]均高于对照组(P<0.05)。结论加味栝楼桂枝汤药浴联合高压氧可提高中风痉挛性偏瘫患者肌张力,改善肢体运动功能障碍,有助于促进患者运动功能的恢复。

Objective To observe the effect of modified Gualou-Guizhi decoction combined with hyperbaric oxygen on muscle tension and motor function in stroke patients with spastic hemiplegia.Methods A total of 70 stroke patients with spastic hemiplegia met the inclusion criteria were randomly divided into the observation group and the control group,with 35 in each group.The control group was given the conventional treatment and hyperbaric oxygen treatment,while the observation group was treated with Gualou-Guizhi decoction on the basis of the control group.Lindmark scale was used to assess limb motor function,Fugl-Meyer Assessment Scale(FMA)was used to assess the degree of limb motor dysfunction,and Modified Ashworth Scale(MAS)was used to assess muscle tension.The root mean square(RMS)and frequency median(FM)of surface electromyography of quadriceps femoris were measured by automatic electromyography,and the clinical efficacy was evaluate.Results The total effective rate of the observation group was 91.4%(32/35),and the total effective rate of the control group was 71.4%(25/35).The total effective rate of the 2 groups was statistically significant(χ^2=4.629,P=0.0314).After treatment,the scores of motor coordination ability and sensory function in the observation group were significantly higher than those in the control group(t value were 5.936,5.182,all Ps<0.05),the FMA scores of upper and lower limbs were significantly higher than those in the control group(t value were 12.310,11.996,all Ps<0.01),and the score of improved Ashworth muscle strength scale was significantly lower than that in the control group(t=5.083,P=0.031).After treatment,the EMG RMS(79.13±7.02 vs.68.45±7.01,t=5.697),FM(99.31±9.65 Hz vs.90.73±9.49 Hz,t=5.382)of the observation group were significantly higher than those of the control group(P<0.05).Conclusions The application of Gualou-Guizhi decoction add and subtract combined with hyperbaric oxygen on muscle tension and motor function in stroke patients with spastic hemiplegia can improve the muscle strength of stroke hemiplegic patients and improve the motor dysfunction of the patients,which can help to promote the recovery of the movement function of the patientst.