头针带针康复训练治疗中风偏瘫随机平行对照研究

Randomized Parallel Contrast Study of Scalp Acupuncture with Needle Combined with Rehabilitation on Apoplectic Hemiplegia

[目的]观察头针带针康复训练治疗中风偏瘫疗效。[方法]使用随机平行对照方法,将60例住院诊患者按随机数字表法随机分为两组。对照组30例体针,手足阳明经穴为主,辅以太阳、少阳经穴。取偏瘫侧肩髃、曲池、手三里、外关、合谷、环跳、风市、足三里、解溪、三阴交、太冲等。风痰瘀阻加中脘、丰隆、膈俞、血海、风池;气虚络瘀加关元、气海、足三里、膈俞、血海;肝肾亏虚加肝俞、肾俞、太溪。用平补平泻手法,留针30 min。康复训练,起针后,根据康复评估结果,选择性的使用神经发育疗法、Bolath、PNF、运动再学习疗法、作业疗法、平衡功能训练等肢体功能康复训练。采取"一对一"的训练方法,每次训练时间以30 min为宜,根据个体情况,制定个体化、针对性的康复训练方案。治疗组30例头针,顶颞前斜线(前神聪至悬厘);顶中线(百会穴至前顶穴之间的连线)。常规消毒,0.35 mm×40 mm毫针,与头皮呈15°~30°角,沿运动区上3/5按照从后向前的方向接力平刺,可连续针刺3~4针,每针均刺入帽状腱膜下的疏松结缔组织层,患者做咀嚼、转颈、耸肩动作,若针刺处疼痛,调整针刺角度及深度至患者耐受方可留针。顶中线沿前顶穴向百会穴透刺1针,均快速刺入帽状腱膜下,捻转200次/min。或滞针手法,使患者头部有紧胀感,留针30min。体针同对照组。连续治疗6周为1疗程。观测神经功能缺损程度评分、Barthel评分、不良反应。[结果]连续治疗1疗程(6周),判定疗效。治疗组基本痊愈6例,显著进步13例,进步8例,无变化3例,恶化0例,总有效率90.00%;对照组基本痊愈3例,显著进步11例,进步9例,无变化7例,恶化0例,总有效率76.70%(P>0.05),神经功能缺损程度评分和日常生活活动能力评定,治疗组优于对照组(P<0.05)。[结论]头针带针康复训练治疗中风偏瘫,疗效满意,无严重不良反应,值得推广。

[Objective]To observe the clinical efficacy of scalp acupuncture with needle combined with rehabilitation on apoplectic hemiplegia.[Methods]Using the randomized parallel control method,60 patients were randomly divided into two groups according to the randomized number table method.In the control group(30 cases),the acupoints were mainly hand and foot Yangming meridians,supplemented by Taiyang and Shaoyang meridians.Jianyu(LI15),Quchi(LI11),Shousanli(LI10),Waiguan(SJ5),Hegu(LI4),Huantiao(GB30),Fengshi(GB31),Zusanli(ST36),Jiexi(ST41),Sanyinjiao(SP6),Taichong(LR3)and so on of the hemiplegia side were selected.Wind-phlegm and blood stasis sydrome would addtionally use Zhongwan(RN12),Fenglong(ST40),Geshu(BL17),Xuehai(SP10)and Fengchi(GB20).Qi deficiency and blood stasis syndrome would addtionally used Guanyuan(RN4),Qihai(RN6),Zusanli(ST36),Geshu(BL17)and Xuehai(SP10).Deficiency of liver and kidney sydnrome would addtionally used Ganshu(BL18),Shenshu(BL23)and Taixi(KI3).We used the even reinforcing-reducing manipulation and the needles were remained for 30 minutes.After acupuncture,according to the results of rehabilitation evaluation,we selectively used the neurodevelopmental therapy,Bolath,PNF,motor relearning program,occupation therapy,balance functional training and other functional rehabilitation training.The"1 to 1"training method was adopted.Each training time was for 30 minutes.According to individual conditions,an individualized and targeted rehabilitation training program was formulated.The treatment group(30 cases)was treated with scalp acupuncture at vertex-temporal anterior oblique lineparietal[Qianshenchong(EX-HN1)to Xuanli(GB6)]and the middle line of vertex[connection between Baihui(DU20)and Qianding(DU21)].After routine disinfection,the acupunture was operated by 0.35 mm×40 mm needle,at an angle of 15°-30°from the scalp,3/5 along the area from back to the forward,continuous acupuncture 3-4 needles.Each needle was inserted into the loose connective tissue layer under the subgaleal fascial.The patients would do chewing,turning the neck and shrugging.If the acupuncture was painful,the acupuncture angle and depth would be adjusted to the patients’tolerance before leaving the needle.The acupuncture at Qianding(DU21)towards to Baihui(DU20)should be quickly penetrated the subgaleal fascialthe and turned 200 times/min or with stagnated needle technique,so that the patients’head had a feeling of tightness,remaining the needle for 30 min.The needles were the same as that of the control group.Six weeks of continuous treatment was a course of treatment.After treatment,we observed the neurofunctional defect score,Bartel score and adverse reactions.Results:After consecutive treatment 1 course(6 weeks),the effect was mearused.In the treatment group,6 cases were basically cured,13 cases were significantly improved,8 cases were improved,3 cases were unchanged,0 case was deteriorated,and the total effective rate was 90.00%.In the control group,3 cases were basically cured,11 cases were significantly improved,9 cases were improved,7 cases were unchanged,0 case was deteriorated and the total effective rate was 76.70%.The treatment group’s degree of neurological deficit scores and ADL scores were better than those of the control group.[Conclusion]Scalp acupuncture with needle combined with rehabilitation has satisfactory effect and no serious adverse reactions,which is worthy of promoting for hemiplegic patients.