针灸联合瓜蒌桂枝汤对脑卒中后上肢屈肘痉挛状态及肌电积分值的影响

Clinical Study on Acupuncture and Moxibustion Combined with Gualou Guizhi Decoction on Upper Limb Elbow Flexion Spasm and EMG Integral Value after Stroke

目的:探究针灸联合瓜蒌桂枝汤对脑卒中后上肢屈肘痉挛状态及肌电积分的影响。方法:选取2016年11月至2019年1月延安大学附属医院收治的脑卒中后上肢屈肘痉挛患者116例作为研究对象,按照就诊顺序编号随机分为对照组和观察组,每组58例。对照组常规康复训练并口服巴氯芬片,观察组在对照组基础上加用针灸联合瓜蒌桂枝汤治疗,均治疗4周。观察2组治疗前、完成治疗临床痉挛指数(CSI)、改良Barthel指数(MBI)、改良Ashworth量表(MAS)、简式Fugl-meyer运动量表(FMA)、肌电积分值、肌电F波、生命质量并比较;治疗后评估疗效。结果:治疗后2组CSI、MAS较治疗前显著下降,MBI、FMA较治疗前显著升高,差异有统计学意义(P<0.05),治疗后观察组MBI、FMA显著高于对照组,CSI、MAS显著低于对照组,差异有统计学意义(P<0.05)。治疗后2组肱二头肌、尺侧腕屈肌、三角肌较治疗前显著下降,肱三头肌则显著升高,差异有统计学意义(P<0.05)。治疗后观察组肱三头肌显著高于对照组,余均显著低于对照组,差异有统计学意义(P<0.05)。治疗后2组肌电F波波幅较治疗前显著下降,阈值较治疗前显著升高,差异有统计学意义(P<0.05),治疗后观察组阈值显著高于对照组,波幅显著低于对照组,差异有统计学意义(P<0.05)。治疗后2组精力影响、家庭角色、语言功能、活动能力、情绪影响、自理能力较治疗前显著升高,差异有统计学意义(P<0.05),治疗后观察组以上指标显著高于对照组,差异有统计学意义(P<0.05)。治疗后观察组治疗有效率显著高于对照组,差异有统计学意义(P<0.05)。结论:针灸联合瓜蒌桂枝汤能通过改善脑卒中上肢屈肘痉挛肌电,促进血液循环,提高生命质量和疗效。

Objective:To explore the effect of acupuncture combined with Gualou Guizhi Decoction on spasticity of elbow flexion and EMG integral of upper limbs after stroke.Methods:A total of 116 patients with upper extremity elbow flexion spasm after stroke were enrolled in Yan′an University Affiliated Hospital from November 2016 to January 2019.They were randomly divided into a control group(58 cases)and an observation group(58 cases).The control group received routine rehabilitation training and oral baclofen tablets.The observation group was treated with acupuncture and moxibustion combined with Gualou Guizhi Decoction on the basis of the control group for 4 weeks.The clinical spasm index(CSI),modified Barthel index(MBI),modified Ashworth scale(MAS),simple Fugl-meyer motor scale(FMA),EMG integral value,EMG F wave and quality of life were observed and compared before and after treatment in the 2 groups.Results:1)After treatment,CSI and MAS in the 2 groups decreased significantly,and MBI and FMA increased significantly(P<0.05).MBI and FMA in the observation group were significantly higher than those in the control group,and CSI and MAS were significantly lower than those in the control group(P<0.05).2)After treatment,biceps brachii,flexor carpi ulnaris and deltoid muscles decreased significantly in both groups,while triceps brachii increased significantly(P<0.05).After treatment,triceps brachii in the observation group was significantly higher than that in the control group,and the rest were significantly lower than that in the control group(P<0.05).3)After treatment,the F wave amplitude of EMG in both groups decreased significantly,and the threshold value increased significantly(P<0.05).After treatment,the threshold value in the observation group was significantly higher than that in the control group,and the amplitude was significantly lower than that in the control group(P<0.05).4)After the completion of treatment,the energy impact,family role,language function,activity ability,emotional impact and self-care ability of the 2 groups were significantly increased than those before treatment(P<0.05),and the above indicators in the observation group were significantly higher than those in the control group(P<0.05).After the completion of treatment,the marked efficiency and total efficiency of the observation group were significantly higher than those of the control group,and the difference was statistically significant(P<0.05).Conclusion:Acupuncture and moxibustion combined with Gualou Guizhi Decoction can improve the quality of life and curative effect by improving the electromyogram of upper limb flexion and elbow spasm and promoting blood circulation.