头针久留配合互动式训练治疗脑卒中后上肢功能障碍疗效观察

Efficacy observation of long-retaining scalp acupuncture plus interactive training for upper-extremity dysfunction after cerebral stroke

目的:观察头针久留针配合互动式训练改善脑卒中患者上肢功能障碍的疗效.方法:将95例脑卒中后上肢功能障碍患者随机分为2组,治疗组48例,对照组47例.两组均进行常规内科基础治疗.两组头针均选取病灶同侧(偏瘫肢体对侧)顶颞前斜线中2/5、顶颞后斜线中2/5.治疗组头针留针7 h并配合互动式训练,对照组仅留针7 h,不进行互动式训练.两组均于治疗前、治疗2周和4周后进行香港版偏瘫上肢功能测试(FTHUE-HK)和简化Fugl-Meyer上肢运动功能评定量表(FMA-UE)评分.结果:治疗组总有效率为97.9%,对照组为74.5%,治疗组总有效率高于对照组(P<0.01).两组治疗2周和4周后的FTHUE-HK评分均高于本组治疗前,组内差异均有统计学意义(均P<0.001);两组治疗4周后的FTHUE-HK评分均高于本组治疗2周后,组内差异均具有统计学意义(均P<0.001).治疗组治疗2周和4周后的FTHUE-HK评分均高于同时间点对照组,组间差异均具有统计学意义(均P<0.05).治疗组在整个治疗期间FTHUE-HK评分虽高于对照组,但两组在治疗2周内的差异趋势无统计学意义(P>0.05),在治疗4周后的差异趋势,具有统计学意义(P<0.05).两组治疗2周和4周后FMA-UE评分均高于本组治疗前,组内差异均具有统计学意义(均P<0.001),且两组治疗4周后FMA-UE评分均高于本组治疗2周后,组内差异均具有统计学意义(均P<0.001).治疗组在治疗2周和4周后的FMA-UE评分均高于同时间点对照组,组间差异均具有统计学意义(均P<0.01).随着治疗次数的增加,两组的FMA-UE评分均逐渐升高,两组FMA-UE评分在治疗2周和4周后的差异趋势,均具有统计学意义(均P<0.05).结论:头针久留针配合互动式训练在改善脑卒中后上肢功能障碍方面疗效优于单纯头针久留针,且持续治疗2周以上时,疗效优势更明显.

Objective:To observe the efficacy of long-retaining scalp acupuncture plus interactive training in improving upper-extremity dysfunction in cerebral stroke patients.Methods:Ninety-five patients with upper-extremity dysfunction after cerebral stroke were randomized into two groups,with 48 cases in the treatment group and 47 cases in the control group.Conventional internal medicine treatment was offered to both groups.In both groups,Anterior Oblique Line of Vertex-temporal(MS 6,the middle 2/5)and Posterior Oblique Line of Vertex-temporal(MS 7,the middle 2/5)were selected from the same side of the brain lesion(the side apposing to the hemiplegic limb)for scalp acupuncture treatment.In the treatment group,the scalp acupuncture needles were retained for 7 h,in combination with interactive training,while the needles were also retained for 7 h in the control group but without interactive training.Prior to treatment and at 2-week and 4-week treatment,the two groups were scored using the functional test for the hemiplegic upper extremity-Hong Kong(FTHUE-HK)and simplified Fugl-Meyer assessment-upper extremity(FMA-UE).Results:The total effective rate was 97.9%in the treatment group,higher than 74.5%in the control group(P<0.01).The FTHUE-HK score was higher at 2-week and 4-week treatment than before treatment in both groups,presenting statistically significant intra-group differences(all P<0.001);the FTHUE-HK score was higher at 4-week treatment than at 2-week treatment in both groups,presenting statistically significant intra-group differences(both P<0.001).At 2-week and 4-week treatment,the FTHUE-HK score was higher in the treatment group than in the control group,showing significant between-group differences(both P<0.05).During the whole treatment process,the treatment group had higher FTHUE-HK scores compared with the control group,but there was no statistical significance comparing the change of the score between the two groups at 2-week treatment(P>0.05),while the between-group difference in the change of the score was statistically significant at 4-week treatment(P<0.05).The FMA-UE score was higher at 2-week and 4-weeks treatment than before treatment in both groups,presenting statistically significant intra-group differences(all P<0.001);the FMA-UE score was higher at 4-week treatment than at 2-week treatment in both groups,presenting statistically significant intra-group differences(both P<0.001).At 2-week and 4-week treatment,the FMA-UE was higher in the treatment group than in the control group,and the between-group differences were statistically significant(both P<0.01).The FMA-UE score rose gradually with the increase of treatment session,and there was statistical significance comparing the change of the score between the two groups at 2-week and 4-week treatment,respectively(both P<0.05).Conclusion:Long-retaining scalp acupuncture plus interactive training results in more significant efficacy than long-retaining scalp acupuncture alone in improving the upper-limb dysfunction after cerebral stroke and the advantage becomes more notable after 2-week consecutive treatment.