运动想象针法改善脑卒中早期上肢偏瘫患者肌张力的优效性观察

Superiority of motor imagery acupuncture in improving muscle tension for patients with upper limb hemiplegia of stroke in early stage

目的:验证运动想象针法改善脑卒中早期上肢偏瘫患者肌张力的优效性。方法:将64例上肢处于软瘫期的脑卒中偏瘫患者,随机分为观察组(32例,脱落1例)和对照组(32例,脱落4例)。观察组采用运动想象针法(针刺治疗同时进行患侧上肢的运动想象疗法)治疗;对照组采用针刺与患侧上肢运动想象疗法(针刺后2h进行)分开治疗,留针期间同时进行下肢运动想象疗法,两组均穴取百会透健侧太阳,风池,患侧肩髃、肩井、曲池、外关等,每日治疗1次,每周5次,共治疗4周。分别于治疗前后及治疗结束后4、8周,比较两组患者改良Ashworth量表(MAS)分级和Brunnstrom分期的变化。结果:与治疗前比较,两组患者治疗后各时间点肩部、肘部、腕部的肌张力均升高(P<0.05)。治疗后,观察组肘部MAS分级Ⅱ级以下比例高于对照组(P<0.05);治疗结束后4周和治疗结束后8周,观察组肩部、肘部、腕部MAS分级Ⅱ级以下比例均高于对照组(P<0.01)。治疗后各时间点两组患者臂部及手部Brunnstrom分期均较前一时间点增高(P<0.05),且观察组均高于对照组(P<0.05)。结论:对于上肢处于软瘫期的脑卒中偏瘫患者,运动想象针法能更好地促进偏瘫上肢肌张力的恢复,使患者逐渐向有分离的精细运动模式转变,抑制和减轻痉挛的出现和发展。

Objective To verify the superiority of motor imagery acupuncture in improving muscle tension for patients with upper limb hemiplegia in early stroke. Methods A total of 64 patients of stroke hemiplegia with upper limb flaccid paralysis were randomly divided into an observation group(32 cases, 1 case dropped off) and a control group(32 cases, 4 cases dropped off). The observation group was treated with motor imagery acupuncture(both acupuncture and motor imagery therapy at affected upper limb were performed).The control group was treated with acupuncture plus motor imagery therapy at affected lower limb, 2 h later after acupuncture, motor imagery therapy was applied to upper limb. Baihui(GV 20) to Taiyang(EX-HN 5) of healthy side, Fengchi(GB 20) and Jianyu(LI 15), Jianjing(GB 21), Quchi(LI 11), Waiguan(TE 5) on the affected side, ect. were selected in both groups, once a day, 5 times a week for 4 weeks. Before and after treatment, 4, 8 weeks after treatment, the modified Ashworth scale(MAS) grade and Brunnstrom stage were compared in the two groups. Results Compared before treatment, the muscle tension of shoulder, elbow and wrist each time point after treatment was increased in the two groups(P<0.05). After treatment, the proportion less than grade Ⅱ of elbow MAS grade in the observation group was higher than the control group(P<0.05);4 and 8 weeks after treatment, the proportion less than grade Ⅱ of shoulder, elbow and wrist MAS grades in the observation group was higher than the control group(P<0.01). The Brunnstrom stage of arm and hand each time point after treatment was higher than the previous time point in the two groups(P<0.05), those in the observation group was higher than the control group(P<0.05). Conclusion Motor imagery acupuncture could promote hemiplegia upper limb muscle tension recovery in patients of stroke hemiplegia with upper limb flaccid paralysis, make the patients gradually shift to the separate fine movement mode, inhibit and relieve the appearance and development of spasm.