放血疗法联合基础疗法治疗血瘀型脑卒中后足内翻28例

Bloodletting Therapy Combined with Basic Therapy in Treatment of Post-Stroke Strephenopodia with Blood Stasis in 28 Cases

目的探讨放血疗法联合基础疗法治疗脑卒中后足内翻的临床疗效。方法将就诊于福建中医药大学附属人民医院的62例血瘀型脑卒中后足内翻住院患者根据随机数字表法分为治疗组和对照组各31例,试验期间治疗组脱落3例,对照组脱落2例。2组均行常规内科治疗、康复治疗等基础疗法,治疗组另选取丘墟、照海、太溪、昆仑等穴行放血疗法,隔日1次,每周3次,对照组加常规针刺治疗,选穴同治疗组,每日1次,每周5次,2组疗程均为4周。比较治疗前后2组踝关节内翻角度、临床痉挛指数(CSI)、下肢Fugl-Meyer运动功能量表(FMA-L)评分、胫神经H反射潜伏期及H反射最大波幅与M反射最大波幅之比(H_(max)/M_(max))变化情况。结果与治疗前比较:治疗后2组踝关节内翻角度、CSI均改善(P均<0.05),且治疗组改善程度优于对照组;FMA-L评分均升高(P<0.05),但治疗后2组比较无统计学意义(P>0.05);2组胫神经H反射潜伏期均延长(P均<0.01),Hmax/Mmax均降低(P均<0.01),且治疗组改善程度均优于对照组(P均<0.01)。结论在内科治疗、康复治疗等基础疗法上配合放血疗法和针刺治疗均可降低血瘀型脑卒中后足内翻患者下肢肌张力,改善踝关节痉挛状态及提高下肢运动功能,但配合放血疗法在改善胫神经H反射相关参数及降低痉挛程度方面均优于配合常规针刺疗法。

Objective:To explore the clinical effect of bloodletting therapy combined with basic therapy in the treatment of post-stroke strephenopodia.Methods:A total of 62 patients with post-stroke strephenopodia with blood stasis were randomly divided into the treatment group and the control group,with 31 cases in each group.During the experiment,3 cases fell off in the treatment group and 2 cases fell off in the control group.Both groups received basic therapies such as routine medical treatment and rehabilitation.The treatment group was given bloodletting,selecting Qiuxu(GB 40),Zhaohai(KI 6),Taixi(KI 3),Kunlun(BL 60),once every other day,3 times a week.The control group received conventional acupuncture treatment,and the selection of points was the same as that of the treatment group,once every other day,5 times a week,and the course of treatment in both groups was 4 weeks.The clinical spasticity index(CSI)score,Fugl-Meyer Assessment of lower limb(FMA-L),tibial nerve H reflex latency and the ratio of the maximum amplitude of H reflection to the maximum amplitude of M reflection(H_(max)/M_(max))were observed.Results:Compared with before treatment,the ankle inversion angle and CSI scores of the two groups were significantly improved after treatment(P<0.05),and the improvement degree of the treatment group was better than that of the control group;The FMA-L scores of two groups were significantly increased(P<0.01),but there was no significant difference between the two groups after treatment(P>0.05);The H reflex latency of the tibial nerve in the two groups were significantly prolonged(both P<0.01),Hmax/Mmax were both significantly decreased(P<0.01),and the improvement degree of the treatment group was significantly better than that of the control group(P<0.01).Conclusions:Combining basic therapies such as routine medical treatment and rehabilitation therapy with bloodletting and acupuncture can reduce muscle tension of the lower limbs of patients with post-stroke strephenopodia of blood stasis,improve the state of ankle joint spasm,and improve the motor function of the lower limbs.However,combined with bloodletting therapy is superior to conventional acupuncture therapy in improving the relevant parameters of tibial nerve H reflex and reducing spasm.