针刺联合康复训练对中风痉挛性偏瘫患者肌电生理指标及运动功能康复的影响

Effects of Acupuncture Combined with Rehabilitation Training on the Electromyographic Physiological Indicators and Motor Function Rehabilitation in Patients with Poststroke Plastic Hemiplegia

目的观察针刺联合康复训练对中风痉挛性偏瘫患者肌电生理指标及运动功能康复的影响。方法将84例中风痉挛性偏瘫患者随机分为治疗组和对照组,每组42例。对照组给予中风基础治疗配合康复训练治疗,治疗组在对照组治疗基础上联合针刺治疗。观察两组治疗前后运动功能[Fugl-Meyer运动功能评分表(FMA)评分]、上下肢痉挛状况[上肢改良Ashworth量表分级和下肢临床痉挛指数(CSI)评分]、肌电生理指标[H反射H/M max值、表面肌电值(iEMG)、均方根值(RMS)及中位频率(MF)]的变化,并比较两组临床疗效及安全性。结果治疗组总有效率(90.5%)明显高于对照组(73.8%)(P<0.05);两组治疗后上肢和下肢FMA评分、CSI评分、上肢痉挛分级、H反射H/M max值、iEMG、RMS及MF均明显高于治疗前(P<0.05),治疗组治疗后上述评分和指标明显优于对照组(P<0.05);两组治疗期间均未出现与治疗有关的不良事件。结论针刺联合康复功能训练能够改善中风痉挛性偏瘫患者上肢H/M值和肌电信号变化,缓解痉挛程度,促进肢体运动功能恢复,提高整体疗效。

Objective To observe the effects of acupuncture plus rehabilitation training on the electromyographic physiological indicators and motor function rehabilitation in patients with poststroke spastic hemiplegia.Method Eighty-four patients with poststroke spastic hemiplegia were randomized into a treatment group and a control group,with 42 cases in each group.The control group was given basic treatment for stroke plus rehabilitation training,and the treatment group was given additional acupuncture therapy.Before and after the treatment,the motor function[Fugl-Meyer assessment(FMA)],upper-limb and lower-limb spasm states[modified Ashworth scale(MAS)grading for upper limbs and clinical spasticity index(CSI)score for lower limbs],and the electromyographic physiological indicators[Hmax/Mmax ratio(H/M),integrated electromyogram(iEMG),root mean square(RMS),and median frequency(MF)]were observed for the two groups.The clinical efficacy and safety rating were also compared.Result The total effective rate in the treatment group(90.5%)was notably higher than that in the control group(73.8%)(P<0.05).After the treatment,the FMA score of both upper and lower limbs,CSI score,upper-limb spasm grading,H/M,iEMG,RMS,and MF significantly increased in both groups(P<0.05),and were better in the treatment group than in the control group(P<0.05).There were no intervention-associated adverse events during the treatment in either group.Conclusion Acupuncture plus rehabilitation training can improve the upper-limb H/M and electromyographic signals,alleviate the spastic state,promote the recovery of limb motor function,and enhance the general efficacy in treating patients with poststroke spastic hemiplegia.