温针经筋刺法联合手法治疗卒中后偏瘫的临床疗效及对患者表面肌电图、肢体功能和脑动脉血流动力学的影响

Clinical efficacy of warm needling at meridian tendons combined with manipulation on stroke-induced hemiplegia and how to impact on surface electromyography, limb function and cerebral arterial hemodynamics

目的观察温针经筋刺法联合手法治疗卒中后偏瘫的临床疗效及对患者表面肌电图、肌力、肢体功能及脑动脉血流动力学的影响。方法选择2019年7月至2021年7月广西壮族自治区钦州市第一人民医院康复科卒中后偏瘫患者80例,按照随机数字表法分为2组。2组均予常规治疗,对照组40例采用电针联合手法治疗,治疗组40例采用温针经筋刺法联合手法治疗。2组均治疗4周。统计2组疗效,比较2组治疗前后中医证候评分、表面肌电图指标[胫骨前肌、股四头肌的均方根值(RMS)、积分肌电值(iEMG)]、徒手肌力测试(MMT)、肢体功能[Fugl-Meyer评定量表(FMA)上肢评分、FMA下肢评分]及脑动脉血流动力学[阻力指数(RI)、收缩期血流速度(Vs)、平均血流速度(Vm)]变化,并记录2组不良反应。结果治疗组总有效率90.00%(36/40),对照组总有效率72.50%(29/40),治疗组疗效优于对照组(P<0.05)。2组治疗后中医证候评分均较本组治疗前降低(P<0.05),且治疗组治疗后均低于对照组(P<0.05)。2组治疗后胫骨前肌、股四头肌的RMS较本组治疗前均降低(P<0.05),iEMG较本组治疗前均升高(P<0.05),且治疗组胫骨前肌、股四头肌RMS、iEMG改善均优于对照组(P<0.05)。2组治疗后MMT评分及FMA上肢、下肢评分较本组治疗前均升高(P<0.05),且治疗组均高于对照组(P<0.05)。2组治疗后RI较本组治疗前降低(P<0.05),Vs、Vm较本组治疗前均升高(P<0.05),且治疗组改善优于对照组(P<0.05)。结论温针经筋刺法联合手法治疗能提高卒中后偏瘫患者的疗效,有效缓解症状,改善肌力水平,促进胫骨前肌及股四头肌功能恢复,改善运动功能,调节脑动脉血流动力学。

Objective To observe the clinical efficacy of warm needling at meridian tendons combined with manipulation on stroke-induced hemiplegia and how to impact on surface electromyography(sEMG),muscle strength,limb function and cerebral arterial hemodynamics.Methods Totally 80 patients with stroke-induced hemiplegia admitted to Department of Rehabilitation,The First People's Hospital of Qinzhou from July 2019 to July 2021 were randomly assigned into the treatment group(n=40)and the control group(n=40).In addition to the conventional therapy,the control group received electroacupuncture combined with manipulation,and the treatment group received warm needling at meridian tendons combined with manipulation based on control group.A 4-week treatment was performed to compare traditional Chinese medicine(TCM)symptom scores,sEMG indexes(root mean square[RMS]and integrated electromyography[iEMG]of tibialis anterior muscle and quadriceps femoris),manual muscle test(MMT),limb function(upper limb score of Fugl-Meyer assessment[FMA],lower limb score of FMA),and cerebral artery hemodynamics(resistance index[RI],peak systolic velocity[Vs],mean blood velocity[Vm]);the adverse reaction and curative effect were assessed.Results The overall effective rate was higher in the treatment group 90.00%(36/40)compared with the control group 72.50%(29/40),(P<0.05).After treatment,TCM symptom scores in groups were decreased(P<0.05),which were decreased in the treatment group compared with the control group(P<0.05);RMS of tibialis anterior muscle and quadriceps femoris in groups was decreased(P<0.05),while iEMG in groups was increased(P<0.05),improvement of which in the treatment group were significantly better(P<0.05);MMT scores,upper limb score and lower limb score of FMA in groups were increased(P<0.05),the treatment group was more prevalent(P<0.05);decreased RI and increased Vs,Vm were measured in groups after treatment,which were significantly pronounced in the treatment group(all P<0.05).Conclusion For patients with stroke-induced hemiplegia,warm needling at meridian tendons combined with manipulation is effectively capable of relieving symptoms,improving muscle strength,promoting the recovery of tibialis anterior muscle and quadriceps femoris function,improving motor function,and regulating cerebral arterial hemodynamics.