贺氏三通法联合拮抗肌+主动肌电针在卒中后上肢痉挛患者康复中的应用效果研究

Combined He’s santong acupuncture therapy with electroacupuncture in rehabilitation of post-stroke upper limb spasticity

目的观察贺氏三通法联合拮抗肌+主动肌电针在卒中后上肢痉挛患者康复中的应用。方法将120例卒中后上肢痉挛患者按照随机数字表法分为3组,普通电针组40例予普通电针治疗,拮抗肌+主动肌电针组40例予拮抗肌+主动肌电针治疗,联合组40例予贺氏三通法联合拮抗肌+主动肌电针治疗。比较3组疗效;比较3组治疗前后上肢简化Fugl-Meyer量表(FMA-UE)评分、改良Barthel指数评定量表(MBI)评分变化;比较3组治疗前后上肢改良Ashoworth量表(MAS)评分变化;比较3组治疗前后表面肌电图特征变化;比较3组治疗前后血清血管相关因子水平变化;比较3组治疗前后血清神经递质水平变化;观察3组安全性。结果普通电针组总有效率57.50%(23/40),拮抗肌+主动肌电针组总有效率72.50%(29/40),联合组总有效率90.00%(36/40),联合组疗效优于普通电针组、拮抗肌+主动肌电针组(P<0.05),普通电针组与拮抗肌+主动肌电针组总有效率比较差异无统计学意义(P>0.05)。3组治疗后FMA-UE评分、MBI评分均较本组治疗前升高(P<0.05),治疗后联合组FMA-UE评分、MBI评分均高于普通电针组、拮抗肌+主动肌电针组(P<0.05),治疗后拮抗肌+主动肌电针组FMA-UE评分、MBI评分均高于普通电针组(P<0.05)。3组治疗后肩关节、肘关节、腕关节及掌指关节MAS评分均较本组治疗前降低(P<0.05);治疗后联合组肩关节、肘关节、腕关节及掌指关节MAS评分均低于普通电针组、拮抗肌+主动肌电针组(P<0.05);治疗后拮抗肌+主动肌电针组肩关节、肘关节、腕关节及掌指关节MAS评分均低于普通电针组(P<0.05)。3组治疗后肱二头肌均方根值(RMS)、肱三头肌RMS均较本组治疗前降低(P<0.05),协同收缩率较本组治疗前升高(P<0.05);治疗后联合组肱二头肌RMS、肱三头肌RMS均低于普通电针组、拮抗肌+主动肌电针组(P<0.05),协同收缩率高于普通电针组、拮抗肌+主动肌电针组(P<0.05);治疗后拮抗肌+主动肌电针组肱二头肌RMS、肱三头肌RMS均低于普通电针组(P<0.05),协同收缩率高于普通电针组(P<0.05)。3组治疗后血管内皮生长因子(VEGF)、碱性成纤维细胞生长因子(bFGF)水平均较本组治疗前升高(P<0.05),血管内皮细胞黏附因子1(VCAM-1)水平较本组治疗前降低(P<0.05);治疗后联合组VEGF、bFGF水平高于普通电针组、拮抗肌+主动肌电针组(P<0.05),VCAM-1水平低于普通电针组、拮抗肌+主动肌电针组(P<0.05);治疗后拮抗肌+主动肌电针组VEGF、bFGF水平高于普通电针组(P<0.05),VCAM-1水平低于普通电针组(P<0.05)。3组治疗后甘氨酸(Gly)、γ-氨基丁酸(GABA)水平均较本组治疗前升高(P<0.05),5-羟色胺(5-HT)水平较本组治疗前降低(P<0.05);治疗后联合组Gly、GABA水平均高于普通电针组、拮抗肌+主动肌电针组(P<0.05),5-HT水平低于普通电针组、拮抗肌+主动肌电针组(P<0.05);治疗后拮抗肌+主动肌电针组Gly、GABA水平高于普通电针组(P<0.05),5-HT水平低于普通电针组(P<0.05)。3组治疗期间均未出现皮下血肿、晕针、感染等不良事件。结论贺氏三通法配合拮抗肌+主动肌电针可有效改善卒中后上肢痉挛患者痉挛状态,提高生活能力,可能与调节血管活性物质和神经递质水平有关。

Objective To evaluate He’s santong acupuncture therapy combined with electroacupuncture(EA)in rehabilitation of post-stroke upper limb spasticity(ULS).Methods Totally 120 post-stroke patients with ULS were randomly assigned in 1:1:1 ratio to receive conventional EA(group A)or EA at antagonistic muscle and agonist muscles(group B)or He’s santong acupuncture therapy combined with the two former(group C).Fugl-Meyer Assessment for the Upper Extremity(FMA-UE),Modified Barthel Index(MBI),Modified Ashoworth Scale(MAS),surface electromyography(sEMG),vascular factors,neurotransmitters were included as comparators.The curative effect was assessed.Results The overall effective rate in group C was better than that in group A and group B(90.00%[36/40]vs 57.50%[23/40],72.50%[29/40],[P<0.05],respectively).After treatment,increased FMA-UE,MBI and decreased MAS were detected in groups,which in group C were superior to group B and the group A(all P<0.05).Root mean square(RMS)decreased and co-contraction ratio increased,group C was better than others for these indexes(all P<0.05).Increased vascular endothelial growth factor(VEGF),basic fibroblast growth factor(bFGF)and decreased vascular cell adhesion molecule-1(VCAM-1)in groups were found(P<0.05),which in group C was superior to others(all P<0.05).Glycine(Gly)and Gamma-Aminobutyric Acid(GABA)increased and 5-hydroxytryptamine(5-HT)decreased in groups,group C was better than others for these indexes(all P<0.05).Conclusion For post-stroke patients with ULS,the combination therapy can effectively improve the spasticity and the ability of life,which may be related to the regulation of vasoactive substances and neurotransmitter levels.