经筋电针对脑卒中后上肢痉挛患者干预的临床疗效

Effects of transtendon puncture in stroke patients with upper limb spasticity based on surface electromyography

目的探讨基于表面肌电图结果观察经筋电针治疗方法在脑卒中后上肢痉挛患者的临床功效。方法选取2019年7月—2020年6月在重庆大学附属涪陵医院住院的脑卒中后上肢痉挛患者52例,运用计算机随机数字生成器方法分为经筋电针组、电针组,每组26例。两组患者均在接受规范临床治疗基础上,以30 min/次,1次/d,6次/周,共两周的治疗频率、疗程接受经筋电针治疗或电针治疗。患者在治疗前及治疗后3个月患侧均接受表面肌电图、改良Ashworth痉挛分级量表(MAS)、Fugl-Meyer上肢运动功能量表和改良Barthel指数量表评定。结果两组患者在治疗前各项观察指标差异均无统计学意义(P>0.05);治疗3个月后,表面肌电图结果显示:两组患者F波阈值均较治疗前明显降低(P<0.05),且经筋电针组较电针组明显降低(P<0.05);但两组患者F波波幅、F波出现率、M波波幅却较治疗前明显增高(P<0.05),且经筋电针组较电针组明显增高(P<0.05);量表评估结果显示:治疗3个月后两组患者改良Ashworth痉挛分级量表(MAS)评级均较治疗前明显降低(P<0.05),且经筋电针组较电针组明显降低(P<0.05);Fugl-Meyer上肢运动功能评分、改良Barthel指数评分显示,两组患者均较治疗前明显增加(P<0.05),且经筋电针组较电针组明显增高(P<0.05)。结论经筋电针治疗在改善脑卒中后上肢痉挛患者上肢痉挛症状、运动功能及提高日常生活能力方面远期疗效优于传统电针治疗。

Objective Based on the surface emG results,the clinical therapeutic effect of transtendon electroacupuncture on patients with upper limb spasm after stroke was investigated.Methods By computer random number generator method,52 patients with upper limb spasm after stroke were divided into transtendon electroacupuncture group and electroacupuncture group,randomly.On the basis of standard clinical treatment,patients in both groups were treated with electroacupuncture 30min,once,6 times a week,2 weeks,totally.Before and after 3 months treatment,SEMG,Modified Ashworth Spasticity Scale(MAS),Fugl-Meyer upper limb motor function assessment and Modified Barthel index were performed in both groups.Results Before treatment,there were no significant differences in all observation indexes between 2 groups(P>0.05).After 3 months of treatment,SEMG results showed that the F wave threshold in both groups was significantly lower than that before treatment(P<0.05),and that in the electroacupuncture group was significantly lower than that in the electroacupuncture group(P<0.05).However,the amplitude of F wave,the occurrence rate of F wave and the amplitude of M wave in the 2 groups were significantly higher than those before treatment(P<0.05),and the amplitude of F wave in the electroacupuncture group was significantly higher than that in the electroacupuncture group(P<0.05).The results showed that after 3 months of treatment,the Modified Ashworth Spasticity Scale(MAS)rating in both groups was significantly lower than that before treatment(P<0.05),and that in the electroacupuncture group was significantly lower than that in the electroacupuncture group(P<0.05).Fugl-Meyer upper limb motor function score and Modified Barthel index score of patients in 2 groups were significantly higher compared with before treatment(P<0.05),and those in the tendon electroacupuncture group were significantly higher compared with the electroacupuncture group(P<0.05).Conclusion Transtendon electroacupuncture has better long-term efficacy than traditional electroacupuncture in improving upper limb spasm symptoms,motor function and daily living ability of patients with upper limb spasm after stroke.