“通督调神”针法联合康复运动对中风后偏瘫患者神经功能及肢体功能的影响

The curative effect of Tongdu Tiaoshen acupuncture on hemiplegia after stroke and its influence on nerve function and limb function

目的探讨“通督调神”针法联合康复运动对中风后偏瘫患者神经功能及肢体功能的影响,评价临床疗效。方法随机对照试验设计。选择2020年1月-2021年12月本院70例中风后偏瘫患者作为观察对象,按随机数字表法分为2组,每组35例。对照组在常规治疗基础上联合康复运动,观察组在对照组基础上给予“通督调神”针法。2组均连续治疗1个月。采用Fugl-Meyer运动功能评定量表(FMA)评估下肢运动功能,改良Ashworth量表(MAS)评估肌张力,美国国立卫生研究院卒中量表(NIHSS)评估神经功能缺损程度,日常生活活动能力量表(ADL)评估生活质量;采用Brunnstrom分期法评估患者运动能力,Holden步行功能分级评估患者步行能力;采用ELISA法检测活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)、凝血酶时间(TT)及血清纤维蛋白原(FIB)、D-二聚体(D-D)、纤溶酶原激活物抑制因子-1(PAI-1)水平。记录不良反应,评价临床疗效。结果观察组总有效率为97.14%(34/35)、对照组为77.14%(27/35),2组比较差异有统计学意义(χ^(2) =6.25,P=0.012)。观察组治疗后FMA、ADL评分高于对照组(t值分别为9.23,9.54,P<0.01);MAS、NIHSS评分低于对照组(t值分别为10.23,11.97,P<0.01)。观察组Brunnstrom分期Ⅴ、Ⅵ期及Holden功能步行分级Ⅳ、Ⅴ级患者分布高于对照组(χ^(2) 值分别为11.96、11.27,P<0.05)。观察组治疗后APTT、PT、TT较对照组延长(t值分别为10.37,13.57,6.54,P<0.01),血清FIB、D-D、PAI-1水平低于对照组(t值分别为12.85,11.94,27.39,P<0.01)。2组治疗期间均未发生不良反应。结论“通督调神”针法联合康复运动可有效改善中风后偏瘫患者神经及肢体功能,运动及步行能力,提高日常生活能力及临床疗效,有效调节患者的凝血状态。

Objective To explore the application of Tongdu Tiaoshen acupuncture in patients with hemiplegia after stroke.Methods Randomized controlled trial.A total of 70 patients who met the inclusion criteria for post-stroke hemiplegia in our hospital from January 2020 to December 2021 were divided into two groups,with 35 cases in each group,according to the random number table.The control group was given conventional treatment combined with rehabilitation exercise therapy,and the observation group was given Tongdu Tiaoshen acupuncture on the basis of the above,and both groups were treated continuously for 1 month.Compare of the two groups Fugl-Meyer Assessment(FMA),Modified Ashworth Scale(MAS),National Institutes of Health Stroke Scale(NIHSS),Activity of Daily Living(ADL)score;Brunnstrom stage method was used to assess the patient's motor ability,and Holden walking function grade was used to assess the patient's walking ability.The activated partial thromboplastin time(APTT),prothrombin time(PT),thrombin time(TT),and serum fibrinogen(FIB),D-dimer(D-D),plasminogen activator inhibitor 1(PAI-1)levels were observed by ELISA.Adverse events were recorded and clinical efficacy was evaluated.Results The total effective rates of the observation group and the control group were 97.14%(34/35)and 77.14%(27/35),respectively,and the difference between the two groups was statistically significant(χ^(2) =6.25,P=0.012).After treatment,the scores of FMA and ADL in the observation group were significantly higher than those in the control group(t values were 9.23 and 9.54,respectively,P<0.01),the MAS and NIHSS scores were significantly lower than those in the control group(t values were 10.23 and 11.97,respectively,P<0.01).After treatment,the distribution of patients in Brunnstrom stageⅤandⅥand Holden functional walking stageⅣandⅤin the observation group was significantly higher than those in the control group(χ^(2) values were 11.96 and 11.27,respectively,P<0.05).After treatment,APTT,PT and TT in the observation group were significantly longer than those in the control group(t values were 10.37,13.57 and 6.54,respectively,P<0.01);serum FIB,D-D and PAI-1 levels were significantly lower than those in the control group(t values were 12.85,11.94 and 27.39,respectively,P<0.01).No adverse reactions occurred in both groups.Conclusion The treatment of post-stroke hemiplegia with Tongdu Tiaoshen acupuncture can improve the effect of clinical treatment and the ability of daily life,neurological function,limb function,movement and walking ability,and stabilize the clotting state.