头针结合绳带疗法对缺血性卒中偏瘫恢复期步行功能障碍的临床研究

Clinical study of scalp acupuncture combined with rope therapy on walking dysfunction during convalescence of cerebral ischemic stroke with hemiplegia

目的:探讨头针结合绳带疗法对缺血性卒中(CIS)偏瘫恢复期步行功能障碍的临床应用效果。方法:将2022年1月至2022年10月我院收治的105例CIS偏瘫患者按照随机数表法分为头针组、绳带组、头针联合绳带组各35例,所有患者均予常规内科治疗,在此基础上,头针组予头针疗法,绳带组予绳带疗法,头针联合绳带组予头针联合绳带疗法,为期4周,比较各组治疗疗效、下肢步行功能及炎性因子水平变化,记录三组治疗期间不良事件发生情况。结果:治疗4周后,三组患者总有效率对比,差异无统计学意义(P>0.05),但头针联合绳带组显效率[71.43%(25/35)]明显高于头针组[42.86%(15/35)]、绳带组[48.57%(17/35)],差异显著(P<0.05),头针组、绳带组显效率对比无统计学差异(P>0.05);治疗4周后,三组患者简式Fugl-Meyer下肢运动功能量表(FMA-LE)、10m步行测试(10MWT)、Tineetti步态与平衡量表(TGA)及Holden步行能力评定(FAC)均高于治疗前,但头针联合绳带组各指标高于头针组、绳带组(P<0.05),头针组、绳带组各指标对比无统计学差异(P>0.05);治疗4周后,三组患者血清白介素-1β(IL-1β)、白介素-6(IL-6)及超敏C反应蛋白(hs-CRP)水平均低于治疗前,但头针组、头针联合绳带组各指标均低于绳带组(均P<0.05),头针组、头针联合绳带组各指标对比无统计学差异(P>0.05)。Pearson相关性分析显示:IL-1β、IL-6、hs-CRP均与FMA-LE、10MWT、TGA、FAC评分呈负相关(P<0.05)。三组治疗后不良事件发生率对比,差异无统计学意义(P>0.05)。结论:头针结合绳带疗法对CIS偏瘫恢复期步行功能障碍疗效显著,能够有效改善患者步行功能,调节机体炎性因子水平。

Objective:To explore the clinical application effects of scalp acupuncture combined with rope therapy on walking dysfunction during convalescence of cerebral ischemic stroke(CIS)with hemiplegia.Methods:105patients with CIS and hemiplegia admitted to the hospital from January 2022to October 2022were divided into scalp acupuncture group,rope group and scalp acupuncture with rope group by the random number table method,with 35cases in each group.All patients were given conventional medical treatment.On this basis,scalp acupuncture group was given scalp acupuncture therapy,rope group was given rope therapy,and scalp acupuncture with rope group was given scalp acupuncture combined with rope therapy,and all the groups were treated for 4weeks.The therapeutic efficacy,lower extremity walking function and levels of inflammatory factors were compared among the groups.Adverse events were recorded in the three groups during treatment.Results:After 4weeks of treatment,there was no statistical significance in the total effective rate among the three groups(P>0.05),but the markedly effective rate in scalp acupuncture with rope group[71.43%(25/35)]was significantly higher than that in scalp acupuncture group[42.86%(15/35)]and rope group[48.57%(17/35)](P<0.05),and there was no statistical difference in markedly effective rate between scalp acupuncture group and rope group(P>0.05).After 4weeks of treatment,the scores of simplified Fugl-Meyer lower extremity motor function scale(FMA-LE),10-min walking distance test(10MWT),Tinetti Gait Analysis(TGA)and Holden Functional Ambulation Classification(FAC)in the three groups were higher than those before treatment,but the indicators in scalp acupuncture with rope group were higher compared with those in scalp acupuncture group and rope group(all P<0.05),but the indicators showed no statistical differences between scalp acupuncture group and rope group(P>0.05).After 4weeks of treatment,the levels of serum interleukin-1β(IL-1β),interleukin-6(IL-6)and high-sensitivity C-reactive protein(hs-CRP)in the three groups were lower than those before treatment,but the levels in scalp acupuncture group and scalp acupuncture with rope group were lower than those in rope group(all P<0.05),and there were no statistical differences between scalp acupuncture group and scalp acupuncture with rope group(P>0.05).Pearson correlation analysis showed that IL-1βwas negatively correlated with FMA-LE,10MWT,TGA and FAC(r=-0.513,-0.422,-0.437,-0.489,all P<0.05).IL-6was negatively correlated with FMA-LE,10MWT,TGA and FAC(r=-0.534,-0.439,-0.428,-0.472,all P<0.05).hs-CRP was negatively correlated with FMA-LE,10MWT,TGA and FAC(r=-0.566,-0.449,-0.441,-0.481,all P<0.05).There was no statistical difference in the incidence rate of adverse events among the three groups after treatment(P>0.05).Conclusion:Scalp acupuncture combined with rope therapy has a significant efficacy on walking dysfunction during CIS hemiplegia convalescence,and it can effectively improve the walking function and regulate the levels of inflammatory factors in the body.