老年急性期脑梗死患者不同针刺治疗干预时间对其肢体功能的影响

Effect of different acupuncture intervention time on limb function in elderly patients with acute-phase cerebral infarction

目的探讨老年急性期脑梗死患者不同针刺治疗干预时间对其肢体功能的影响。方法选择2020年8月至2021年8月建德中医院收治的老年急性期脑梗死患者90例,按照随机数字表法分为针刺早干预组、针刺晚干预组及对照组,各30例。3组患者均采用常规药物治疗,针刺早干预组、针刺晚干预组患者于发病3~6 d和7~10 d接受针刺干预治疗。比较3组患者的治疗效果、肢体运动功能、表面肌电指标[包括肌电积分值(IEMG)、肌肉最大收缩力(MVC)、均方根值(RMS)]、日常生活活动能力(Barthel指数)。结果治疗后3组患者总有效率比较,差异有统计学意义(P<0.01),针刺早干预组总有效率优于针刺晚干预组、对照组,差异均有统计学意义(均P<0.05)。3组患者Fugl-Meyer运动功能评分量表(FMA)评分(上肢)和FMA评分(下肢)均较治疗前明显升高且针刺早干预组、针刺晚干预组高于对照组,针刺早干预组高于针刺晚干预组,差异均有统计学意义(均P<0.05)。3组患者IEMG、MVC水平均升高且针刺早干预组、针刺晚干预组均高于对照组,针刺早干预组高于针刺晚干预组;RMS水平均降低且针刺早干预组、针刺晚干预组均低于对照组,针刺早干预组又低于针刺晚干预组,差异均有统计学意义(均P<0.05)。3组患者干预1、2、3个疗程后Barthel指数评分均逐渐升高且针刺早干预组、针刺晚干预组均高于对照组,针刺早干预组高于针刺晚干预组,差异均有统计学意义(均P<0.05)。结论老年急性期脑梗死患者及早开始针刺干预治疗能够提高治疗效果,改善患者肢体运动功能、表面肌电指标以及日常生活活动能力,有助于患者更好地康复。

Objective To investigate the effects of different time of acupuncture therapy on limb function in elderly patients with acute-phase cerebral infarction.Methods Ninety patients with acute-phase cerebral infarction admitted to Jiande Hospital of Traditional Chinese Medicine from August 2020 to August 2021 were randomly divided into three groups with 30 cases in each group.All patients received conventional medication,while patients in early intervention group and late intervention group received additional acupuncture intervention on d3~d6 and d7~d10 of the onset of the disease.To compare the treatment effect,limb motor function,surface electromyographic indexes[including electromyographic integral value(IEMG),muscle maximal contraction force(MVC),and root mean square value(RMS)],and activities of daily living ability(Barthel index)of patients in the three groups.Results Comparison of the total effective rate of the patients in the three groups after treatment,the difference was statistically significant(P<0.01).The overall effective rate of the early intervention group was higher than that of the acupuncture late intervention group and the control group(both P<0.05).The FMA scores of upper extremity and lower extremity were significantly increased compare with those before the treatment in all three groups;while the scores in the acupuncture early intervention group was higher than those in late intervention group and control group,and scores in late intervention group was higher that of control group(all P<0.05).The IEMG and MVC levels increased in all three groups after treatment,and were higher in the acupuncture early intervention group and late intervention group than those in the control group,and higher in the acupuncture early intervention group than those in the acupuncture late intervention group(all P<0.05).The RMS levels decreased in all three groups after treatment,and were lower in the acupuncture early intervention group and late intervention group than those in the control group,and lower in the acupuncture early intervention group than those in the acupuncture late intervention group(all P<0.05).The Barthel index scores gradually increased after 1,2,and 3 courses of treatment in all three groups,and were higher in the acupuncture early intervention group and acupuncture late intervention group than those in the control group,and were higher in the acupuncture early intervention group than those in the late intervention group(all P<0.05).Conclusion Early initiation of acupuncture intervention can increase the therapeutic effect,improve limb motor function,surface electromyographic indexes and daily life function in elderly patients with acute-phase cerebral infarction.