电针手部经筋结点治疗脑卒中后痉挛期手运动功能障碍临床观察

Clinical Observation of Electroacupuncture at Hand Tendon Nodes in Treatment of Hand Movement Dysfunction of Spasticity after Stroke

目的比较电针手部经筋结点疗法与电针传统穴位疗法治疗脑卒中后(痉挛期)手运动功能障碍的临床疗效差异。方法纳入64例脑卒中后痉挛期手运动功能障碍患者,随机分为经筋结点组和传统穴位组,每组32例,其中经筋结点组脱落1例,传统穴位组脱落2例。两组均加电针,每次治疗30 min,每天2次,每周6 d,共4周。经筋结点组针刺指伸肌结点和指外展结点,传统穴位组针刺外关和合谷、阳池、后溪、大陵。通过改良Ashworth痉挛评定量表(modified Ashworth scale,MAS)、临床神经功能缺损程度评分、腕手部关节主动活动度(active range of motion,AROM)、简化Fugl-Meyer运动功能评分法(Fugl-Meyer assessment,FMA)(手部分)进行疗效判定。结果治疗后经筋结点组和传统穴位组AROM、FMA较治疗前均有提高(P<0.05),临床神经功能缺损程度、MAS评分均较治疗前降低(P<0.01,P<0.05),且治疗后经筋结点组MAS、AROM、FMA、临床神经功能缺损程度评分均优于传统穴位组(P<0.05);电针针刺经筋结点组总有效率为87%(27/31),电针传统穴位组总有效率为70%(21/30),两组比较结果有统计学意义(P<0.05)。结论电针手部经筋结点疗法对脑卒中后痉挛期手运动功能障碍治疗有效,且疗效优于电针传统穴位疗法。

Objective To compare the clinical effect of electroacupuncture at hand tendon nodes therapy and electroacupuncture at traditional acupoints therapy in post-stroke(spasticity)hand movement dysfunction.Methods Sixty-four patients with post-stroke spastic hand movement dysfunction were included and randomly divided into tendon nodes group and traditional acupoints group,with 32 patients in each group,1 patient fell off in the tendon nodes group and 2 patients fell off in the traditional acupoints group.The two groups were supplemented with electroacupuncture for 30 min twice a day,6 days a week,lasting for 4 weeks.The tendon nodes group was treated with acupuncture at the finger extension node and the finger abduction nodes.The traditional acupoints group was treated with acupuncture at Waiguan(SJ5),Hegu(LI4),Yangchi(SJ4),Houxi(SI3)and Daling(PC7).The results were evaluated with the use of the modified Ashworth scale(MAS),the degree score of clinical neurological deficit,active range of motion(AROM)of wrist and hand joints and the simplified Fugl-Meyer assessment(FMA)of motor function(hand part).Results After treatment,the scores of AROM and FMA in both groups were improved(P<0.05).The scores of MAS scores in both groups and the degree score of clinical neurological deficit were decreased(P<0.01,P<0.05).The scores of MAS,AROM,FMA and the degree score of clinical neurological deficit in the tendon nodes group were better than those of the traditional acupoints group after treatment(P<0.05).The total effective rate of tendon nodes group was 87%(27/31),and the total effective rate of the traditional acupoints group was 70%(21/30),with statistical significance(P<0.05).Conclusion Electroacupuncture at hand tendon nodes therapy is effective in the treatment of hand movement dysfunction after stroke,and the efficiency is better than traditional acupoints therapy.