通督调神法针刺联合Bobath康复训练治疗卒中后上肢痉挛:随机对照试验

Tongdu Tiaoshen acupuncture combined with Bobath rehabilitation training for upper limb spasm after stroke:a randomized controlled trial

目的:观察通督调神法针刺联合Bobath康复训练治疗卒中后上肢痉挛的临床疗效。方法:将66例卒中后上肢痉挛患者随机分为观察组(33例,脱落1例)和对照组(33例,脱落2例)。对照组采用Bobath康复训练;观察组在对照组基础上予通督调神法针刺,穴取百会、风府、命门、腰阳关及双侧C4-T1夹脊穴等。两组均每日治疗1次,连续治疗6 d后休息1 d,共治疗4周。比较两组患者治疗前后改良Ashworth量表(MAS)评级、上肢Fugl-Meyer运动量表(FMA-UE)评分、改良Barthel指数(MBI)评分及血清神经递质谷氨酸(Glu)、γ-氨基丁酸(GABA)水平,并评定临床疗效。结果:治疗后,两组患者MAS评级、血清Glu水平均较治疗前降低(P<0.05),FMA-UE、MBI评分及血清GABA水平均较治疗前升高(P<0.05);观察组MAS评级、血清Glu水平低于对照组(P<0.05),FMA-UE、MBI评分及血清GABA水平高于对照组(P<0.05)。观察组总有效率为87.5%(28/32),高于对照组的45.2%(14/31,P<0.05)。结论:通督调神法针刺联合Bobath康复训练可有效降低卒中后上肢痉挛患者的上肢肌张力,改善上肢运动功能,提升生活自理能力,调控血清神经递质水平。

Objective To observe clinical effect of Tongdu Tiaoshen(promoting the circulation of the governor vessel and regulating the spirit)acupuncture combined with Bobath rehabilitation training in the treatment of upper limb spasm after stroke.Methods A total of 66 patients with upper limb spasm after stroke were randomly divided into an observation group(33 cases,1 case dropped out)and a control group(33 cases,2 cases dropped out).The control group received Bobath rehabilitation training.On the basis of the control group,the patients in the observation group received Tongdu Tiaoshen acupuncture at Baihui(GV 20),Fengfu(GV 16),Mingmen(GV 4),Yaoyangguan(GV 3)and bilateral C4-T1 Jiaji points(EX-B 2),etc.Both groups were treated once a day,with 6 days of continuous treatment followed by 1 day of rest,and totally 4 weeks were required.The modified Ashworth scale(MAS)grade,Fugl-Meyer assessment of upper extremity(FMA-UE)score,modified Barthel index(MBI)score,serum level of neurotransmitter(glutamic acid[Glu]andγ-aminobutyric acid[GABA])were compared between the two groups before and after treatment,and the clinical effect was evaluated.Results After treatment,MAS grade and serum level of Glu in the two groups were lower than those before treatment(P<0.05),and FMAUE,MBI scores and serum level of GABA were higher than those before treatment(P<0.05).The MAS grade and serum level of Glu in the observation group were lower than those in the control group(P<0.05),and the FMA-UE,MBI scores and serum level of GABA were higher than those in the control group(P<0.05).The total effective rate of the observation group was 87.5%(28/32),which was better than 45.2%(14/31)of the control group(P<0.05).Conclusion The combination of Tongdu Tiaoshen acupuncture and Bobath rehabilitation training can effectively reduce the upper limb muscle tension level of patients with upper limb spasm after stroke,improve upper limb motor function,enhance self-care ability,and regulate serum level of neurotransmitter.