针刺“手十四针”治疗缺血性中风恢复期偏瘫手的临床疗效观察

Clinical Study on the Treatment of Hand Dysfunction on Ischemic Stroke Decubation by Acupuncture“Hand Fourteen Acupuncture”

目的观察“手十四针”针刺治疗缺血性中风恢复期偏瘫手的临床疗效。方法选取2021年3月—2022年6月于首都医科大学附属北京中医医院针灸科病房及门诊就诊的60例缺血性中风恢复期手运动功能障碍患者作为研究对象,采用随机对照试验设计方法,将60例患者随机分为研究组和对照组各30例,对照组予常规针刺治疗,研究组在对照组基础上于患手背侧五指掌指关节、近侧指间关节、远端指间关节的伸肌远端肌腱附近进行针刺,7 d为1个疗程,比较治疗4个疗程后两组患者改良Ashworth评分、Brunnstrom运动功能评分、改良Fugl-meyer评分及手关节活动度变化。结果治疗后,研究组总有效率(83.33%)显著高于对照组(60.00%)(P<0.05);两组Ashworth痉挛评定等级在治疗后均有降低(P<0.01),且研究组显著低于对照组(P<0.05);两组Brunnstrom运动功能分级数据在治疗后均有增加(P<0.01),且研究组分级显著高于对照组(P<0.05);两组患者Fugl-meyer运动功能评分均有提升(P<0.01),且研究组评分显著高于对照组(P<0.01);两组患者手关节活动度TAM均较治疗前显著增加(P<0.01),且研究组显著高于对照组(P<0.01);治疗期间两组均未发生明显不良反应。结论针刺加用“手十四针”可更有效改善中风后手的运动功能,缓解手痉挛性瘫的状态,恢复手精细运动协调能力,能提高患者的日常生活能力,是一种安全并且有效的局部针刺疗法,值得临床推广应用。

Objective To observe the clinical effect of acupuncture on hemiplegic hand in ischemic stroke.Methods The 60 patients were randomized into 30 study cases and 30 control cases.Both groups for conventional Western medicine treatment,rehabilitation training and routine acupuncture treatment,the study group and in the back,proximal,distal joint distal tendon attachment,control group to routine acupuncture treatment,7 days for 1 course,treatment of four courses of two patients Brunnstrom motor function score,improved Ashworth score,improved Fugl-meyer score and hand joint activity changes.By comparing the scores and grades before and after treatment between the study and control groups,the collected data was processed by applying statistical software to compare the differences and observe the efficacy.Results The total treatment efficiency(83.33%)was significantly better than the control group(60.00%)(P<0.05).Both groups of Modified Ashworth Scale(MAS)decreased after treatment(P<0.01),and the study group was significantly lower than the control group(P<0.05);Both group of Brunnstrom motor function classification data were statistically significant after treatment(P<0.01),and the study group was better than the control group(P<0.05).Both group of Fugel-Meyer(FMA)datawere statistically significant after treatment(P<0.01),and the FMA data score in the study group improved better than the control group(P<0.01).Both group of Total Passive Motion(TAM)datawere statistically significant after treatment(P<0.01),and the TAM data score in the study group improved better than the control group(P<0.01).No significant adverse effect occurred in either group during the treatment period.Conclusion On the basis of conventional acupuncture and rehabilitation treatment,the addition of“hand fourteen acupuncture”can lessen the degree of finger spasm after stroke,alleviate the state of spastic paralysis efficiently,improve the motor function of hands after stroke and regain the fine motor ability of the hand,which can refine the treatment of hand dysfunction in the recovery stage of ischemic stroke,worthy of clinical application.