不同留针时间对针刺治疗中风后肌张力增高的影响

目的比较不同留针时间对针刺治疗中风后肌张力增高的影响。方法将90例中风后肌张力增高患者随机分为A组、B组和C组,每组30例。3组均采用金针王乐亭"中风十三治"之"手足十二针法"针刺,每日1次,每星期治疗5次,共治疗20次。A组针刺得气后不留针,即刻起针;B组得气后留针30 min;C组得气后留针60 min。比较3组治疗前后改良Ashworth痉挛量表评分(MAS)、临床痉挛指数(CSI)及Fugl-Meyer运动功能评分(FAS)。结果 3组治疗后改良Ashworth分级比较,差异具有统计学意义(P<0.05)。3组治疗后CSI评分及患侧肢体Fugl-Meyer评分与同组治疗前比较,差异均具有统计学意义(P<0.05)。A组和B组治疗后CSI评分及患侧肢体Fugl-Meyer评分与C组比较,差异均具有统计学意义(P<0.05)。结论相对于针刺后留针60 min,针刺后不留针及留针30 min均更能改善中风后肌张力增高、痉挛程度及肢体运动功能。

Acupuncture for spastic hemiplegia after ischemic stroke: a systematic review

Objective:To systematically assess the effectiveness and safety of acupuncture for spastic hemiplegia after ischemic stroke.Methods:Randomized controlled trials(RCTs)of acupuncture treatment for spastic hemiplegia after ischemic stroke meeting the inclusion criteria in Cochrane Library,Medline,Excerpta Medica Database(EMBASE),PubMed,China National Knowledge Infrastructure(CNKI),SinoMed,Chongqing VIP Database(VIP),and Wanfang Data Knowledge Service Platform(Wanfang)published from each database’s inception to February 2023 were retrieved by computer.Two reviewers independently extracted data and evaluated the risk of bias using Cochrane’s risk of bias tool.Review Manager 5.4 was used for data analysis.Continuous data were evaluated using mean difference(MD)with a 95%confidence interval(CI),and dichotomous data were analyzed using risk ratio(RR).Results:A total of 24 trials,including 1970 participants,were included in the study.The meta-analysis of 7 trials showed that compared to the rehabilitation therapy,acupuncture therapy was more effective in improving the simplified Fugl-Meyer assessment score after 1-month treatments[MD=10.52,95%CI(7.81,13.23),P<0.001].The meta-analysis of 2 articles showed the same tendency after 6-month treatments[MD=19.18,95%CI(11.34,27.02),P<0.001],and the 6-month treatment course resulted in better outcomes than the 1-month course.The meta-analysis of 8 trials showed that acupuncture had a better improvement on the Barthel index score than rehabilitation therapy after 1-month treatments[MD=10.78,95%CI(8.91,12.64),P<0.001].The meta-analysis of 2 articles showed the same tendency after 6-month treatments[MD=19.94,95%CI(19.02,20.87),P<0.001],and the 6-month course was better than the 1-month course.The meta-analysis of 2 trials showed that the effective rate of the modified Ashworth scale score improvement was more notable in the acupuncture group after 1-month treatments[RR=1.20,95%CI(1.02,1.40),P=0.020].One trial reported no adverse event,and 1 trial reported 3 adverse events without severe influence.Conclusion:Acupuncture might be an effective and safe therapy for spastic hemiplegia after ischemic stroke,but more high-quality,large-sample objectively-evaluated RCTs are needed to validate the conclusion.

Clinical Observation on Acupuncture Treatment for Post-stroke Spastic Hemiplegia

Objective:To observe the clinical effect of contralateral needling plus rehabilitation for post-stroke spastic hemiplegia. Methods:Thirty-six patients with post-stroke spastic hemiplegia were randomly divided into a treatment group and a control group, 18 cases in each group. The two groups were all given rehabilitation training. The contralateral needling was adopted in the treatment group on the acupoints group of brain-refreshing and orifice-opening needling method. The routine acupuncture was applied in the control group on the same acupoints. Respectively before and after the treatment, the modified Ashworth scale (MAS) and clinical spasticity index (CSI) were used to assess the therapeutic effects. Results:The total effective rate was 94.4% in the treatment group and 67.7% in the control group, with a statistical difference in comparison of the two groups (P<0.05). In comparison of MAS and CSI scores after the treatment between the treatment group and control group, the differences were statistically significant (P<0.05). Conclusion:The contralateral needling plus rehabilitation training is an effective method for the treatment of post-stroke spastic hemiplegia.

Clinical observation on muscle regions of meridians needling method in improving upper limb function for children with cerebral palsy of spastic hemiplegia type

Objective:To observe the improving effect of muscle regions of meridians needling method on the upper limb function in children with cerebral palsy of spastic hemiplegic type.Methods:A total of 100 children with cerebral palsy of spastic hemiplegia type were divided into a treatment group and a control group according to the visiting sequence,with 50 cases in each group.The control group was treated with conventional rehabilitation plus conventional acupuncture treatment.The treatment group was treated with conventional rehabilitation plus muscle regions of meridians needling method.The electromyography(EMG)signal values of triceps brachii and pronator teres were detected before treatment,and 3 months and 6 months after treatment.The clinical efficacy was evaluated by Peabody developmental motor scale-fine motor(PDMS-FM)and fine motor function measure(FMFM).Results:Three and six months after treatment,the EMG signal values of triceps brachii and pronator teres,grasping scores and visual-motor integrated scores of PDMS-FM and the FMFM scores in both groups increased to varying degrees compared with the same group before treatment,and the intra-group differences were all statistically significant(all P<0.05).Six months after treatment,the results of the above three items in the treatment group were all better than those in the control group,and the differences between the groups were statistically significant(all P<0.05).Conclusion:Muscle regions of meridians needling method added on the basis of conventional rehabilitation can effectively reduce the muscle tone of upper limb and enhance the muscle strength,and improve the upper limb function in children with cerebral palsy of spastic hemiplegia type.The efficacy is superior to that of the conventional rehabilitation plus conventional acupuncture treatment.