體針聯(lián)合本體感覺(jué)強(qiáng)化訓(xùn)練治療卒中偏癱上肢的療效觀察
發(fā)布時(shí)間：2018-08-01 10:37
【摘要】：目的:觀察體針聯(lián)合本體感覺(jué)強(qiáng)化訓(xùn)練治療卒中偏癱上肢功能障礙的臨床療效,探討兩者結(jié)合治療卒中后患者偏癱上肢功能及提高日常生活活動(dòng)能力的有效性和臨床推廣價(jià)值,優(yōu)化卒中偏癱上肢運(yùn)動(dòng)障礙恢復(fù)的治療方案,為臨床上治療卒中后偏癱上肢功能障礙尋求一種更為有效的中西醫(yī)結(jié)合康復(fù)干預(yù)方法,并提供循證醫(yī)學(xué)證據(jù)。方法:采用單盲法隨機(jī)對(duì)照試驗(yàn)研究方案,將符合納入診斷標(biāo)準(zhǔn)的60例首次卒中且病程小于3個(gè)月的存在上肢功能障礙的患者按病人就診先后順序編號(hào)利用隨機(jī)數(shù)字表法分成治療組和對(duì)照組兩組,每組各30例。兩組受試者均予神經(jīng)內(nèi)科基礎(chǔ)藥物治療和常規(guī)康復(fù)訓(xùn)練。對(duì)照組采取偏癱側(cè)上肢體針治療,若患者處于弛緩期上肢選穴則以屈肌群穴位即陰經(jīng)穴為主,如內(nèi)關(guān)、曲澤、青靈、尺澤、極泉等,若患者處于痙攣期則取患側(cè)上肢伸肌群穴位即陽(yáng)經(jīng)穴為主如外關(guān)、支正、曲池、臂佈、肩毭等,針刺得氣后留針20分鐘(同時(shí)在療程中根據(jù)患者的康復(fù)進(jìn)程和中醫(yī)的辨證分型不同對(duì)穴位做適當(dāng)調(diào)整以適應(yīng)病情發(fā)展和減少穴位耐受現(xiàn)象)。治療組則在對(duì)照組的治療基礎(chǔ)上加用本體感覺(jué)強(qiáng)化訓(xùn)練,治療30min/天。所有受試者在納入研究后給予治療1次/天,周日休息,前后共治療8周,共治療48次,療程56天。并在治療前、治療后(8 周)使用簡(jiǎn)化 Fugl-Mayer 運(yùn)動(dòng)功能量表(Fugl-Mayer assessment scale,FMA)評(píng)估上肢運(yùn)動(dòng)功能,改良Barthel指數(shù)(the modified barthel index,MBI)進(jìn)行日常生活活動(dòng)能力(ADL)評(píng)定,分別進(jìn)行組內(nèi)比較和組間比較以評(píng)價(jià)療效。統(tǒng)計(jì)學(xué)分析:使用Excel表格統(tǒng)一錄入并保存數(shù)據(jù),結(jié)果均以均數(shù)士標(biāo)準(zhǔn)差(x±s),應(yīng)用SPSS19.0軟件進(jìn)行分析:兩組獨(dú)立樣本組間比較,如為計(jì)量資料,服從正態(tài)分布且方差齊性相等,則采用成組t檢驗(yàn),反之采用四格表資料的卡方檢驗(yàn);治療前后組內(nèi)比較,如為計(jì)量資料,服從正態(tài)分布且方差齊性相等,則采用配對(duì)t檢驗(yàn),反之采用四格表資料的卡方檢驗(yàn)。各檢驗(yàn)過(guò)程均以P0.05表示具有統(tǒng)計(jì)學(xué)意義。結(jié)果:FMA評(píng)分(上肢部分)結(jié)果分析。①組內(nèi)比較:治療組患者在治療8周后的FMA評(píng)分較治療前有明顯增加,差異具有統(tǒng)計(jì)學(xué)意義(P0.01);對(duì)照組患者在治療8周后的FMA評(píng)分較治療前亦有所增加,差異具有統(tǒng)計(jì)學(xué)意義(P0.01)。②組間比較:兩組治療前FMA評(píng)分比較無(wú)統(tǒng)計(jì)學(xué)意義(P0.05);兩組治療8周后FMA評(píng)分具有差異性(P0.05),且治療組FMA評(píng)分較對(duì)照組增加明顯,兩組FMA評(píng)分差值具有顯著統(tǒng)計(jì)學(xué)意義(P0.01)。MBI指數(shù)評(píng)分結(jié)果分析。①組內(nèi)比較:治療組患者在治療8周后的MBI指數(shù)較治(?)療前有明顯增加,差異具有統(tǒng)計(jì)學(xué)意義(P0.01);對(duì)照組患者在治療8周后的MBI指數(shù)較治療前亦有所增加,差異具有統(tǒng)計(jì)學(xué)意義(P0.01)。②組間比較:兩組治療前MBI指數(shù)比較無(wú)統(tǒng)計(jì)學(xué)意義(P0.05);兩組治療8周后MBI指數(shù)具有差異性(P0.05),且治療組MBI指數(shù)較對(duì)照組增加明顯,兩組MBI指數(shù)差值具有顯著統(tǒng)計(jì)學(xué)意義(P0.01)。結(jié)論:(1)表明體針治療與本體感覺(jué)強(qiáng)化訓(xùn)練在促進(jìn)偏癱上肢功能恢復(fù)的療效優(yōu)于對(duì)照組即體針治療。(2)表明體針治療與本體感覺(jué)強(qiáng)化訓(xùn)練相聯(lián)合的治療方法可以有效改善腦卒中后患者上肢的日常生活能力,且療效顯著于體針組。
[Abstract]:Objective: To observe the clinical effect of body acupuncture combined with proprioceptive intensive training in the treatment of stroke hemiplegia upper limb dysfunction, to explore the effectiveness and clinical popularization value of combined treatment of hemiplegic upper limb function and daily living ability after stroke, and to optimize the treatment plan for the recovery of hemiplegia Upper Limb Dyskinesia for clinical treatment. A more effective method of combining traditional Chinese and Western medicine was sought after stroke, and evidence based evidence-based medical evidence was provided. Method: a single blind randomized controlled trial was used in 60 patients with upper limb dysfunction which were in accordance with the diagnostic criteria for the first stroke and the course of the disease was less than 3 months. The sequence number was divided into two groups, the treatment group and the control group, with 30 cases in each group. The two groups were all given the basic medicine treatment and routine rehabilitation training in the neurology department. The control group took the hemiplegia side upper limb needle treatment, if the patient was in the relaxation period, the main points were the flexor group acupoints, such as the Neiguan and the zanze. If the patient is in spasticity, the acupoints of the extensor group of the upper limb, that is, the Yang Meridian Acupoints, such as the external customs, the support, the Chi Chi, the arm cloth and the shoulder, are taken for 20 minutes (and the acupuncture points are adjusted to adapt to the development and reduction of the acupoints according to the patients' rehabilitation process and the TCM syndrome differentiation. " The treatment group was treated with proprioceptive intensive training on the basis of the treatment of the control group on the basis of the treatment of 30min/ days. All the subjects were given treatment 1 times / day, Sunday rest and 8 weeks before and after treatment, 48 times and 56 days of treatment. And before treatment, after treatment (8 weeks), the simplified Fugl-Mayer exercise function was used. The table (Fugl-Mayer assessment scale, FMA) evaluated the upper limb motor function, improved the Barthel index (the modified Barthel index, MBI) for daily living activity (ADL) evaluation, compared the intra group comparison with the group to evaluate the curative effect respectively. Difference (x + s), using SPSS19.0 software to analyze: two groups of independent sample groups, for example, for measurement data, obey normal distribution and equal variance homogeneity, then adopt group t test and vice versa test of four lattice data; in group comparison before and after treatment, if the data, obey normal distribution and the homogeneity of variance is equal, then use paired t Test, on the other hand, we used the chi square test of four grid data. All the tests were statistically significant with P0.05. Results: FMA score (upper limb part) results analysis. (1) in group comparison: the FMA score of the treatment group was significantly increased after 8 weeks of treatment, and the difference was statistically significant (P0.01); the control group was treated for 8 weeks. After the treatment, the FMA score of the two groups was not statistically significant (P0.01). There was no significant difference between the two groups before treatment (P0.05); the FMA score in the two groups was different after 8 weeks of treatment (P0.05), and the FMA score in the treatment group was significantly higher than that in the control group, and the difference value of the FMA score in the two groups had significant statistical significance (P0.). 01).MBI index score analysis. (1) in group comparison: the MBI index in the treatment group was significantly increased after 8 weeks of treatment than before treatment (?), and the difference was statistically significant (P0.01); the MBI index in the control group was also increased after 8 weeks of treatment, and the difference was statistically significant (P0.01). (2) group comparison: two groups before treatment (MBI). The index of the index was not statistically significant (P0.05); the MBI index in the two groups was different after 8 weeks (P0.05), and the MBI index in the treatment group was significantly higher than that in the control group. The difference between the two groups was statistically significant (P0.01). Conclusion: (1) the effect of the body acupuncture therapy and the proprioceptive intensive training on the recovery of the hemiplegia upper limb was better than that of the pair. (2) it shows that the combined treatment of body acupuncture and proprioception can effectively improve the daily living ability of the upper limbs of the patients after stroke, and the curative effect is significant in the body acupuncture group.
【學(xué)位授予單位】：廣州中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R743.3
本文編號(hào)：2157298
[Abstract]:Objective: To observe the clinical effect of body acupuncture combined with proprioceptive intensive training in the treatment of stroke hemiplegia upper limb dysfunction, to explore the effectiveness and clinical popularization value of combined treatment of hemiplegic upper limb function and daily living ability after stroke, and to optimize the treatment plan for the recovery of hemiplegia Upper Limb Dyskinesia for clinical treatment. A more effective method of combining traditional Chinese and Western medicine was sought after stroke, and evidence based evidence-based medical evidence was provided. Method: a single blind randomized controlled trial was used in 60 patients with upper limb dysfunction which were in accordance with the diagnostic criteria for the first stroke and the course of the disease was less than 3 months. The sequence number was divided into two groups, the treatment group and the control group, with 30 cases in each group. The two groups were all given the basic medicine treatment and routine rehabilitation training in the neurology department. The control group took the hemiplegia side upper limb needle treatment, if the patient was in the relaxation period, the main points were the flexor group acupoints, such as the Neiguan and the zanze. If the patient is in spasticity, the acupoints of the extensor group of the upper limb, that is, the Yang Meridian Acupoints, such as the external customs, the support, the Chi Chi, the arm cloth and the shoulder, are taken for 20 minutes (and the acupuncture points are adjusted to adapt to the development and reduction of the acupoints according to the patients' rehabilitation process and the TCM syndrome differentiation. " The treatment group was treated with proprioceptive intensive training on the basis of the treatment of the control group on the basis of the treatment of 30min/ days. All the subjects were given treatment 1 times / day, Sunday rest and 8 weeks before and after treatment, 48 times and 56 days of treatment. And before treatment, after treatment (8 weeks), the simplified Fugl-Mayer exercise function was used. The table (Fugl-Mayer assessment scale, FMA) evaluated the upper limb motor function, improved the Barthel index (the modified Barthel index, MBI) for daily living activity (ADL) evaluation, compared the intra group comparison with the group to evaluate the curative effect respectively. Difference (x + s), using SPSS19.0 software to analyze: two groups of independent sample groups, for example, for measurement data, obey normal distribution and equal variance homogeneity, then adopt group t test and vice versa test of four lattice data; in group comparison before and after treatment, if the data, obey normal distribution and the homogeneity of variance is equal, then use paired t Test, on the other hand, we used the chi square test of four grid data. All the tests were statistically significant with P0.05. Results: FMA score (upper limb part) results analysis. (1) in group comparison: the FMA score of the treatment group was significantly increased after 8 weeks of treatment, and the difference was statistically significant (P0.01); the control group was treated for 8 weeks. After the treatment, the FMA score of the two groups was not statistically significant (P0.01). There was no significant difference between the two groups before treatment (P0.05); the FMA score in the two groups was different after 8 weeks of treatment (P0.05), and the FMA score in the treatment group was significantly higher than that in the control group, and the difference value of the FMA score in the two groups had significant statistical significance (P0.). 01).MBI index score analysis. (1) in group comparison: the MBI index in the treatment group was significantly increased after 8 weeks of treatment than before treatment (?), and the difference was statistically significant (P0.01); the MBI index in the control group was also increased after 8 weeks of treatment, and the difference was statistically significant (P0.01). (2) group comparison: two groups before treatment (MBI). The index of the index was not statistically significant (P0.05); the MBI index in the two groups was different after 8 weeks (P0.05), and the MBI index in the treatment group was significantly higher than that in the control group. The difference between the two groups was statistically significant (P0.01). Conclusion: (1) the effect of the body acupuncture therapy and the proprioceptive intensive training on the recovery of the hemiplegia upper limb was better than that of the pair. (2) it shows that the combined treatment of body acupuncture and proprioception can effectively improve the daily living ability of the upper limbs of the patients after stroke, and the curative effect is significant in the body acupuncture group.
【學(xué)位授予單位】：廣州中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R743.3
【參考文獻(xiàn)】
相關(guān)期刊論文 前10條
1 肖洪波;朱宗俊;陳瑞全;邵俊;蔡潤(rùn);羅金發(fā);;任務(wù)導(dǎo)向性訓(xùn)練聯(lián)合肉毒素對(duì)腦卒中后上肢痙攣患者功能恢復(fù)的影響[J];中國(guó)臨床保健雜志;2015年01期
2 王維;馬躍文;楊巍;;鏡像療法對(duì)腦卒中偏癱患者上肢功能和手功能的影響[J];大連醫(yī)科大學(xué)學(xué)報(bào);2013年06期
3 莊衛(wèi)生;錢(qián)寶延;曹留拴;鄒麗麗;;基于鏡像神經(jīng)元的動(dòng)作觀察療法在運(yùn)動(dòng)功能康復(fù)中的應(yīng)用[J];中國(guó)康復(fù);2013年05期
4 王秋純;陳紅霞;;任務(wù)導(dǎo)向性訓(xùn)練對(duì)腦卒中患者上肢功能的療效觀察[J];中國(guó)康復(fù);2013年04期
5 方向延;王南;趙建華;李志強(qiáng);黃艷萍;;本體感覺(jué)強(qiáng)化訓(xùn)練對(duì)腦卒中恢復(fù)期患者偏癱功能的療效分析[J];現(xiàn)代診斷與治療;2013年10期
6 呂靜;李鑫銘;;“醒腦開(kāi)竅”針刺法治療中風(fēng)后上肢痙攣性癱瘓30例[J];湖南中醫(yī)雜志;2013年06期
7 宋如敏;李和平;;腦卒中后手功能障礙針灸治療的研究進(jìn)展[J];光明中醫(yī);2013年05期
8 趙嘉誠(chéng);鄧昌明;;針刺配合康復(fù)訓(xùn)練治療缺血性中風(fēng)患者運(yùn)動(dòng)功能障礙42例[J];湖南中醫(yī)雜志;2013年03期
9 薛晴;崔仁愛(ài);邢艷麗;;運(yùn)動(dòng)想象療法結(jié)合針康法治療腦卒中后上肢功能障礙的臨床療效觀察[J];針灸臨床雜志;2012年09期
10 倪歡歡;崔曉;胡永善;吳毅;黃德權(quán);瞿佩育;汪軍;吳佶;史駿超;;針刺十宣、小海穴配合功能訓(xùn)練治療中風(fēng)后手功能障礙療效觀察[J];上海針灸雜志;2012年05期
相關(guān)碩士學(xué)位論文 前1條
1 馮麗媛;合谷刺電針動(dòng)法對(duì)腦卒中后腕背伸功能恢復(fù)的臨床研究[D];黑龍江中醫(yī)藥大學(xué);2010年
，本文編號(hào)：2157298
本文鏈接：http://sikaile.net/yixuelunwen/shenjingyixue/2157298.html
最近更新
教材專著
