【摘要】：目的：針對(duì)中風(fēng)后上肢運(yùn)動(dòng)功能障礙難以恢復(fù)的問題,改進(jìn)現(xiàn)有的治療方法,采用表面肌電客觀評(píng)價(jià)低頻穴位電刺激結(jié)合強(qiáng)制性運(yùn)動(dòng)療法與電針對(duì)手抓握功能的影響,旨在為臨床尋求一種更有效的治療方法提供根據(jù)并驗(yàn)證臨床療效。 方法：選擇符合標(biāo)準(zhǔn)的腦卒中患者60例,隨機(jī)分為兩組,在常規(guī)康復(fù)的基礎(chǔ)上,對(duì)照組給予電針治療,波形為2Hz連續(xù)波,刺激強(qiáng)度以肉眼可見肌肉收縮為度,每次治療30分鐘；治療組先采用低頻穴位電刺激,給予50Hz斷續(xù)比為1：1的斷續(xù)波,刺激強(qiáng)度以出現(xiàn)拇指內(nèi)收四指屈曲、拇指外展四指伸展兩組動(dòng)作交替為度,每次治療30分鐘,然后采用強(qiáng)制性運(yùn)動(dòng)療法,限制健側(cè)肢體使用,強(qiáng)迫患者患肢作握杯子、握筆、拾物以及和日常生活相關(guān)的穿衣、刷牙、系扣等訓(xùn)練,每個(gè)動(dòng)作重復(fù)10～15次,每次治療30分鐘,兩組都選取手三里、外關(guān)、魚際、大陵、內(nèi)關(guān)、靈道穴。采集患者患肢的療前、療后手做拇指內(nèi)收四指屈曲、拇指外展四指伸展動(dòng)作時(shí)的伸、屈肌群的sEMG信號(hào),提取最大值(MAX)、均方根值(RMS),采用MAX、RMS、手關(guān)節(jié)活動(dòng)度(ROM).Fugl-Meyer量表(上肢).BarthelADL指數(shù)、并根據(jù)神經(jīng)功能缺損評(píng)分(上肢)計(jì)算有效率作為療效判定指標(biāo) 結(jié)果： 1.低頻穴位電刺激結(jié)合強(qiáng)制性運(yùn)動(dòng)組與電針組患者患側(cè)療后伸、屈肌群的MAX.RMS較治療前均有顯著性差異(p0.01),且治療組患側(cè)MAX、RMS的差值較對(duì)照組有顯著性差異(p0.01),治療組優(yōu)于對(duì)照組。 2.低頻穴位電刺激結(jié)合強(qiáng)制性運(yùn)動(dòng)組與電針組患者療后Fugl-Meyer量表,Barthel ADL指數(shù)與治療前比較均有顯著性差異(p0.01),且治療組患側(cè)Fugl-Meyer量表、Barthel ADL指數(shù)評(píng)分的差值較對(duì)照組有顯著性差異(p0.01),治療組優(yōu)于對(duì)照組。 3.低頻穴位電刺激結(jié)合強(qiáng)制性運(yùn)動(dòng)組與電針組患者療后手關(guān)節(jié)活動(dòng)度(ROM)評(píng)分比未治療前存在明顯差異(p0.01),結(jié)果顯示治療組優(yōu)于對(duì)照組。 4.低頻穴位電刺激結(jié)合強(qiáng)制性運(yùn)動(dòng)組與電針組患者治療后神經(jīng)功能缺損評(píng)分較療前有顯著性差異(p0.01),治療組優(yōu)于對(duì)照組。 結(jié)論： 1.低頻穴位電刺激結(jié)合強(qiáng)制性運(yùn)動(dòng)療法與電針療法可提高手部及上肢伸、屈肌群收縮功能和單位時(shí)間內(nèi)的做功能力,從而提高患側(cè)伸、屈肌肌力,改善上肢運(yùn)動(dòng)功能。 2.低頻穴位電刺激結(jié)合強(qiáng)制性運(yùn)動(dòng)療法與電針療法均可改善上肢日常生活能力,對(duì)恢復(fù)手抓握功能療效肯定,但低頻穴位電刺激結(jié)合強(qiáng)制性運(yùn)動(dòng)療法要優(yōu)于電針療法。
[Abstract]:Objective: to improve the existing treatment methods and to evaluate the effects of low frequency acupoint electric stimulation combined with compulsory motor therapy and electroacupuncture on grip function of the upper limb motor dysfunction after apoplexy. The aim is to find a more effective treatment for the clinical basis and verify the clinical efficacy. Methods: sixty stroke patients who met the standard were randomly divided into two groups. On the basis of routine rehabilitation, the control group was treated with electroacupuncture, the waveform was 2Hz continuous wave, and the intensity of stimulation was as follows: muscle contraction was visible to the naked eye for 30 minutes each time. In the treatment group, the low frequency acupoint electrical stimulation was first used, and the intermittent wave of 50 Hz was given to 1:1. The intensity of the stimulation was to show the flexion of the thumb with four fingers flexion, and the extension of the four fingers of the thumb was alternately divided into two groups, for 30 minutes each time. Then we used compulsory exercise therapy to restrict the use of healthy limbs, and forced the patients to hold cups, pens, pick up objects and clothing, brush their teeth, fasten their buckles, and so on. Each exercise was repeated 1015 times. Each treatment for 30 minutes, the two groups are selected hand Sanli, Ouguan, thenar, Daling, Neiguan, Lingdao acupoints. The SEMG signals of the flexor and flexor muscles were collected before and after the treatment. The maximum (Max) and root mean square (RMS) were extracted. The index of hand joint motion (ROM). Fugl-Meyer scale (upper limb). Barthel ADL index was used to extract the maximum value (Max), root mean square (RMS), mean square value (RMS), and the index of hand joint motion (ROM), Fugl-Meyer scale (upper limb). According to the nerve function defect score (upper limb), the effective rate was calculated as the index of curative effect: 1. Low frequency acupoint electrical stimulation combined with compulsory exercise group and electroacupuncture group patients with side extension after treatment, There were significant differences in MAX.RMS of flexor group compared with those before treatment (p0.01), and the difference of MAX-RMS in the treatment group was significantly higher than that in the control group (p0.01), and the difference between the treatment group and the control group was better than that in the control group (p0.01). There were significant differences between the low frequency acupoint electric stimulation and compulsory exercise group and electroacupuncture group after treatment with the Fugl-Meyer scale Barthel ADL index (p0.01), and the difference in the score of Barthel ADL index between the treatment group and the control group was significant compared with that of the control group. The difference (p0.01), the treatment group was better than the control group. The range of motion (ROM) of hand joint in the low frequency acupoint electric stimulation combined with compulsory exercise group and electroacupuncture group was significantly different from that before treatment (p0.01). The results showed that the treatment group was better than the control group. 4. There was significant difference in the scores of nerve function defect between the low frequency acupoint electric stimulation group and the electroacupuncture group after treatment (p0.01), and the treatment group was superior to the control group. Conclusion: 1. Low frequency acupoint electrical stimulation combined with forced exercise therapy and electroacupuncture therapy can improve the contractile function of hand and upper limb, flexor group and the ability to do work per unit time, thus increasing the muscle strength of the affected side and flexor muscle. Improved upper limb motor function. 2. Low frequency acupoint electric stimulation combined with compulsory exercise therapy and electroacupuncture therapy can improve the daily life ability of upper limb and have a positive effect on the recovery of hand grip function, but low frequency acupoint electric stimulation combined with compulsory exercise therapy is better than electroacupuncture therapy.
【學(xué)位授予單位】：黑龍江中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2013
【分類號(hào)】：R245.97

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 江征;何堅(jiān);蔡素芳;王輝;郭毅堅(jiān);;神經(jīng)肌肉電刺激療法對(duì)腦卒中上肢功能的影響[J];福建中醫(yī)藥大學(xué)學(xué)報(bào);2010年05期

2 陳英;曹晶晶;楊衛(wèi)杰;;電針治療中風(fēng)偏癱肩-手綜合征療效觀察[J];光明中醫(yī);2009年06期

3 侯天舒;封敏;吳巧鳳;;“治痿獨(dú)取陽明”淺析及針灸臨床應(yīng)用[J];甘肅中醫(yī);2011年05期

4 王東巖;李慶玲;杜志江;孫立寧;;5 DOF穿戴式上肢康復(fù)機(jī)器人控制方法研究[J];哈爾濱工業(yè)大學(xué)學(xué)報(bào);2007年09期

5 石學(xué)敏;“醒腦開竅”針刺法治療中風(fēng)病9005例臨床研究[J];中醫(yī)藥導(dǎo)報(bào);2005年01期

6 周運(yùn)峰;焦凡;石洪霞;;手三里穴臨床應(yīng)用概況[J];河南中醫(yī);2010年08期

7 盧巖;王世軍;;電針對(duì)局灶性腦缺血大鼠腦葡萄糖代謝的影響[J];遼寧中醫(yī)雜志;2011年05期

8 張麗麗;杜宇征;褚芹;;近年來“醒腦開竅”針刺法治療中風(fēng)的臨床及基礎(chǔ)研究[J];遼寧中醫(yī)雜志;2011年06期

9 張軍峰;許月紅;李震中;王惠凌;王洪娟;尹晶;;缺血性腦卒中危險(xiǎn)因素知曉率的流行病學(xué)調(diào)查及趨勢(shì)分析[J];腦與神經(jīng)疾病雜志;2007年06期

10 王東巖;王偉;周圍;郇靖;張然;;基于表面肌電信號(hào)的腕手功能評(píng)定與重建研究[J];中國臨床保健雜志;2009年02期

相關(guān)會(huì)議論文 前1條

1 周宇;;基于中風(fēng)病現(xiàn)代病機(jī)學(xué)說的手功能障礙巨刺方法探討[A];2011中國針灸學(xué)會(huì)年會(huì)論文集（摘要）[C];2011年

相關(guān)碩士學(xué)位論文 前1條

1 朱瑩;屈伸肌交替功能性電刺激與電針對(duì)中風(fēng)抓握功能影響的對(duì)比研究[D];黑龍江中醫(yī)藥大學(xué);2011年

，

本文編號(hào)：2122202