本文選題：靳三針療法 + 中風(fēng)后痙攣性偏癱　； 參考：《廣州中醫(yī)藥大學(xué)》2016年博士論文

【摘要】：中風(fēng)后痙攣性癱瘓是指腦卒中后大部分肌群出現(xiàn)肌張力增高,腱反射亢進,運動時阻力增加,生硬,肢體常被拉向肌群痙攣方向,不能產(chǎn)生協(xié)調(diào)運動,并可造成患肢肌肉萎縮、關(guān)節(jié)攣縮及變形的一系列臨床癥狀,是腦卒中患者存在的最常見的殘障表現(xiàn)之一,也是康復(fù)治療中最棘手的后遺癥。隨著醫(yī)學(xué)水平的不斷提高,腦卒中后生存率不斷上升,使得腦卒中后肢體恢復(fù)問題日益突顯,腦卒中后肢體出現(xiàn)痙攣性癱瘓不僅嚴重影響患者的日常生活能力,而且給家庭和社會帶來沉重的負擔(dān)。目的：“靳三針”療法是廣州中醫(yī)藥大學(xué)首席教授靳瑞創(chuàng)治,采用靳三針在治療中風(fēng)后痙攣性癱瘓已開展了多項臨床研究工作,對該病的治療積累了豐富的經(jīng)驗,具有確切肯定的臨床療效。為觀察靳三針療法治療中風(fēng)后痙攣性癱瘓的針刺干預(yù)時機及選穴位配伍,優(yōu)化治療方案,研究采用多因素分析法,對影響臨床療效的兩個重要因素(針刺時機、選穴配伍)進行2×2析因分組,以探討該療法治療痙攣性癱瘓的最優(yōu)選穴配伍及針刺時機。尋求在在針刺時機、穴位配伍這兩個關(guān)鍵技術(shù)要點上有新的突破,為該療法進一步地推廣應(yīng)用提供理論依據(jù)。方法：本研究嚴格按照循證醫(yī)學(xué)的方法,進行大樣本、隨機研究,采用統(tǒng)一的藥物治療,并采用統(tǒng)一的診斷及療效判定標準,用多因素分析法(2×2析因統(tǒng)計)進行穴位配伍、針刺時機分析,以中風(fēng)后痙攣性偏癱患者為研究對象。其方法是：將影響靳三針療法的兩個重要因素(針刺時機、選穴配伍)進行2×2析因組合,取針刺時機、選穴配伍兩個因素,分為2個水平(中風(fēng)后-14天/中風(fēng)后15-30天、顳三針+手足攣三針/顳三針+手足三針)進行兩兩組合后進行比較,將觀察對象分為四組(1組：中風(fēng)后I-14天+顳三針、手足攣三針組；2組：中風(fēng)后-14天+顳三針、手足三針組；3組：中風(fēng)后15-30-天+顳三針、手足攣三針組；4組：中風(fēng)后15-30天+顳三針、手足三針組)。治療時間為每日1次,每次30min,每周連續(xù)針刺5天,隔2日,再行下周治療,2周為1個療程,一共治療2個療程,相關(guān)指標評測于治療前、療程結(jié)束后觀察患者改良Ashworth痙攣量表(MAS)、臨床痙攣指數(shù)(CSI)量表、臨床神經(jīng)功能缺損程度評分(NDS)、四肢簡化Fugl-Meyer運動功能評分、日常生活活動能力AQL (Barthel)指數(shù),進行評定后進入統(tǒng)計分析處理。結(jié)果：1臨床療效1.1在臨床療效方面,臨床治愈率從高到低分別為：1組(中風(fēng)后-14天+顳三針、手足攣三針)臨床治愈率最高,為19.0%；2組(中風(fēng)后-14天+顳三針、手足三針)；3組(中風(fēng)后15-30天+顳三針、手足攣三針)、4組(中風(fēng)后15-30天+顳三針、手足三針)的臨床治愈率分別為9.8%、8.5%和5.0%,組間療效相比,經(jīng)統(tǒng)計學(xué)處理有異常顯著性差異(P0.01)；1組與其它三組臨床治愈率相比,經(jīng)統(tǒng)計學(xué)處理有異常顯著性差異(P0.01)；2、3兩組臨床治愈率相仿,經(jīng)統(tǒng)計學(xué)處理,無顯著性差異(P0.05)。總有效率方面：1組(中風(fēng)后1-14天+顳三針、手足攣三針)總有效率為94.90%；2組(中風(fēng)后1-14天+顳三針、手足三針)、3組(中風(fēng)后15-30天+顳三針、手足攣三針)、4組(中風(fēng)后15-30天+顳三針、手足攣三針)的總有效率分別為90.2%、89.0%和83.75%,組間療效相比,經(jīng)統(tǒng)計學(xué)處理有異常顯著性差異(P0.01)；1組與其它三組總有效率相比,經(jīng)統(tǒng)計學(xué)處理有異常顯著性差異(P0.01、P0.05)；2、3兩組總有效率相仿,經(jīng)統(tǒng)計學(xué)處理,無顯著性差異(P0.05)。綜上結(jié)論：在內(nèi)科及常規(guī)治療同等的基礎(chǔ)上,在中風(fēng)后1-14天介入針刺療法,采用靳三針(顳三針+手足攣三針)治療,對改善中風(fēng)后痙攣性癱瘓患者的痙攣程度臨床療效最佳。2臨床痙攣指數(shù)(CSI)評分2.1療程結(jié)束后,在針刺時機相同的前提下,比較痙攣指數(shù)(CSI)評分顯示：1組(中風(fēng)后1-14天+顳三針、手足攣三針)與2組(中風(fēng)后-14天+顳三針、手足三針)兩組相比,以1組為優(yōu),有顯著性差異(P0.05)；3組(中風(fēng)后15-30天+顳三針、手足攣三針)與4組(中風(fēng)后15-30天+顳三針、手足三針)兩組相比,以3組為優(yōu),有異常顯著性差異(P0.01)。提示：在介入針刺時機相同的前提下,在改善痙攣指數(shù)(CSI)得分方面,選用顳三針+手足攣三針組臨床療效更佳(P0.01、P0.05)。2.2療程結(jié)束后,在選穴配伍相同的前提下,比較痙攣指數(shù)(CSI)評分得分顯示：1組(中風(fēng)后-14天+顳三針、手足攣三針)與3組(中風(fēng)后15-30天+顳三針、手足攣三針)兩組相比,以1組為優(yōu),有顯著性差異(P0.05)；2組(中風(fēng)后-14天+顳三針、手足三針)與4組(中風(fēng)后15-30天+顳三針、手足三針)兩組相比,以2組為優(yōu),有異常顯著性差異(P0.01)。提示：在選穴配伍相同的前提下,在改善痙攣指數(shù)(CSI)得分方面,早介入針刺治療組(中風(fēng)后-14天)在療效更佳(P0.01、P0.05)。3日常生活能力ADL (Barthel)指數(shù)評分3.1療程結(jié)束后,在針刺時機相同的前提下,比較日常生活能力(ADL Barther指數(shù))顯示：1組(中風(fēng)后-14天+顳三針、手足攣三針)與2組(中風(fēng)后1-14天+顳三針、手足三針)兩組相比,以1組為優(yōu),有異常顯著性差異(P0.01)；3組(中風(fēng)后15-30天+顳三針、手足攣三針)與4組(中風(fēng)后15-30天+顳三針、手足三針)兩組相比,以3組為優(yōu),有異常顯著性差異(P0.01)。提示：在時間因素固定的前提下,在改善日常生活能力ADL (Barthel指數(shù))方面,選用顳三針+手足攣三針組臨床療效更佳(P0.01)。3.2療程結(jié)束后,在選穴配伍相同的前提下,比較日常生活能力(ADL Barthel指數(shù))顯示：1組(中風(fēng)后1-14天+顳三針、手足攣三針)與3組(中風(fēng)后15-30天+顳三針、手足攣三針)兩組相比,以1組為優(yōu),有異常顯著性差異(P0.01)；2組(中風(fēng)后1-14天+顳三針、手足三針)與4組(中風(fēng)后15-30天+顳三針、手足三針)兩組相比,以2組為優(yōu),有異常顯著性差異(P0.01)。提示：在選穴配伍相同的前提下,在日常生活能力ADL (Barthel)指數(shù)方面,早介入針刺治療組(中風(fēng)后1-14天)在療效更佳(P0.01)。4神經(jīng)功能缺損程度(NDS)評分表4.1療程結(jié)束后,在針刺時機相同的前提下,比較神經(jīng)功能缺損(NDS)評分顯示：1組(中風(fēng)后1-14天+顳三針、手足攣三針)與2組(中風(fēng)后1-14天+顳三針、手足三針)兩組相比,以1組為優(yōu),有異常顯著性差異(P0.01)；3組(中風(fēng)后15-30天+顳三針、手足攣三針)與4組(中風(fēng)后15-30天+顳三針、手足三針)兩組相比,以3組為優(yōu),有顯著性差異(P0.05)。提示：介入針刺時機相同的前提下,在改善神經(jīng)功能缺損(NDS)評分方面,選用顳三針+手足攣三針組臨床療效更佳(P0.01、P0.05)。4.2療程結(jié)束后,在選穴配伍相同的前提下,比較神經(jīng)功能缺損(NDS)評分顯示：1組(中風(fēng)后1-14天+顳三針、手足攣三針)與3組(中風(fēng)后15-30天+顳三針、手足攣三針)兩組相比,以1組為優(yōu),有異常顯著性差異(P0.01)；2組(中風(fēng)后1-14天+顳三針、手足三針)與4組(中風(fēng)后15-30天+顳三針、手足三針)兩組相比,以2組為優(yōu),有顯著性差異(P0.05)。提示：在選穴配伍相同的前提下,在改善神經(jīng)功能缺損(NDS)評分方面,早介入針刺治療組(中風(fēng)后1-14天)在療效更佳(P0.01、P0.05)。5簡化FugI-Meyer運動功能評定5.1療程結(jié)束后,在介入針刺時機相同的前提下,比較Fugl-Meyer運動功能得分顯示：1組(中風(fēng)后1-14天+顳三針、手足攣三針)與2組(中風(fēng)后1-14天+顳三針、手足三針)兩組相比,以1組為優(yōu),有異常顯著性差異(P0.01)；3組(中風(fēng)后15-30天+顳三針、手足攣三針)與4組(中風(fēng)后15-30天+顳三針、手足三針)兩組相比,以3組為優(yōu),有異常顯著性差異(P0.01)。提示：介入針刺時機相同的前提下,在改善Fugl-Meyer得分方面,選用顳三針+手足攣三針組臨床療效更佳(P0.01)。5.2療程結(jié)束后,在選穴配伍相同的前提下,比較Fugl-Meyer得分顯示：1組(中風(fēng)后1-14天+顳三針、手足攣三針)與3組(中風(fēng)后15-30天+顳三針、手足攣三針)兩組相比,以1組為優(yōu),有異常顯著性差異(P0.01)；2組(中風(fēng)后1-14天+顳三針、手足三針)與4組(中風(fēng)后15-30天+顳三針、手足三針)兩組相比,以2組為優(yōu),有異常顯著性差異(P0.01)。提示：在選穴配伍相同的前提下,在改善Fugl-Meyer得分方面,早介入針刺治療組(中風(fēng)后1-14天)在療效更佳(P0.01)。6針刺時機和選穴配伍聯(lián)合干預(yù)作用分析6.1痙攣指數(shù)(CSI)評分針刺時機和選穴配伍聯(lián)合作用(中風(fēng)后1-14天早期針刺干預(yù)+顳三針、手足攣三針治療中風(fēng)后痙攣性偏癱患者在痙攣指數(shù)(CSI)評分雖然統(tǒng)計學(xué)分析上無存在明顯的協(xié)同、交互干預(yù)作用點,但根據(jù)交叉作用圖(見圖八、圖九),應(yīng)有良好的交叉作用趨勢；根據(jù)選穴配伍、針刺時機的固定因素分析,聯(lián)合作用后可顯著降低中風(fēng)后痙攣性偏癱患者痙攣指數(shù)CSI評分(P0.01)有效緩解偏癱肢體肌張力緊張狀態(tài)、改善偏癱肢體痙攣程度。6.2日常生活能力ADL (Barthel)指數(shù)評分針刺時機和選穴配伍聯(lián)合作用(中風(fēng)后1-14天早期針刺干預(yù)+顳三針、手足攣三針治療中風(fēng)后痙攣性偏癱患者在日常生活能力ADL (Barthel)指數(shù)評分存在良好的協(xié)同、交互干預(yù)作用；聯(lián)合作用后可顯著提高中風(fēng)后痙攣性偏癱患者日常生活能力ADL(Barthel)指數(shù)評分((見圖十一、圖十二)有效提高患者的日常生活能力,提高患者的生活質(zhì)量。6.3神經(jīng)功能缺損(NDS)評分針刺時機和選穴配伍聯(lián)合作用(中風(fēng)后1-14天早期針刺干預(yù)+顳三針、手足攣三針治療中風(fēng)后痙攣性偏癱患者在神經(jīng)功能缺損(NDS)評分雖然統(tǒng)計學(xué)分析上無存在明顯的協(xié)同、交互干預(yù)作用點,但根據(jù)交叉作用圖(見圖十四、圖十五),應(yīng)有良好的交叉作用趨勢；根據(jù)選穴配伍、針刺時機的固定因素分析,聯(lián)合作用后可顯著降低中風(fēng)后痙攣性偏癱患者神經(jīng)功能缺損(NDS)評分有效促進偏癱患者神經(jīng)功能康復(fù),提高了患者的生活質(zhì)量。6.4簡化Fugl-Meyer運動功能評定針刺時機和選穴配伍聯(lián)合作用(中風(fēng)后1-14天早期針刺干預(yù)+顳三針、手足攣三針)治療中風(fēng)后痙攣性偏癱患者在簡化Fugl-Meyer運動功能存在良好的協(xié)同、交互干預(yù)作用；聯(lián)合作用后可顯著提高中風(fēng)后痙攣性偏癱患者簡化Fugl-Meyer運動功能評分(見圖十七、圖十八P0.01),有效改善中風(fēng)后痙攣性偏癱患者肢體運動功能能力。結(jié)論：在中風(fēng)后-14天或中風(fēng)后15-30天開始介入靳三針療法(針刺顳三針+手足攣三針或顳三針+手足三針)治療中風(fēng)后痙攣性偏癱患者,均能有效緩解患者偏癱肢體緊張程度,降低患者神經(jīng)缺損程度,改善肢體的運動能力,提高日常生活能力,可獲得良好的臨床療效。治療中風(fēng)后痙攣性偏癱最優(yōu)先方案：中風(fēng)后1-14天配合顳三針、手足攣三針
[Abstract]:Spastic paralysis after apoplexy refers to the most common symptoms of stroke patients, such as increased muscle tension, hyperreflexiism, increased resistance, stiffness, and limbs often pulling into the direction of spasm of the muscle group, which can not produce coordinated movement, and can cause limb muscle atrophy, joint contracture and deformation. One of the manifestations of disability is also the most difficult sequelae in the rehabilitation treatment. With the continuous improvement of medical level, the survival rate of stroke is increasing, which makes the problem of limb recovery more and more obvious after stroke. Spastic paralysis of limbs after stroke not only seriously affects the daily living ability of patients, but also brings family and society to the family and society. Objective: Jin three needles, the chief professor of Guangzhou University of Chinese Medicine, Jin Rui Chuang Zhi, has carried out several clinical studies on the treatment of spastic paralysis after apoplexy with Jin three needles, and has accumulated rich experience in the treatment of the disease and has a definite curative effect on the bed. The timing of the acupuncture intervention for the acupoint and the compatibility of acupoints, the optimization of the treatment plan, the study of the multiple factor analysis, the two important factors (the timing of acupuncture, the compatibility of the acupoint selection) and the 2 x 2 factorial grouping to explore the best combination of the acupoints and the timing of acupuncture for the treatment of spastic paralysis. There are new breakthroughs in the two key technical points of compatibility, which provide theoretical basis for further application of this therapy. Methods: This study is strictly based on the method of evidence-based medicine to carry out large sample, random study, unified drug treatment, unified diagnostic and therapeutic criteria, and multi factor analysis (2 x 2 factorial analysis). Statistics) acupoint compatibility, the timing analysis of acupuncture, with spastic hemiplegic patients after apoplexy as the research object. The method is: the two important factors (acupuncture timing, selection of acupoints compatibility) to carry on the 2 x 2 factorial combination, take the timing of acupuncture, select the combination of two factors, divided into 2 levels (after apoplexy -14 days / 15-30 days after apoplexy, temporomandibular) After three needles + hand, foot and foot -, three needles, temporal three needles + hand foot three needles and three needles, they were divided into four groups (1 groups: 1 groups: I-14 days after apoplexy + temporal three needles, hand foot and foot three needles; 2 groups after apoplexy + temporal three needles, hand foot three needle groups; 3 groups after apoplexy 15-30- days + temporal three needles, hand and foot tus three needles; 4: 15-30 days + temporal after apoplexy. Three needles, hand and foot three needle groups). The treatment time was 1 times a day, 30min each time, 5 days of continuous acupuncture, 2 days, next week, 2 weeks for 1 courses, and 2 courses of treatment. The related indexes were evaluated before the treatment. After the treatment, the modified Ashworth spasmodic scale (MAS), the clinical spasm index (CSI) scale, and the clinical nerve function defect were observed. The degree score (NDS), the limb simplified Fugl-Meyer motor function score and the daily living ability AQL (Barthel) index were evaluated and entered into statistical analysis. Results: 1 clinical curative effect 1.1 in clinical curative effect, the clinical cure rate is from high to low respectively: 1 groups (after medium wind -14 days + temporal three needles, hand foot and foot three needles) have the highest clinical cure rate. 19%, 2 groups (-14 days after apoplexy + temporal three needles, hand and foot three needles); 3 groups (15-30 days after apoplexy + temporal three needles, hand foot and foot three needles), 4 groups (15-30 days after stroke + temporal three needles, three hands of hand and foot three needles), respectively, 9.8%, 8.5% and 5%, compared with statistical treatment, statistically significant difference (P0.01); 1 group and other clinical treatment of other groups. There was a significant difference in statistical treatment (P0.01); the clinical cure rate of 2,3 two groups was similar, and there was no significant difference (P0.05). The total effective rate of 1 groups (1-14 days after apoplexy + temporal three needles and hand foot and foot three needles) was 94.90%; 2 groups (1-14 days after apoplexy + temporal three needles, hand foot three needles), 3 groups (15-30 after stroke 15-30) The total effective rate of the 4 groups (15-30 days after apoplexy after 15-30 + temporal three needles and hand foot and foot three needles) was 90.2%, 89% and 83.75%, respectively. Compared with the other groups, there were statistically significant differences (P0.01), and the 1 groups were significantly different from the other three groups (P0.01, P0.05); 2,3 two The total effective rate of the group was similar, with no significant difference (P0.05). Conclusion: on the basis of the same medicine and routine treatment, acupuncture therapy was intervened 1-14 days after the stroke, and the treatment of Jin Sanzhen (temporal three needles + hand and foot three needles) was used to improve the clinical effect of the spasticity of the patients with spastic paralysis after apoplexy, the best clinical spasm of.2. After the end of the index (CSI) score of 2.1 courses, the comparative spasm index (CSI) score showed that 1 groups (1-14 days after apoplexy + temporal three needles, hand and foot twin three needles) and two groups (P0.05 after -14 + temporal three needles and three hands and feet) were compared with the two groups, and there were significant differences (P0.05); 3 groups (15-30 days after stroke + temporal three needles, hand foot and foot) Three needle) and 4 groups (15-30 days after apoplexy + temporal three needles, hand and foot three needles), compared with the two groups, the 3 groups were superior and had abnormal significant difference (P0.01). On the same basis of the acupoint compatibility, the score of the comparative spasm index (CSI) score showed that the 1 groups (-14 days after stroke + temporal three needles, hand and foot tus three needles) were compared with the 3 groups (15-30 days after apoplexy + temporal three needles and three hands of hand and foot three), with 1 groups of excellent differences (P0.05); 2 groups (after Apoplectic -14 days + temporal three needles, hand foot three needles) and 4 groups (15-30 days after apoplexy + temporomandibular) Three needles, hand and foot three needles in the two groups, compared with the 2 groups, there was an abnormal significant difference (P0.01). Prompt: in the same premise of the compatibility of the acupoints, in the improvement of the spastic index (CSI) score, early intervention group (-14 days after stroke) in the better curative effect (P0.01, P0.05).3 daily living ability ADL (Barthel) index score after the end of 3.1 courses, On the premise of the same timing of acupuncture, the daily living ability (ADL Barther index) showed that 1 groups (-14 days after apoplexy + temporal three needles, hand foot and foot three needles) were compared with the 2 groups (1-14 days after apoplexy + temporal three needles and three hands of hand and foot), with 1 groups of excellent and abnormal significant differences (P0.01); 3 groups (15-30 days after stroke + temporal three needles, hand, foot - and - foot three needles) and 4 groups (middle 15-30 days after the wind (15-30 days + temporal three needles, hand foot and foot three needles), compared with the two groups, the 3 groups were superior and had abnormal significant difference (P0.01). It was suggested that, on the premise of fixed time factors, the clinical curative effect of temporal three needles + hand and foot - and three needle group was better (P0.01) after the end of the.3.2 course of.3.2. Compared with the daily living ability (ADL Barthel index), 1 groups (1-14 days after apoplexy + temporal three needles, hand and foot tus three needles) and 3 groups (15-30 days after apoplexy + temporal three needles and three hand and foot TUS) were compared with the two groups of 1 groups, with abnormal significant difference (P0.01); 2 groups (1-14 days after stroke + temporal three needles, hand foot three needles) and 4 group (15-30 days after stroke + temporal three) Acupuncture, hand and foot three needles in the two groups, compared with the 2 groups, there was an abnormal significant difference (P0.01). It was suggested that in the same premise of the compatibility of the acupoints, the early intervention group (Barthel) index (1-14 days after the stroke) was in the better effect (P0.01).4 nerve function defect (NDS) score after the 4.1 course of treatment, at the end of the 4.1 course of treatment. On the premise of the same time, the comparison of nerve function defect (NDS) scores showed that 1 groups (1-14 days after apoplexy + temporal three needles, hand and foot twin three needles) and two groups (1-14 days after apoplexy + temporal three needles and three hands and feet) were compared with 1 groups, with abnormal significant difference (P0.01), 3 groups (15-30 days after stroke + temporal three needles, hand and foot - and three needles) and 4 group (after stroke 15-30) Day + temporal three needles, hand foot and foot three needles, compared with 3 groups, there were significant differences (P0.05). Hint: on the premise of the same timing of acupuncture, in improving the nerve function defect (NDS) score, the temporal three needles + hand - foot - and - foot three needle group had better clinical effect (P0.01, P0.05).4.2 course. The function defect (NDS) score showed that 1 groups (1-14 days after apoplexy + temporal three needles, hand and foot - and three needles) and 3 groups (15-30 days after apoplexy + temporal three needles and three hand and foot - and - foot) were superior in 1 groups, with abnormal significant difference (P0.01); 2 groups (1-14 days after stroke + temporal three needles, hand foot three needles) and 4 group (after stroke 15-30 days + temporal three needles, hand foot three needles) Compared with the 2 groups, there were significant differences (P0.05). It was suggested that in the same premise of the compatibility of the acupoints, in the improvement of the neurological deficit (NDS) score, the early intervention acupuncture group (1-14 days after the stroke) was in better curative effect (P0.01, P0.05).5 simplified FugI-Meyer exercise ability to evaluate the 5.1 course of treatment after the intervention of the same timing of acupuncture. The score of Fugl-Meyer motor function showed that 1 groups (1-14 days after apoplexy + temporal three needles, hand and foot - and three needles) and 2 groups (1-14 days after apoplexy + temporal three needles and three hands and feet) were compared with 1 groups, with abnormal significant difference (P0.01); 3 groups (15-30 days after stroke + temporal three needles, hand foot and foot three needles) and 4 group (15-30 days after stroke + temporal three needles, hand foot three needles) Two groups, compared with 3 groups, there were significant difference (P0.01). Hint: on the premise of the same timing of intervention acupuncture, in improving the score of Fugl-Meyer, the clinical curative effect of the temporal three needles + hand and foot double three needle group was better (P0.01).5.2 treatment end, and the Fugl-Meyer score was compared to the same premise, and the score of Fugl-Meyer was compared, and the 1 groups (1-14 after stroke) were compared. The day + temporal three needles, hand and foot three needles, compared with the 3 groups (15-30 days after apoplexy + temporal three needles and hand foot and foot three needles), were superior in 1 groups and had abnormal significant difference (P0.01); the 2 group (1-14 days after stroke + temporal three needles, hand foot three needles) and 4 groups (15-30 days after apoplexy + temporal three needles and hands and feet three needles) were superior to the two groups, and had abnormal significant difference (P0.01). To improve the score of Fugl-Meyer, early intervention in acupuncture treatment group (1-14 days after apoplexy) in the treatment group (1-14 days after apoplexy) in the treatment of better curative effect (P0.01) in the treatment group (1-14 days after apoplexy) in the treatment of better therapeutic effect (P0.01) the timing of acupuncture and the combination of combination intervention analysis of the combined intervention analysis of the timing of the acupuncture time and the combination of the selection of acupoints (CSI) (acupuncture intervention after 1-14 days after apoplexy + temporal three needling. There was no obvious synergy in spasticity index (CSI) score of spastic hemiplegic patients after apoplexy with three needles, although there was no obvious synergy and interactive intervention point, but according to the cross action map (see figure eight, figure nine), there should be a good cross effect trend. According to the compatibility of acupoints, the fixed factor analysis of the timing of acupuncture, after combined effect, can be used. The spasticity index CSI score (P0.01) of patients with spastic hemiplegia after apoplexy can effectively alleviate the tension of hemiplegic limbs, improve the degree of hemiplegic limb spasticity,.6.2 daily living ability, ADL (Barthel) index score of acupuncture timing and combination of selection of acupoints (1-14 days after apoplexy acupuncture intervention + temporal three needles, hand foot and foot three needles treatment) Patients with spastic hemiplegic after apoplexy have good synergy and interactive intervention in the ADL (Barthel) index of daily living ability. After combined action, the ADL (Barthel) index score of patients with spastic hemiplegia after apoplexy can be significantly improved (see Figure eleven, figure twelve) effectively improving the patient's daily living ability and improving the patient. Quality of life.6.3 nerve function defect (NDS) score of acupuncture timing and combined combination of selection of acupoints (1-14 days after apoplexy acupuncture intervention + temporal three needles, hand foot and foot three needles in the treatment of spastic hemiplegic patients after apoplexy, although there is no obvious synergy in the statistical analysis of neural function defect (NDS) score, but the interaction point of intervention, but according to the results. The cross action diagram (see Figure fourteen, figure fifteen) should have a good cross effect trend. According to the combination of acupoints compatibility and the fixed factor analysis of the timing of acupuncture, the combined effect can significantly reduce the neurological function defect (NDS) score of patients with hemiplegic hemiplegia after apoplexy to effectively promote the rehabilitation of neurologic function in hemiplegic patients and improve the quality of life of patients with simplified F. Ugl-Meyer motor function evaluation: the combined effect of acupuncture timing and acupoint compatibility (1-14 days after stroke, acupuncture intervention + time three needling, hand foot and foot three).

【學(xué)位授予單位】：廣州中醫(yī)藥大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2016
【分類號】：R246.6
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本文編號：1875873