本文選題：中風 + 上肢��； 參考：《福建中醫(yī)藥大學(xué)》2016年碩士論文

【摘要】：目的：觀察經(jīng)皮刮拭法治療中風后上肢痙攣臨床療效。方法：符合中風西醫(yī)診斷標準及納入標準,并完成規(guī)定治療療程的89例患者,其中治療1組29例,治療2組30例,對照組30例。分組情況：三組治療在康復(fù)訓(xùn)練、普通針刺治療及內(nèi)科疾病基礎(chǔ)治療的基礎(chǔ)上,對照組配合口服巴氯芬控制肌張力(巴氯芬每日最高劑量不得超過80mg)。治療組配合經(jīng)皮刮拭法控制肌張力,其中治療1組選取患側(cè)上肢陰經(jīng)部位及陽經(jīng)部位進行分段刮拭治療,治療2組選取患側(cè)上肢陽經(jīng)部位進行分段刮拭治療。每日1次,W1-6,持續(xù)治療4周。觀察指標：1、三組患者于治療前1天、治療2周及治療結(jié)束后1天對患者上肢進行改良Ashworth張力評分。2、治療組患者在第6、12、18、24次治療時,施術(shù)者記錄患者刮拭前及刮拭后4小時內(nèi)每隔60min患側(cè)上肢肌張力情況,以計算患側(cè)上肢治療后松弛時間。3、依據(jù)簡化Fugl-Meyer上肢運動功能評分量表,對三組受試者治療前1天及治療結(jié)束后1天患側(cè)上肢進行功能評分。采用SPSS20.0統(tǒng)計軟件包對數(shù)據(jù)統(tǒng)計分析。結(jié)果：改良Ashworth張力評分：經(jīng)治療4周后,三組患者痙攣程度較治療前均有改變,三組患者進行相應(yīng)治療2周及4周后,組間改良Ashworth張力評分比較提示P值均小于0.05,具有統(tǒng)計學(xué)差異,分別對三組治療前后改良Ashworth張力評分變化程度進行統(tǒng)計學(xué)比較,P值均小于0.05,提示三組治療前后均具有統(tǒng)計學(xué)差異。治療組于第6、12、18、24次刮拭治療后患側(cè)上肢松弛時間以分類資料記錄,經(jīng)4周治療后,治療組患者上肢松弛時間較治療前均有不同程度延長,分別對4次記錄進行組間比較,P值均小于0.05,具有統(tǒng)計學(xué)差異,對治療組第6次及第24次治療時的患側(cè)上肢松弛時間變化程度比較,提示P值均小于0.05,具有統(tǒng)計學(xué)差異。簡化Fugl-Meyer運動功能評分：經(jīng)治療4周后,三組患者患側(cè)簡化Fug-Meyer上肢運動功能評分較治療前均有不同程度的提高,對治療4周后三組的簡化Fugl-Meyer上肢運動功能評分進行統(tǒng)計學(xué)處理,組間比較提示P大于0.05,無統(tǒng)計學(xué)差異,對各組治療前及治療后簡化Fugl-Meyer上肢運動功能評分進行組內(nèi)比較,P值均小于0.05,具有統(tǒng)計學(xué)差異。結(jié)論：經(jīng)皮刮拭上肢經(jīng)脈及口服巴氯芬均可改善中風后上肢痙攣情況；在延長患者上肢松弛時間方面刮拭上肢陰、陽經(jīng)方法療效較佳,可為中風患者上肢康復(fù)訓(xùn)練提供有效的治療時間窗,以期提高康復(fù)療效。在改善上肢運動功能方面三組無明顯差異,目前尚不能明確經(jīng)皮刮拭對患側(cè)上肢功能恢復(fù)的作用。
[Abstract]:Objective: to observe the clinical effect of percutaneous wiping on upper limb spasm after stroke. Methods: 89 patients who met the criteria of western medicine diagnosis and inclusion of apoplexy and completed the prescribed course of treatment were divided into treatment group (n = 29), treatment group (n = 30) and control group (n = 30). Grouping: on the basis of rehabilitation training, general acupuncture treatment and basic treatment of internal diseases, the control group combined with oral baclofen to control muscle tension (the maximum daily dose of baclofen should not exceed 80 mg / g). The treatment group combined with percutaneous wiping method to control muscle tension, treatment group 1 selected the upper side of the upper limb Yin meridian and Yang meridian part of the curettage treatment, treatment group 2 selected the affected side of the upper limb with the positive part of scraping treatment. W1-6, once a day, for 4 weeks. Outcome measures: 1: one, the patients in the three groups were given modified Ashworth tension score of the upper extremities at 1 day before treatment, 2 weeks after treatment and 1 day after treatment. The patients in treatment group were treated with modified Ashworth tension score. The muscle tension of the affected upper extremities was recorded before and 4 hours after the operation in order to calculate the relaxation time of the affected upper extremities. According to the simplified Fugl-Meyer motor function scale, the muscle tension of the affected upper extremities was calculated. The upper limbs of the three groups were evaluated one day before treatment and one day after treatment. The data were analyzed by SPSS20.0 software package. Results: the modified Ashworth tension score: after 4 weeks of treatment, the spasm degree of the three groups was changed compared with that before treatment, and the patients in the three groups were given corresponding treatment for 2 weeks and 4 weeks. The comparison of modified Ashworth tension score between the three groups showed that P value was less than 0.05, and there was statistical difference. The change degree of modified Ashworth tension score before and after treatment in the three groups were all less than 0.05, indicating that the three groups had statistical difference before and after treatment. In the treatment group, the relaxation time of the affected upper limb was recorded as classified data after 24 times of scrape treatment. After 4 weeks of treatment, the relaxation time of the upper limb in the treatment group was prolonged to some extent than that before treatment. The P values of the four records were all less than 0.05, which had statistical difference. The changes of relaxation time of the affected upper extremities in the treatment group at the 6th and 24th times showed that the P values were all less than 0.05, which had statistical difference. Simplified Fugl-Meyer motor function score: after 4 weeks of treatment, the motor function score of affected side simplified Fug-Meyer upper limb in the three groups was improved in varying degrees compared with that before treatment. The simplified Fugl-Meyer motor function score of the three groups was statistically analyzed after 4 weeks of treatment. The comparison between groups showed that P > 0.05, there was no statistical difference. The scores of simplified Fugl-Meyer motor function of upper limb before and after treatment were all less than 0.05, which had statistical difference. Conclusion: percutaneous wiping of upper limb meridians and oral baclofen can improve the condition of upper limb spasm after stroke, and the effect of yang meridian method is better in prolonging the relaxation time of upper limb. It can provide an effective time window for upper limb rehabilitation training of stroke patients in order to improve the curative effect. There was no significant difference among the three groups in improving the motor function of the upper limb, and it was not clear at present that the effect of percutaneous wiping on the recovery of the upper limb function of the affected side.
【學(xué)位授予單位】：福建中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R246.6

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本文編號：1965113