本文選題：醒腦開竅”針法 + 運(yùn)動(dòng)療法�。� 參考：《湖北中醫(yī)藥大學(xué)》2017年碩士論文

【摘要】：目的:腦卒中有發(fā)病率高、致殘率高的特點(diǎn),卒中后肢體運(yùn)動(dòng)功能障礙不僅嚴(yán)重影響患者日常生活,而且給家庭乃至社會(huì)帶來(lái)了沉重的經(jīng)濟(jì)負(fù)擔(dān)。因此,如何提高康復(fù)療效,降低致殘率已經(jīng)成為腦卒中康復(fù)熱點(diǎn)問題。目前,針灸結(jié)合運(yùn)動(dòng)療法是腦卒中后的主要康復(fù)治療手段,是卒中單元的重要內(nèi)容。傳統(tǒng)針灸在我國(guó)古代就應(yīng)用于腦卒中康復(fù)治療,到了現(xiàn)代,石學(xué)敏院士創(chuàng)立了“醒腦開竅”針法,該針法是一種特殊的針刺方法,其要求針刺時(shí)手法的量學(xué)規(guī)范,成熟應(yīng)用于腦卒中康復(fù)治療。目前針灸結(jié)合康復(fù)治療能夠改善腦卒中患者運(yùn)動(dòng)功能已被證實(shí),“醒腦開竅”針法對(duì)腦卒中患者的運(yùn)動(dòng)功能有確切的治療作用,且其機(jī)制也逐步走向成熟。為進(jìn)一步研究“醒腦開竅”針法結(jié)合運(yùn)動(dòng)療法對(duì)腦卒中患者的康復(fù)機(jī)制,本課題借助SEP來(lái)觀察治療前后患者功能變化,為后期腦卒中康復(fù)治療提供科學(xué)參考,促進(jìn)康復(fù)治療精準(zhǔn)化。同時(shí)對(duì)患者日常生活活動(dòng)能力、肢體運(yùn)動(dòng)功能變化進(jìn)行觀察,進(jìn)一步分析SEP與BMI、FMA分值之間的相關(guān)性。方法:按照納入及排除標(biāo)準(zhǔn)將30例腦卒中患者按照隨機(jī)數(shù)表法分為治療組(“醒腦開竅”針法聯(lián)合運(yùn)動(dòng)療法)和對(duì)照組(運(yùn)動(dòng)療法),每組各15例。兩組組內(nèi)根據(jù)Brunnstrom分期進(jìn)行分層。在治療前、治療后4周、治療后8周分別進(jìn)行患側(cè)肢體運(yùn)動(dòng)功能評(píng)定(FMA)、日常生活活動(dòng)能力(MBI)評(píng)定,在治療前與治療8周后分別行SEP檢測(cè)。治療第3、6個(gè)月做好隨訪工作。結(jié)果:兩組患者治療4周、8周后,患側(cè)肢體FMA評(píng)分均較治療前提高,差異具有統(tǒng)計(jì)學(xué)意義(P0.05);治療4周后兩組患者FMA評(píng)分無(wú)明顯差異(P0.05),治療8周后聯(lián)合治療組評(píng)分明顯優(yōu)于對(duì)照組(P0.05);兩組患者治療4周、8周后,MBI評(píng)分均較治療前提高(P0.05),兩組患者治療8周較治療4周后MBI評(píng)分差異不顯著(P0.05),治療4周及8周后治療組MBI提高值與對(duì)照組MBI提高值對(duì)比無(wú)顯著差異(P0.05);兩組患者治療8周后患側(cè)肢體N20、P40潛伏期均較治療前縮短,波幅較均較治療前升高(P0.05),治療8周后治療組患側(cè)肢體N20、P40潛伏期縮短數(shù)值及波幅升高數(shù)值明顯大于對(duì)照組(P0.05)。結(jié)論:醒腦開竅針法聯(lián)合運(yùn)動(dòng)療法能夠改善腦卒中患者偏癱肢體運(yùn)動(dòng)功能及日常生活能力,能夠促進(jìn)中樞神可塑性的發(fā)生,從而提高康復(fù)療效。該聯(lián)合治療法能夠有效縮短患側(cè)SEP潛伏期,升高其波幅,其康復(fù)療效較單純運(yùn)動(dòng)療法好。腦卒中患者SEP潛伏期及波幅的變化與其FMA評(píng)分及MIB評(píng)分呈正相關(guān)。
[Abstract]:Objective: stroke has the characteristics of high incidence and high disability rate. Limb motor dysfunction after stroke not only seriously affects patients' daily life, but also brings heavy economic burden to family and society. Therefore, how to improve rehabilitation efficacy and reduce disability rate has become a hot issue in stroke rehabilitation. At present, acupuncture combined with exercise therapy is the main rehabilitation method after stroke and an important part of stroke unit. The traditional acupuncture and moxibustion was used in the rehabilitation treatment of stroke in ancient China. In modern times, academician Shi Xuemin established the acupuncture method, which is a special acupuncture method, which requires the quantitative standard of acupuncture manipulation. Mature treatment is applied to stroke rehabilitation. At present, it has been proved that acupuncture combined with rehabilitation therapy can improve motor function of stroke patients. The acupuncture method of "refreshing brain and opening resuscitation" has definite therapeutic effect on motor function of stroke patients, and its mechanism is gradually maturing. In order to further study the mechanism of rehabilitation of stroke patients by acupuncture therapy combined with exercise therapy, the purpose of this study was to observe the functional changes of stroke patients before and after treatment by means of SEP, and to provide a scientific reference for the rehabilitation treatment of stroke in the later stage. Promote the precision of rehabilitation therapy. At the same time, the changes of activity of daily living and motor function of limbs were observed, and the correlation between SEP and BMI-FMA score was analyzed. Methods: according to the criteria of inclusion and exclusion, 30 patients with stroke were divided into two groups: treatment group (combined with acupuncture and exercise therapy) and control group (15 cases in each group). Stratification was performed according to Brunnstrom stage in both groups. Before treatment, 4 weeks after treatment, 8 weeks after treatment, the motor function of the affected limbs was assessed with FMAA, and the activity of daily living (ADL) was assessed by MBI. SEP was measured before and after 8 weeks of treatment. Follow-up work was done in the 3rd and 6th month of treatment. Results: after 4 weeks and 8 weeks of treatment, the FMA scores of the affected limbs in both groups were higher than those before treatment. There was no significant difference in FMA scores between the two groups after 4 weeks of treatment, but the scores in the combined treatment group were significantly better than those in the control group after 8 weeks of treatment, and the MBI scores in the two groups were significantly higher than those in the control group after 4 weeks and 8 weeks of treatment. There was no significant difference in MBI scores between the two groups after 8 weeks of treatment and 4 weeks after treatment, but there was no significant difference in MBI enhancement values between the treatment group and the control group after 4 weeks and 8 weeks of treatment, and there was no significant difference between the two groups after 8 weeks of treatment. The duration of treatment was shorter than that before treatment. After 8 weeks of treatment, the N20P40 latency and amplitude of the affected limbs in the treatment group were significantly higher than those in the control group (P 0.05). Conclusion: the combination of activating brain and resuscitation acupuncture combined with exercise therapy can improve the motor function and daily living ability of hemiplegic limbs, promote the occurrence of central nervous plasticity, and improve the curative effect of rehabilitation. The combined therapy can effectively shorten the latent period and increase the amplitude of SEP in the affected side, and its rehabilitation effect is better than that of simple exercise therapy. The changes of SEP latency and amplitude were positively correlated with FMA score and MIB score.
【學(xué)位授予單位】：湖北中醫(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)】：R246.6

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