針刺配合現(xiàn)代康復(fù)治療對中風(fēng)恢復(fù)期上肢痙攣的臨床觀察
發(fā)布時間：2018-07-26 18:21
【摘要】：目的為了探求更加科學(xué)的腦卒中的診療方案,本課題采用針刺配合現(xiàn)代康復(fù)治療中風(fēng)恢復(fù)期上肢痙攣,研究從多個方面及不同角度觀察其臨床治療效果,探討并分析該治療方案的基本作用原理,通過研究該治療方案為本病在今后的臨床診療中提供參考。方法選取2015年1月至2016年12月就診于黃石市中心醫(yī)院康復(fù)醫(yī)學(xué)科的符合條件的中風(fēng)恢復(fù)期患者60人,研究方法分為兩組,針刺現(xiàn)代康復(fù)組采取針刺(包括體針和頭針)配合現(xiàn)代康復(fù)治療(包括肌肉牽伸技術(shù)、作業(yè)療法、電子生物反饋療法),現(xiàn)代康復(fù)組則采用單純現(xiàn)代康復(fù)治療(包括肌肉牽伸技術(shù)、作業(yè)療法、電子生物反饋療法),各30例。在針刺治療時要求整個療程中操作手法及選穴處方一致,治療的時間均為8周。所有參與實驗的患者在療程中按照治療處方治療,不得接受除治療處方之外其他任何形式的治療。觀察開始時、觀察中期和觀察結(jié)束時,為其臨床療效做出評價,并觀察臨床神經(jīng)功能缺損程度(CSS)分?jǐn)?shù)來評估患者神經(jīng)功能條件;觀察改良的Ashworth肌張力評估量,來測定上肢肌肉痙攣程度;通過Fugl-Meyer(FMA)評定量表觀察結(jié)果,來表明患者上肢的功能狀況;評估巴氏指數(shù)(BI),從而測定患者的日常生活活動能力(ADL);并綜合的比較與分析兩組,對本觀察的臨床療效采取相應(yīng)的統(tǒng)計學(xué)數(shù)據(jù)分析。結(jié)果1.CSS結(jié)果比較:兩組患者的CSS,在經(jīng)過相應(yīng)治療后均有改善,通過統(tǒng)計學(xué)分析顯示,差異有顯著性(P0.O5)。表示兩組患者都明顯的改善了體征和臨床癥狀。從分析可以看出,針刺現(xiàn)代康復(fù)組的治療效果更加突出,優(yōu)于現(xiàn)代康復(fù)組。2.改良的Ashworth肌張力的分級對比:兩組患者在通過治療后,上肢的肌張力都出現(xiàn)下降,前后對照針刺現(xiàn)代康復(fù)組的肌張力,提示差異具備極顯著意義(P0.01);同樣現(xiàn)代康復(fù)組肌張力前后對照,其差別亦有明顯的對比意義(P0.05)。再對兩組患者治療后的肌張力進(jìn)行比較,差異顯示出極顯著性意義(P0.01)。該數(shù)據(jù)表明針刺現(xiàn)代康復(fù)組可以明顯降低中風(fēng)恢復(fù)期患者的上肢屈肌肌張力,其療效優(yōu)于現(xiàn)代康復(fù)組。3.Fugl-Meyer(FMA)評分對比:兩組患者經(jīng)治療后,上肢的功能均出現(xiàn)提高,針刺現(xiàn)代康復(fù)組FMA得分前后對照,差異具備極明顯的對比意義(P0.01);前后比較現(xiàn)代康復(fù)組的FMA得分,差別有明顯的對比意義(P0.05)。兩組患者在診治后FMA的得分相對比,差別表現(xiàn)出極明顯的對比意義(P0.01)。故針刺現(xiàn)代康復(fù)組的治療效果優(yōu)于現(xiàn)代康復(fù)組,針刺現(xiàn)代康復(fù)組可明顯提高中風(fēng)恢復(fù)期患者上肢的功能。4.兩組病人BI相較:經(jīng)相關(guān)診治后,兩組病人的ADL都呈現(xiàn)變好趨勢,前后比較針刺現(xiàn)代康復(fù)組的BI,表示差別具備極明顯的對比意義(P0.01);先后比較現(xiàn)代康復(fù)組的BI,差別具有明顯的對比意義(P0.05)。兩組病人診治后BI得分比對,差別具有極明顯的對比意義(P0.01)。表明針刺現(xiàn)代康復(fù)組可以極大改善中風(fēng)恢復(fù)期患者的日常生活能力,其治療效果優(yōu)于現(xiàn)代康復(fù)組。5.臨床治療效果相對比:針刺現(xiàn)代康復(fù)組30例,其中基本痊愈4例,顯效18例,好轉(zhuǎn)5例,無效3例,總的有效率為90%;現(xiàn)代康復(fù)組觀察例數(shù)也是30例,其中0例是基本痊愈,8例為顯效、10例是好轉(zhuǎn),無效的有12例,其總的有效率為60%。經(jīng)統(tǒng)計學(xué)檢測,兩組總的有效率相對照,差異具有顯著性意義(P0.O5),我們可以看出,針刺現(xiàn)代康復(fù)組的治療效果優(yōu)于現(xiàn)代康復(fù)組。結(jié)論臨床觀察結(jié)果表示針刺配合現(xiàn)代康復(fù)治療中風(fēng)恢復(fù)期上肢痙攣的患者,治療效果顯著,中風(fēng)患者在恢復(fù)期時CSS可得到有效的提高,患者上肢的肌張力也可以有效的降低,能明顯提高中風(fēng)恢復(fù)期上肢痙攣患者的上肢功能,提高患者的ADL,綜合療效優(yōu)于單純現(xiàn)代康復(fù)治療,是一種,值得臨床上去推廣,值得人們進(jìn)一步深入研究的治療效果明確的治療方法。
[Abstract]:Objective to explore a more scientific diagnosis and treatment scheme for stroke, this subject uses acupuncture combined with modern rehabilitation to treat the upper limb spasticity in the recovery period of apoplexy. The study has been studied from many aspects and different angles to observe its clinical therapeutic effect, and to explore and analyze the basic principle of the treatment scheme, and to study the treatment scheme for the future. Methods 60 patients were selected from January 2015 to December 2016 in the rehabilitation medical department of Huangshi Central Hospital. The methods were divided into two groups. The modern rehabilitation group was treated with acupuncture (including body acupuncture and head needle) combined with modern rehabilitation therapy (including muscle drafting and operation therapy). In the modern rehabilitation group, the modern rehabilitation group was treated with simple modern rehabilitation (including muscle drafting, occupational therapy, and electronic biofeedback therapy) in 30 cases. In the treatment of acupuncture, the operation technique and the prescription of the selection were consistent in the whole course of treatment, and the time of treatment was 8 weeks. All the patients who participated in the experiment were treated in the course of treatment. Prescription treatment is not acceptable to any other form of treatment except for the treatment prescription. Observation start, observation at the mid-term and the end of observation, evaluate the clinical efficacy, and observe the clinical nerve function defect (CSS) score to evaluate the patient's neurological condition; observe the improved Ashworth muscle tension assessment to determine the upper limb muscles. The degree of spasm; the results were observed by the Fugl-Meyer (FMA) assessment scale to indicate the functional status of the upper limbs of the patients; to evaluate the pasteurized index (BI) and to determine the patient's daily living ability (ADL); and a comprehensive comparison and analysis of the two groups, and to analyze the clinical efficacy of this observation. Results the results of 1.CSS were compared: two groups. The CSS of the patient was improved after the corresponding treatment. Statistical analysis showed that the difference was significant (P0.O5). It indicated that the two groups were obviously improved the physical signs and clinical symptoms. It can be seen from the analysis that the therapeutic effect of the modern rehabilitation group was more prominent than that of the modern rehabilitation group, which was better than the classification of the Ashworth muscle tone improved by the modern rehabilitation group.2.. Ratio: after the two groups of patients, the muscle tension of the upper extremities decreased and the muscle tension of the modern rehabilitation group was compared with those of the modern rehabilitation group (P0.01), and the difference was also significant (P0.05) in the modern convalescence group before and after the muscle tension. The muscle tension of the two groups was compared. The difference showed significant significance (P0.01). The data showed that the acupuncture modern rehabilitation group could obviously reduce the flexor muscle tension of the upper limb in the stroke recovery period, and the effect was better than the modern rehabilitation group.3.Fugl-Meyer (FMA) score comparison: after the treatment, the function of the upper limbs increased and the FMA score of the modern rehabilitation group was compared before and after the score of the two groups. The difference has a very obvious contrast significance (P0.01); compared with the FMA score of the modern rehabilitation group, the difference has obvious contrast significance (P0.05). The difference between the two groups of patients after the diagnosis and treatment of FMA is very significant (P0.01). Therefore, the therapeutic effect of the acupuncture modern rehabilitation group is better than the modern rehabilitation group, and the modern rehabilitation group is needled. The BI of the functional.4. two groups of the upper limb of the patients with apoplexy can be significantly improved. After the diagnosis and treatment, the ADL of the two groups of patients showed a trend of better, compared with the BI in the modern rehabilitation group before and after the acupuncture, indicating that the difference had a significant contrast significance (P0.01), and the difference of BI in the modern rehabilitation group had a significant contrast significance (P0.05). The difference of BI score comparison between the two groups was very significant (P0.01). It showed that the acupuncture modern rehabilitation group could greatly improve the daily living ability of the patients in the recovery period of apoplexy. The treatment effect was better than that of the modern rehabilitation group.5. clinical treatment effect: 30 cases of the acupuncture at the present rehabilitation group, of which 4 cases were cured and 18 were markedly effective. 5 cases were improved, 3 cases were invalid, the total effective rate was 90%, and the number of cases observed in the modern rehabilitation group was 30 cases, of which 0 cases were basically healed, 8 were developed, 10 were improved, and 12 were ineffective. The total effective rate was 60%., the total efficiency of the two group was relative, and the difference was significant (P0.O5). We can see that acupuncture is modern. The curative effect of the rehabilitation group is better than that of the modern rehabilitation group. Conclusion the results of clinical observation indicate that the effect of acupuncture combined with the modern rehabilitation treatment for the upper limb spasticity in the recovery period of the stroke is remarkable. The CSS can be effectively improved during the recovery period, the muscle tension of the upper limb can also be effectively reduced, and it can obviously improve the recovery period of the stroke. The upper limb function of the patients with limb spasm, improving the patient's ADL, is better than the simple modern rehabilitation therapy. It is one kind, worthy of clinical promotion and worthy of further study.
【學(xué)位授予單位】：湖北中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R246.6
本文編號：2146896
[Abstract]:Objective to explore a more scientific diagnosis and treatment scheme for stroke, this subject uses acupuncture combined with modern rehabilitation to treat the upper limb spasticity in the recovery period of apoplexy. The study has been studied from many aspects and different angles to observe its clinical therapeutic effect, and to explore and analyze the basic principle of the treatment scheme, and to study the treatment scheme for the future. Methods 60 patients were selected from January 2015 to December 2016 in the rehabilitation medical department of Huangshi Central Hospital. The methods were divided into two groups. The modern rehabilitation group was treated with acupuncture (including body acupuncture and head needle) combined with modern rehabilitation therapy (including muscle drafting and operation therapy). In the modern rehabilitation group, the modern rehabilitation group was treated with simple modern rehabilitation (including muscle drafting, occupational therapy, and electronic biofeedback therapy) in 30 cases. In the treatment of acupuncture, the operation technique and the prescription of the selection were consistent in the whole course of treatment, and the time of treatment was 8 weeks. All the patients who participated in the experiment were treated in the course of treatment. Prescription treatment is not acceptable to any other form of treatment except for the treatment prescription. Observation start, observation at the mid-term and the end of observation, evaluate the clinical efficacy, and observe the clinical nerve function defect (CSS) score to evaluate the patient's neurological condition; observe the improved Ashworth muscle tension assessment to determine the upper limb muscles. The degree of spasm; the results were observed by the Fugl-Meyer (FMA) assessment scale to indicate the functional status of the upper limbs of the patients; to evaluate the pasteurized index (BI) and to determine the patient's daily living ability (ADL); and a comprehensive comparison and analysis of the two groups, and to analyze the clinical efficacy of this observation. Results the results of 1.CSS were compared: two groups. The CSS of the patient was improved after the corresponding treatment. Statistical analysis showed that the difference was significant (P0.O5). It indicated that the two groups were obviously improved the physical signs and clinical symptoms. It can be seen from the analysis that the therapeutic effect of the modern rehabilitation group was more prominent than that of the modern rehabilitation group, which was better than the classification of the Ashworth muscle tone improved by the modern rehabilitation group.2.. Ratio: after the two groups of patients, the muscle tension of the upper extremities decreased and the muscle tension of the modern rehabilitation group was compared with those of the modern rehabilitation group (P0.01), and the difference was also significant (P0.05) in the modern convalescence group before and after the muscle tension. The muscle tension of the two groups was compared. The difference showed significant significance (P0.01). The data showed that the acupuncture modern rehabilitation group could obviously reduce the flexor muscle tension of the upper limb in the stroke recovery period, and the effect was better than the modern rehabilitation group.3.Fugl-Meyer (FMA) score comparison: after the treatment, the function of the upper limbs increased and the FMA score of the modern rehabilitation group was compared before and after the score of the two groups. The difference has a very obvious contrast significance (P0.01); compared with the FMA score of the modern rehabilitation group, the difference has obvious contrast significance (P0.05). The difference between the two groups of patients after the diagnosis and treatment of FMA is very significant (P0.01). Therefore, the therapeutic effect of the acupuncture modern rehabilitation group is better than the modern rehabilitation group, and the modern rehabilitation group is needled. The BI of the functional.4. two groups of the upper limb of the patients with apoplexy can be significantly improved. After the diagnosis and treatment, the ADL of the two groups of patients showed a trend of better, compared with the BI in the modern rehabilitation group before and after the acupuncture, indicating that the difference had a significant contrast significance (P0.01), and the difference of BI in the modern rehabilitation group had a significant contrast significance (P0.05). The difference of BI score comparison between the two groups was very significant (P0.01). It showed that the acupuncture modern rehabilitation group could greatly improve the daily living ability of the patients in the recovery period of apoplexy. The treatment effect was better than that of the modern rehabilitation group.5. clinical treatment effect: 30 cases of the acupuncture at the present rehabilitation group, of which 4 cases were cured and 18 were markedly effective. 5 cases were improved, 3 cases were invalid, the total effective rate was 90%, and the number of cases observed in the modern rehabilitation group was 30 cases, of which 0 cases were basically healed, 8 were developed, 10 were improved, and 12 were ineffective. The total effective rate was 60%., the total efficiency of the two group was relative, and the difference was significant (P0.O5). We can see that acupuncture is modern. The curative effect of the rehabilitation group is better than that of the modern rehabilitation group. Conclusion the results of clinical observation indicate that the effect of acupuncture combined with the modern rehabilitation treatment for the upper limb spasticity in the recovery period of the stroke is remarkable. The CSS can be effectively improved during the recovery period, the muscle tension of the upper limb can also be effectively reduced, and it can obviously improve the recovery period of the stroke. The upper limb function of the patients with limb spasm, improving the patient's ADL, is better than the simple modern rehabilitation therapy. It is one kind, worthy of clinical promotion and worthy of further study.
【學(xué)位授予單位】：湖北中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R246.6
【參考文獻(xiàn)】
相關(guān)期刊論文 前10條
1 吉貞料;盧桂蘭;李海輝;;針灸結(jié)合中藥熏洗在中風(fēng)痙攣偏癱患者康復(fù)中的應(yīng)用[J];中醫(yī)藥導(dǎo)報;2015年13期
2 黃賽芝;侯健;;頭皮針抽提法配合運動療法治療中風(fēng)偏癱61例療效觀察[J];湖南中醫(yī)雜志;2015年05期
3 時國臣;鄭祖艷;徐博佳;鄭曉旭;宋楠楠;;電針夾脊穴治療中風(fēng)后下肢痙攣性癱的臨床觀察[J];中醫(yī)藥信息;2014年06期
4 涂新生;;在陰陽經(jīng)中分別應(yīng)用不同電針波型對中風(fēng)偏癱患者的影響[J];中醫(yī)外治雜志;2014年04期
5 卞鏑;隋月皎;田輝;;麥粒灸配合巨刺法治療腦卒中痙攣性偏癱患者療效評價[J];按摩與康復(fù)醫(yī)學(xué);2014年07期
6 劉宏玲;涂林芬;何_g硯;張科;冉彬陵;文雪念;;任督二脈穴位埋線治療腦卒中后肌張力增高臨床研究[J];實用中醫(yī)藥雜志;2014年05期
7 汪瑛;朱春沁;陳少飛;;廉泉穴齊刺治療腦梗死后運動性失語療效觀察[J];上海針灸雜志;2014年03期
8 李作偉;李平;王珩;麻微;;中醫(yī)對中風(fēng)后肌張力障礙的認(rèn)識[J];中國藥物經(jīng)濟(jì)學(xué);2014年03期
9 王琳晶;王玉琳;王春英;王繼坤;;巨刺結(jié)合夾脊穴針法治療中風(fēng)偏癱痙攣狀態(tài)的臨床觀察[J];中醫(yī)藥信息;2014年02期
10 彭華;江小榮;仝樹坡;李賢;;針刺配合十宣放血治療卒中手指功能障礙療效觀察[J];實用中醫(yī)藥雜志;2014年02期
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