巨刺配合常規(guī)針刺治療腦梗塞后痙攣性偏癱療效觀察
發(fā)布時間：2019-06-13 19:11
【摘要】：研究目的：通過在觀察巨刺配合常規(guī)針刺與單純常規(guī)針刺治療腦梗塞后痙攣性偏癱療效,探討巨刺法療效的產(chǎn)生機(jī)制,為臨床治療腦梗塞后痙攣性偏癱針刺方法的選擇提供參考。研究方法：將符合納入標(biāo)準(zhǔn)的60例腦梗塞后痙攣性偏癱患者隨機(jī)分為兩組,具體研究方法為：1、治療組在康復(fù)治療基礎(chǔ)上采用巨刺法配合常規(guī)針刺治療,患側(cè)按常規(guī)操作取提插瀉法,健側(cè)按常規(guī)操作取提插補(bǔ)法,治療時先針健側(cè),后針患側(cè),每穴操作約30s,留針30min,每日治療1次,每周5次,兩周為1個療程。2、康復(fù)訓(xùn)練按照《中國腦卒中康復(fù)治療指南(2011完全版)》對患者進(jìn)行運動功能評估并制定相應(yīng)的康復(fù)方案,每日治療1次,每周5次,兩周為1個療程。3、對照組在康復(fù)治療基礎(chǔ)上采用單純常規(guī)針刺治療,針刺方法與治療組患側(cè)主穴、配穴的取穴和操作方法相同,康復(fù)訓(xùn)練內(nèi)容同治療組。4、治療前進(jìn)行基線和各觀察指標(biāo)的比較,治療中注意觀察安全性,經(jīng)過兩周治療后以簡化Fugl-Meyer評分評定患側(cè)運動功能恢復(fù)情況,改良Barthel指數(shù)(MBI)量表評定患者日常生活能力改善情況,臨床神經(jīng)功能缺損程度評分評定患者神經(jīng)功能恢復(fù)情況,中風(fēng)病療效評定標(biāo)準(zhǔn)評定臨床癥狀改善情況。研究結(jié)果：1、基線及安全性評價：本研究納入60例合格受試對象均順利完成研究,未發(fā)生脫落及剔除,無針刺不良反應(yīng)發(fā)生。兩組病例在性別、年齡、病程、肌張力分級等方面基線可比,治療前組間比較簡化Fugl-Meyer運動功能評分、改良Barthel指數(shù)(MBI)評定量表、腦卒中患者臨床神經(jīng)功能缺損程度評分差異均無統(tǒng)計學(xué)意義。2、簡化Fugl-Meyer評分比較：治療前后治療組評分分別為35.48±20.95、42.03±23.43；治療前后對照組評分分別為35.19±24.86、42.58±26.06；治療后組間比較差異無統(tǒng)計學(xué)意義(P0.05),但治療組和對照組治療后評分均較治療前明顯提高(P0.05)。3、改良Barthel指數(shù)(MBI)量表比較：治療前后治療組評分分別為29.59±26.42、40.34±32.63；治療前后對照組評分分別為33.84±32.72、41.03±33.84；治療后組間比較差異無統(tǒng)計學(xué)意義(P0.05),但治療組和對照組治療后評分均較治療前明顯提高(P0.05)。4、臨床神經(jīng)功能缺損程度評分比較：治療前后治療組評分分別為19.21±8.30、16.07±8.87；治療前后對照組評分分別為18.84±9.57、15.77±9.46；治療后組間比較差異無統(tǒng)計學(xué)意義(P0.05),但治療組和對照組治療后評分均較治療前明顯提高(P0.05)。5、中風(fēng)病臨床療效評定標(biāo)準(zhǔn)比較：治療前后治療組評分分別為18.76±8.74、15.31±9.34；治療前后對照組評分分別為18.13±9.30、15.23±9.49；治療后組間比較差異無統(tǒng)計學(xué)意義(P0.05),但治療組和對照組治療后評分均較治療前明顯提高(P0.05),治療組有效率65.52%；對照組有效率61.29%,兩組有效率比較差異無統(tǒng)計學(xué)意義(P0.05)。研究結(jié)論：在康復(fù)訓(xùn)練基礎(chǔ)上的巨刺配合常規(guī)針刺與單純常規(guī)針刺在改善腦梗塞后痙攣性偏癱患者肢體運動功能、日常生活能力、神經(jīng)功能缺損程度和中風(fēng)病臨床癥狀方面差異無顯著性,但巨刺法用于腦梗塞后痙攣性偏癱已有中醫(yī)學(xué)和現(xiàn)代醫(yī)學(xué)理論及實踐的支撐,本研究也暴露出病例數(shù)少、觀察時間短、指標(biāo)不夠客觀等不足,因此,本研究認(rèn)為腦梗塞后痙攣性偏癱可以采用“補(bǔ)健側(cè)、瀉患側(cè)”的方法,應(yīng)該完善進(jìn)一步研究。
[Abstract]:Objective: To explore the mechanism of the treatment of spastic hemiplegia after the treatment of cerebral infarction with the conventional acupuncture combined with conventional acupuncture and conventional acupuncture, and to provide a reference for the selection of the method for the treatment of spastic hemiplegia after cerebral infarction. Methods:60 patients with spastic hemiplegia after cerebral infarction were randomly divided into two groups. The health-care side is used for extracting and inserting by the conventional operation, the needle-forming side and the back-needle affected side are arranged at the time of treatment, the operation for each point is about 30s, the needle is left for 30 minutes, once a day,5 times a week, and the two-week period is 1 treatment course. The rehabilitation training is carried out according to the guidelines for rehabilitation of stroke in China (2011 complete edition)> to evaluate the exercise function of the patient and to develop the corresponding rehabilitation program, once a day,5 times a week and 1 course of treatment for two weeks.3. The control group is treated with simple conventional acupuncture on the basis of rehabilitation therapy. the acupuncture method is the same as that of the main point in the affected side of the treatment group, the points of the acupuncture point and the operation method, the rehabilitation training content is the same as the treatment group,4, the baseline and the observation indexes are compared before the treatment, and the safety is observed in the treatment, After two weeks of treatment, the functional recovery of the affected side was assessed by the simplified Fugl-Meyer score, the improvement of the daily life of the patient was assessed by the modified Barthel index (MBI) scale, and the neurological function recovery of the patient was assessed according to the clinical neurological deficit score. To assess the improvement of the clinical symptoms in the evaluation of the curative effect of apoplexy. The results of the study:1. Baseline and safety evaluation: The study included 60 eligible subjects successfully completed the study, no drop-off and elimination, no needle-punched side effects occurred. There was no statistical significance between the two groups in terms of sex, age, course of disease, and grading of muscle tone, and the scores of the Fugl-Meyer exercise function and the improved Barthel index (MBI) scale were compared between the two groups. The scores of the treatment group before and after treatment were 35.48, 20.95, 42.03 and 23.43, respectively. The scores of the control group and the control group were 35.19, 24.86, 42.58 and 26.06, respectively. The scores of the modified Barthel index (MBI) were 29.59, 26.42, 40.34 and 32.63, respectively. The scores of the control group and the control group were 33.84, 32.72, 41.03 and 33.84, respectively. In the treatment group and the control group, the scores of the treatment group and the control group were significantly improved (P0.05).4. The score of clinical nerve function defect was compared with that of the treatment group before and after treatment: 19.21, 8.30, 16.07 and 8.87, respectively. The scores of the control group before and after treatment were 18.84, 9.57, 15.77 and 9.46, respectively. There was no significant difference between the treatment group and the control group (P0.05). However, the post-treatment scores of the treatment group and the control group were significantly improved (P0.05). The standard of the clinical curative effect of the apoplexy was compared with that of the treatment group before and after treatment: 18.76-8.74, 15.31-9.34, respectively. The scores of the control group and the control group were 18.13, 9.30, 15.23 and 9.49, respectively. There was no significant difference between the treatment group and the control group (P0.05). The effective rate of the treatment group was 65.52%, and the effective rate of the control group was 61.29%. There was no significant difference between the two groups (P0.05). The results of the study showed that the conventional acupuncture combined with conventional acupuncture and conventional acupuncture on the basis of rehabilitation training had no significant difference in the function of limb movement, the ability of daily life, the degree of neurological function and the clinical symptoms of stroke in the patients with spastic hemiplegia after cerebral infarction. But the giant needling method is used in the treatment of spastic hemiplegia after cerebral infarction, and the support of the theory and practice of modern medicine. The study also shows that the number of cases is small, the observation time is short, and the index is not objective and so on. Therefore, the present study is of the opinion that after the cerebral infarction, the spastic hemiplegia can adopt the "Complementing the side and the affected side" method, Further research should be done.
【學(xué)位授予單位】：廣州中醫(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
[Abstract]:Objective: To explore the mechanism of the treatment of spastic hemiplegia after the treatment of cerebral infarction with the conventional acupuncture combined with conventional acupuncture and conventional acupuncture, and to provide a reference for the selection of the method for the treatment of spastic hemiplegia after cerebral infarction. Methods:60 patients with spastic hemiplegia after cerebral infarction were randomly divided into two groups. The health-care side is used for extracting and inserting by the conventional operation, the needle-forming side and the back-needle affected side are arranged at the time of treatment, the operation for each point is about 30s, the needle is left for 30 minutes, once a day,5 times a week, and the two-week period is 1 treatment course. The rehabilitation training is carried out according to the guidelines for rehabilitation of stroke in China (2011 complete edition)> to evaluate the exercise function of the patient and to develop the corresponding rehabilitation program, once a day,5 times a week and 1 course of treatment for two weeks.3. The control group is treated with simple conventional acupuncture on the basis of rehabilitation therapy. the acupuncture method is the same as that of the main point in the affected side of the treatment group, the points of the acupuncture point and the operation method, the rehabilitation training content is the same as the treatment group,4, the baseline and the observation indexes are compared before the treatment, and the safety is observed in the treatment, After two weeks of treatment, the functional recovery of the affected side was assessed by the simplified Fugl-Meyer score, the improvement of the daily life of the patient was assessed by the modified Barthel index (MBI) scale, and the neurological function recovery of the patient was assessed according to the clinical neurological deficit score. To assess the improvement of the clinical symptoms in the evaluation of the curative effect of apoplexy. The results of the study:1. Baseline and safety evaluation: The study included 60 eligible subjects successfully completed the study, no drop-off and elimination, no needle-punched side effects occurred. There was no statistical significance between the two groups in terms of sex, age, course of disease, and grading of muscle tone, and the scores of the Fugl-Meyer exercise function and the improved Barthel index (MBI) scale were compared between the two groups. The scores of the treatment group before and after treatment were 35.48, 20.95, 42.03 and 23.43, respectively. The scores of the control group and the control group were 35.19, 24.86, 42.58 and 26.06, respectively. The scores of the modified Barthel index (MBI) were 29.59, 26.42, 40.34 and 32.63, respectively. The scores of the control group and the control group were 33.84, 32.72, 41.03 and 33.84, respectively. In the treatment group and the control group, the scores of the treatment group and the control group were significantly improved (P0.05).4. The score of clinical nerve function defect was compared with that of the treatment group before and after treatment: 19.21, 8.30, 16.07 and 8.87, respectively. The scores of the control group before and after treatment were 18.84, 9.57, 15.77 and 9.46, respectively. There was no significant difference between the treatment group and the control group (P0.05). However, the post-treatment scores of the treatment group and the control group were significantly improved (P0.05). The standard of the clinical curative effect of the apoplexy was compared with that of the treatment group before and after treatment: 18.76-8.74, 15.31-9.34, respectively. The scores of the control group and the control group were 18.13, 9.30, 15.23 and 9.49, respectively. There was no significant difference between the treatment group and the control group (P0.05). The effective rate of the treatment group was 65.52%, and the effective rate of the control group was 61.29%. There was no significant difference between the two groups (P0.05). The results of the study showed that the conventional acupuncture combined with conventional acupuncture and conventional acupuncture on the basis of rehabilitation training had no significant difference in the function of limb movement, the ability of daily life, the degree of neurological function and the clinical symptoms of stroke in the patients with spastic hemiplegia after cerebral infarction. But the giant needling method is used in the treatment of spastic hemiplegia after cerebral infarction, and the support of the theory and practice of modern medicine. The study also shows that the number of cases is small, the observation time is short, and the index is not objective and so on. Therefore, the present study is of the opinion that after the cerebral infarction, the spastic hemiplegia can adopt the "Complementing the side and the affected side" method, Further research should be done.
【學(xué)位授予單位】：廣州中醫(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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