通督调神针法配合热敏灸治疗脑卒中后痉挛性瘫痪40例

目的 比较通督调神针法配合热敏灸与单纯通督调神针法治疗脑卒中后痉挛性瘫痪的临床疗效。方法 将80例患者随机分为治疗组（通督调神针法配合热敏灸）和对照组（单用通督调神针法），每组40例。两组患者均给予基础疾病的常规治疗，对照组以风府、大椎、百会、腰阳关、至阳为针刺主穴；治疗组在对照组基础上配合热敏灸，取穴范围为肩髃、天井、三阳络、外关、阴陵泉、悬钟附近的热敏点，灸至热敏现象消失。治疗前及治疗4、8周末，分别采用改良的Ashworth量表（modified Ashworth scale, MAS）评定肢体痉挛程度，采用修订的Barthel指数(modified Barthel index, MBI)评定日常生活能力，采用改良的Rankin量表评定脑卒中后残疾程度，采用美国国立卫生研究院卒中量表（National Institute of Health Stroke Scale，NIHSS)评定神经功能的缺损程度，采用临床痉挛指数（clinical spasm index，CSI）评定脑卒中后肢体痉挛程度。结果 随治疗时间延长，两组患者MAS分级逐渐改善，MBI评分逐渐升高，改良Rankin、NIHSS和CSI评分逐渐降低；广义评估方程分析结果显示，治疗组在改善MAS分级方面明显优于对照组（P<0.05）；治疗4周末，治疗组患者MBI评分显著高于对照组（P＜0.05），改良Rankin和CSI评分显著低于对照组（P＜0.05）；治疗8周末，治疗组仅CSI评分显著低于对照组（P＜0.05）。结论 通督调神针法配合热敏灸可改善脑卒中后痉挛性瘫痪患者的肢体痉挛和日常生活能力，两者具有协同作用。

Clinical Effect of Tongdu Tiaoshen Acupuncture Combined with Heat-sensitive Moxibustion in Treatment of Spastic Paralysis After Stroke: An Analysis of 40 Cases

Objective To investigate the clinical effect of Tongdu Tiaoshen acupuncture combined with heat-sensitive moxibustion versus Tongdu Tiaoshen acupuncture alone in the treatment of spastic paralysis after stroke. Methods A total of 80 patients were randomly divided into treatment group (treated with Tongdu Tiaoshen acupuncture combined with heat-sensitive moxibustion) and control group (treated with Tongdu Tiaoshen acupuncture alone), with 40 patients in each group. In addition to the routine treatment of underlying diseases, the patients in the control group were given acupuncture at the main acupoints of Fengfu, Dazhui, Baihui, Yaoyangguan, and Zhiyang, and those in the treatment group were given heat-sensitive moxibustion at the heat-sensitive points near Jianyu, Tianjing, three Yang collaterals, Waiguan, Yinlingquan, and Xuanzhong until the disappearance of heat-sensitive phenomenon in addition to the treatment in the control group. Before treatment and at the end of weeks 4 and 8 of treatment, modified Ashworth scale (MAS) was used to evaluate the degree of limb spasm, modified Barthel index (MBI) was used to evaluate the activities of daily living, modified Rankin scale was used to evaluate the degree of disability after stroke, National Institute of Health Stroke Scale (NIHSS) was used to evaluate neurological deficit, and clinical spasm index (CSI) was used to evaluate limb spasm after stroke. Results Over the time of treatment, both groups had a gradual improvement in MAS grade, a gradual increase in MBI, and gradual reductions in modified Rankin score, NIHSS score, and CSI score. The generalized estimating equation showed that compared with the control group, the treatment group had a significantly better improvement in MAS (P<0.05). Compared with the control group, the treatment group had a significantly higher MBI score and significantly lower modified Rankin score and CSI score at the end of week 4 of treatment (P<0.05), as well as a significantly lower CSI score at the end of week 8 of treatment (P<0.05). Conclusion Tongdu Tiaoshen acupuncture combined with heat-sensitive moxibustion can improve limb spasm and activities of daily life in patients with spastic paralysis after stroke, with a synergistic effect between them.