针刺结合现代康复技术治疗脑卒中后偏瘫临床研究

目的观察针刺结合康复技术治疗脑卒中后偏瘫的临床疗效。方法将45例脑卒中后偏瘫患者随机分为针刺组、康复组和针康组,每组15例。针刺组患者每日接受针刺治疗1次,康复组患者每日接受康复治疗1次,针康组患者每日接受针刺治疗与康复治疗各1次。3组每周治疗6 d,2周为1个疗程。治疗期间3组患者均接受常规基础药物治疗。治疗前、治疗2周后和治疗4周后,分别采用Fugel-Meyer评估量表(Fugel-Meyer assessment scale,FMA)评价肢体运动功能,采用改良Barthel指数(modified Barthel index,MBI)评价日常生活能力,采用Brunnstrom量表评定肢体运动功能恢复情况。结果3组基于MBI评分的疗效比较,差异有统计学意义(P<0.05),针康组疗效明显优于针刺组和康复组(P<0.05)。与治疗前比较,治疗4周后3组患者FMA评分均显著升高(P<0.05);针康组FMA评分升高程度显著大于针刺组和康复组(P<0.05)。治疗2、4周后,3组患者MBI评分均较前一时点显著升高(P<0.05),针康组MBI评分均显著高于针刺组和康复组(P<0.05)。广义评估方程分析结果显示:与针刺组比较,针康组在改善患者上肢、下肢Brunnstrom分级方面具有明显优势(P<0.05),而康复组在改善患者上肢、下肢Brunnstrom分级方面无明显优势(P>0.05);与治疗前比较,治疗4周后患者在上肢、下肢Brunnstrom分级的改善方面具有明显优势(P<0.05)。结论针刺结合康复疗法在改善患肢运动功能,提高日常生活活动能力以及促进瘫痪肢体康复等方面优于单纯针刺或单纯康复疗法。

Clinical Effect of Acupuncture Combined with Modern Rehabilitation Technique in Treatment of Post-stroke Hemiplegia

Objective To observe the clinical effect of acupuncture combined with rehabilitation technique in the treatment of post-stroke hemiplegia. Methods Forty-five patients with post-stroke hemiplegia were randomly divided into acupuncture group, rehabilitation group, and acupuncture-rehabilitation group, with 15 cases in each group. The acupuncture group received acupuncture once daily, the rehabilitation group received rehabilitation once daily, and the acupuncture-rehabilitation group received both acupuncture and rehabilitation once daily. The three groups were treated for 6 days each week, with 2 weeks as a course of treatment. All patients received conventional basic medication during the period of treatment. Before treatment and after 2 and 4 weeks of treatment, Fugl-Meyer assessment (FMA) was used to evaluate limb motor function, modified Barthel index (MBI) was used to evaluate activities of daily living (ADL), and the Brunnstrom scale was used to assess the recovery of limb motor function. Results There was a significant difference in the treatment outcome based on MBI score between the three groups (P<0.05), and the acupuncture-rehabilitation group had a significantly better outcome than the other two groups (P<0.05). FMA score was significantly increased in the three groups after 4 weeks of treatment (P<0.05), greater in the acupuncture-rehabilitation group than in the other two groups (P<0.05). After 2 and 4 weeks of treatment, the three groups showed significant increases in MBI score compared with the previous time points (P<0.05), and the acupuncture-rehabilitation group had a significantly higher MBI score than the acupuncture group and the rehabilitation group (P<0.05). Generalized estimating equation analysis showed that compared with the acupuncture group, the acupuncture-rehabilitation group had a significantly better improvement in Brunnstrom stage of the upper and lower extremities (P<0.05), while the rehabilitation group showed no significantly better improvement in this regard (P>0.05); the patients showed a significant improvement in Brunnstrom stage of the upper and lower extremities after 4 weeks of treatment (P<0.05). Conclusion Acupuncture combined with rehabilitation is superior to acupuncture or rehabilitation alone in improving the motor function of affected limbs and ADL and promoting the functional recovery of paralyzed limbs.