东垣针法对缺血性脑卒中后偏瘫患者运动功能及皮质脊髓束损伤的影响研究.pdf
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1、14综上所述,基于“根结”理论辨经选穴针刺治疗偏头痛取穴简单,操作简便,起效迅速,疗效显著,并能有效改善生活质量,缓解焦虑情绪,具有很高的临床推广价值。参考文献:1 HAY S I,ABAJOBIR A A,ABATE K H,et al.Global,regional,andnational disability-adjusted life-years(DALYs)for 333 diseasesand injuries and healthy life expectancy(HALE)for 195 countriesand territories,1990-2016:a systemat
2、ic analysis for the Global Bur-den of Disease Study 2016 J.The Lancet,2017,390(10100):1260-1344.2YU S,LIU R,ZHAO G,et al.The prevalence and burden of primaryheadaches in China:a population-based door-to-door survey J.Headache,2012,52(4):582-591.3王军,赵吉平,戴京璋.针刺井穴治疗偏头痛即时疗效观察J.北京中医药大学学报(中医临床版),2 0 10,17
3、(6):1416.4WEWERS M,LOWE N.A critical review of visual analogue scales inthe measurement of clinical phenomena J.Research in nursinghealth,1990,13(4):227-236.JCAM.Aug.2023,Vol.39,NO.85 MCWILLIAMS L,GOODWIN R,COX B.Depression and anxiety sso-ciated with three pain conditions:results from a nationally
4、representa-tive sampleJ.Pain,2004,111:77-83.6 PATRICK D,HURST B,HUGHES J.Further development and testingof the migraine-specific quality of life(MSQOL)measure J.Headache,2000,40(7):550-560.7田德禄.中医内科学M.北京:人民卫生出版社,2 0 0 2.8赵吉平,李瑛.针灸学M.北京:人民卫生出版社,2 0 2 1.9赵吉平,陈晟,从“辨”与“治”谈针灸临床中辨证方法的择宜而用J.北京中医药大学学报(中医临床版
5、),2 0 12,19(5):1-6.【10 张少珍,丘汉春.依根结标本理论选穴治疗96 例偏头痛J.新中医,19 9 6(11):2 9 -30.11周丽莎.遵循标本根结理论针刺治疗偏头痛J.湖北中医杂志,2003(3):44 45.【12 赵玉广,王秀丽,申瑶,等.根结标本理论临床运用举隅J.中国医刊,2 0 0 0(1):49.13宋佳杉,刘兵,朱江.试从气血、根结标本论治偏头痛J.河北中医药学报,2 0 10,2 5(2);12-13.收稿日期:2 0 2 2-12-12?东垣针法对缺血性脑卒中后偏瘫患者运动功能及皮质脊髓束损伤的影响研究董莹慧,张立杰(唐山市中医医院,河北唐山0 6
6、30 0 0)摘要目的:观察东垣针法对缺血性脑卒中后偏瘫患者运动功能及皮质脊髓束(CST)损伤的影响。方法:选择2 0 2 0 年1月一2 0 2 1年3月接诊的12 8 例缺血性脑卒中后偏瘫患者,采用随机数字表法随机分为对照组和观察组各6 4例。对照组予常规药物和康复治疗,观察组在对照组治疗基础上联合东垣针法治疗,连续治疗 8 周。在治疗前 1 d及治疗结束后 1 d,采用改良 Ashworth 痉李评定量表(MAS)、Fu g l -Meyer运动功能量表(FMA)、改良Barthel指数(MBI)、Be r g 平衡量表(BBS)、起立行走计时测试(T U G T)进行运动功能评定,使用
7、MRI弥散张量成像技术检测患侧及健侧CST的各向异性分数(FA),计算患侧与健侧FA比值(rFA),根据弥散张量纤维束成像结果进行CST损伤评分。结果:观察组治疗后腕屈肌、肘屈肌、膝伸肌和踝屈肌的MAS评分均低于对照组,差异具有统计学意义(P0.05);观察组治疗后 FMA评分、MBI评分均高于对照组,差异具有统计学意义(P0.05);观察组治疗后BBS 评分高于对照组,TUGT时间短于对照组,差异具有统计学意义(P0.05);观察组治疗后rFA大于对照组,CST损伤评分低于对照组,差异具有统计学意义(P0.05)。结论:东垣针法治疗缺血性脑卒中后偏瘫的效果较好,能有效改善患者的运动功能,促进
8、CST损伤恢复。关键词缺血性脑卒中;偏瘫;东垣针法;运动功能;皮质脊髓束损伤中图分类号:R246.6D0I:10.19917/ki.1005-0779.023150文献标识码:A基金项目:河北省中医药管理局科研计划,编号:2 0 2 2 2 8 7。作者简介:董莹慧(1990),女,主治中医师,从事中医内科相关研究。针灸临床杂志2 0 2 3年第39卷第8 期Effect of Dongyuan Needling on Motor Function and CST Injury in Patients(Tangshan Hospital of Traditional Chinese Medic
9、ine,Tangshan 063000,China)Abstract Objective:To observe the effects of Dongyuan needling on motor function and corticospinal tract(CST)injury in patients with hemiplegia after ischemic stroke.Methods:A total of 128 patients withhemiplegia after ischemic stroke were randomly divided into the control
10、group and the observation group,with64 cases in each group.The control group was given conventional medication and rehabilitation training;onwhich basis,the observation group was also treated with Dongyuan needling.The treatment duration was 8weeks in both groups.One day before and one day after the
11、 treatment,motor function was assessed by modifiedAshworth Spasmodic Rating Scale(MAS),Fugl-Meyer Motor Function Scale(FMA),modified Barthel Index(MBI),Berg Balance Scale(BBS),a n d s t a n d i n g u p a n d w a l k i n g T i m e t e s t (T U G T).T h e f r a c t i o n a lanisotropy(FA)of CST on the
12、 affected side and the healthy side was measured by MRI diffusion tensorimaging,and the ratio of FA on the affected side and the healthy side(rFA)was calculated.The CST injuryscore was calculated according to the results of the diffusion tensor fiber bundle imaging.Results:The MASscores of wrist fle
13、xor,elbow flexor,knee extensor and ankle flexor were significantly lower in the observationgroup than those in the control group(P O.05).The FMA score and the MBI score were higher in theobservation group than those in the control group after the treatment(P0.05).The BBS score was higher andthe TUGT
14、 was shorter in the observation group than those in the control group(P0.05).The rFA was higherand the CST injury score was lower in the observation group than those in the control group(P 0.05),具可比性。161.2诊断标准符合中国急性缺血性脑卒中诊治指南2 0 18 4关于缺血性脑卒中的诊断标准,具体如下:急性起病,存在局灶神经功能缺损,症状或体征持续时间不限(影像学显示有责任制备性病灶),排除非血管
15、性病因及经脑CT、M RI 排除脑出血。1.3纳人标准病情稳定后伴有瘫痪,瘫痪肢体肌张力Brunnstrom分级:I V 级;年龄50 7 5岁;病程1418 0 d;生命体征相对稳定,意识清楚,能配合随访和各项治疗。1.4排除标准合并严重的基础疾病且难以控制病情者;存在其他原因引起的肢体运动障碍者;近30 d接受肌肉松弛剂治疗者;不耐受东垣针法治疗者。1.5治疗方法据中国缺血性脑卒中和短暂性脑缺血发作二级预防指南2 0 145,对照组予常规药物和康复治疗,对症治疗高血压、高血糖和冠心病等,严格控制吸烟、饮酒等危险因素,酌情开展改善脑循环、营养神经、抑制血小板聚集和预防深静脉血栓形成、感染等并
16、发症发生,逐渐行抗痉挛体位、牵伸躯干肌、坐位和立位平衡、坐站转换、步行和上肢控制能力训练等康复训练。观察组在对照组治疗基础上联合东垣针法治疗,主穴:百会、神庭平刺15 2 5mm,极泉、尺泽和内关直刺1535mm,鼠蹊、阴陵泉和三阴交斜刺30 35 mm;随症取穴:上下肢严重痉挛者加刺人中、涌泉和中冲穴,腕关节严重痉挛者加刺阳溪、阳池和大陵穴,踝关节内翻者加刺太溪、昆仑和解溪穴。使用0.2 5mm(2 550)m m 无菌针针刺上述穴位,双侧取穴,施用“同精导气”针法,缓慢捻转进针,均匀、缓慢与平和地提插捻转,由浅层至深层,再由深层至浅层,直至感知针下和缓平衡,留针于穴位中层2 0 min,1
17、次/d,每周治疗6次,休息1 日,连续治疗8 周。1.6随访及观察指标以定期电话、回院复查的形式进行随访2 个月;在治疗前1 d及治疗结束后1 d,采用改良 Ashworth痉挛评定量表(MAS)、Fu g l-M e y e r 运动功能量表(FMA)、改良Barthel指数(MBI)、Be r g 平衡量表(BBS)和起立行走计时测试(TUGT)进行运动功能评定。组别例数对照组64观察组64注:与治疗前比较,*P0.05;与对照组比较,#P0.05。JCAM.Aug.2023,Vol.39,NO.81.6.1MAS总分分别对患者腕屈肌、肘屈肌、膝伸肌和踝屈肌的肌张力进行测定,分为0 级、1
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- 针法 缺血性 脑卒中 偏瘫 患者 运动 功能 皮质 脊髓 损伤 影响 研究