目的 探讨以针康法为主的中医整合康复技术对脑卒中后偏瘫患者的干预效果及对患者肢体肌力、肢体运动功能的影响。方法 将医院针灸科、康复科收治的脑卒中后偏瘫患者90例纳入研究，随机分为对照组与中医整合康复组，各45例。两组均给予脑卒中常规西药治疗，对照组在此基础上给予常规康复训练，中医整合康复组在常规治疗基础上给予针康法、易筋经联合推拿治疗，共治疗8周后判定疗效。比较两组的中医证候积分，比较治疗前后患者肢体肌力[徒手肌力检查(Manual muscle testing，MMT)]、肌张力[改良Ashworth分级标准(MAS)]、肢体运动功能[Fug-Meyer运动功能量表(Fugl-Meyer assessment scale，FMA)]、神经功能[美国国立卫生研究院卒中量表(National Institute of Health stroke scale，NIHSS)]及生活质量[脑卒中专用生活质量量表(Stroke Specific Quality of Life，SS-QOL)]。彩色多普勒超声测定颈总动脉收缩期最大流速(Peak systolic velocity，PSV)、舒张末期最低流速(End diastolic velocity，EDV)及阻力指数(Resistance index，RI)等脑血流动力学参数。结果 两组治疗后半身不遂、偏身麻木、口舌歪斜、言语謇涩、步履不稳、气短乏力等中医证候积分及总积分均较治疗前显著降低(P＜0。05)，中医整合康复组显著低于对照组(P＜0。05)。中医整合康复组的显效率(51。1％，23/45)和有效率(95。5％，43/45)均明显优于对照组[24。4％(11/45)和82。2％(37/45)]，组间比较差异有统计学意义(P＜0。05)。两组治疗后MMT、FAM、SS-QOL评分及PSV、EDV值均较治疗前显著升高(P＜0。05)，中医整合康复组显著高于对照组(P＜0。05);两组治疗后MAS、NIHSS评分及RI值均较治疗前显著降低(P＜0。05)，中医整合康复组显著低于对照组(P＜0。05)。结论 以针康法为主的中医整合康复技术治疗脑卒中后偏瘫效果显著，能够明显增强患者肢体肌力，降低肌张力，改善患者的肢体运动功能和神经功能，提高患者生活质量。
Effect of Traditional Chinese Medicine Integrated Rehabilitation Techniques with Acupuncture and Rehabilitation as Main Method on Limb Muscle Strength and Motor Function in Patients with Hemiplegia after Stroke
Objective To investigate the effect of TCM integrated rehabilitation techniques,mainly based on acupuncture and rehabilitation,on post-stroke hemiplegic patients and its impact on limb muscle strength and motor function of patients.Method Ninety patients with hemiplegia after stroke admitted to acupuncture and rehabilitation department of the hospital were included in the study and randomly divided into control group and TCM integrated rehabilitation group,45 cases in each.Both groups were given routine neurological drug treatment.The control group was given routine rehabilitation training on the basis of this,and the TCM integrated rehabilitation group was given acupuncture-rehabilitation method and Yijinjing combined with Tuina on the basis of conventional treatment.The curative effect was evaluated after a total of 8 weeks of treatment.TCM syndrome scores of the two groups were compared,and limb muscle strength(MMT),muscle tension(MAS),limb motor function(FMA),nerve function(NIHSS)and quality of life(SS-QOL)were compared before and after treatment.The maximum systolic flow velocity(PSV),minimum end-diastolic flow velocity(EDV)and resistance index(RI)of common carotid artery were measured by color Doppler ultrasound.Result After treatment,the scores and total scores of TCM syndrome such as hemiplegia,hemianesthesia,crooked tongue,sharp tongue,unsteady gait and shortness of breath in both groups were significantly lower than those before treatment(P＜0.05),and the score of the TCM integrated rehabilitation group was significantly lower than that of the control group(P＜0.05).The significant efficiency(51.1％)and effective rate(95.5％)of TCM integrated rehabilitation group were significantly better than those of control group(24.4％and 82.2％),and the difference between groups was statistically significant(P＜0.05).After treatment,the values of MMT,PSV and EDV,the scores of FAM and SS-QOL in both groups were significantly higher than those before treatment(P＜0.05),and the values and scores of TCM integrated rehabilitation group were significantly higher than those of the control group(P＜0.05).The scores of MAS and NIHSS and RI values in both groups after treatment were significantly lower than those before treatment(P＜0.05),and the scores and RI values of the TCM integrated rehabilitation group were significantly lower than those of the control group(P＜0.05).Conclusion TCM integrated rehabilitation therapy based on acupuncture-rehabilitation method has remarkable effect in the treatment of hemiplegia after stroke,which can significantly enhance the limb muscle strength of patients,reduce the muscle tension,improve the limb motor function and nerve function of patients,and improve the quality of life of patients.
strokehemiplegiaTCM integrated rehabilitationacupuncture-rehabilitation methodYijinjinglimb muscle strengthlimb motor function
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