针刺、推拿及康复疗法3种治疗方案对脑卒中后痉挛性偏瘫患者生活质量的影响
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摘要
目的:观察针刺、推拿及康复疗法3种治疗方案对脑卒中后痉挛性偏瘫患者生活质量的影响。方法:选取100例脑卒中后痉挛性偏瘫患者,按患者治疗意愿分为康复训练组(n=38)、针刺组(n=30)与推拿组(n=32),3组均给予常规药物治疗,在此基础上,康复训练组予以康复训练疗法,针刺组予以针刺疗法,推拿组予以推拿疗法,疗程为4周,采用Ashworth痉挛(MAS)量表、Barthel指数(BI)及卒中痉挛性偏瘫基于患者报告的结局(PRO)量表评估患者痉挛程度、日常生活能力及生活质量。结果:推拿组治疗总有效率为90. 63%,明显高于康复训练组(65. 79%)及针刺组(66. 67%),差异有统计学意义(P <0. 05)。治疗后康复训练组与针刺组上下肢MAS评分比较差异无统计学意义(P> 0. 05),但均明显高于推拿组(P <0. 05);治疗后康复训练组与推拿组BI评分比较差异无统计学意义(P> 0. 05),但均明显高于针刺组(P <0. 05);治疗后康复训练组与针刺组卒中痉挛性偏瘫PRO评分比较差异无统计学意义(P> 0. 05),但均明显高于推拿组(P <0. 05)。结论:在缓解脑卒中后肢体痉挛上,针刺疗法与康复训练疗效相当,而推拿疗法疗效优于前两者;在改善患者日常生活能力方面,康复训练与推拿疗法疗效相当,且均优于针刺; 3种治疗方案中,推拿疗法对患者生活质量的改善效果最佳。
Objective: To observe the effect of acupuncture,tuina and rehabilitation therapy on the quality of life in the patients with post-stroke spastic paralysis. Methods: 100 patients with post-stroke spastic paralysis were divided into the rehabilitation training group( n = 38),the acupuncture group( n = 30) and the tuina group( n = 32) according to their own will. All the three groups were also treated with conventional medications. The course of the treatment was 4 weeks. The degree of spasm,activities of daily living and quality of life were evaluated with the Ashworth spasm( MAS) scale,Barthel index( BI) and patient reported outcome( PRO)scale. Results: The total effective rate was 90. 63% in the tuina group,which was significantly higher than65. 79% in the rehabilitation training group and 66. 67% in the acupuncture group( P < 0. 05). After the treatment,there was no significant difference in MAS scores of upper and lower limbs between the rehabilitation training group and the acupuncture group( P > 0. 05),which were both higher than those in the tuina group( P < 0. 05). In terms of BI scores,there was no statistical difference between the rehabilitation training group and the tuina group( P > 0. 05),which were both higher than those in the acupuncture group( P < 0. 05). In terms of PRO scores,there was no statistical difference between the rehabilitation training group and the acupuncture group( P > 0. 05),which were both higher than those in the tuina group( P < 0. 05). Conclusion: In terms of relieving post-stroke limb spasm,tuina therapy has the best effect,and acupuncture therapy is similar to rehabilitation training. In terms of improving the activities of daily living,rehabilitation training is similar to tuina,which are both superior to acupuncture. Among the three therapies,effects of tuina is best in improving the life quality of the patients.
Objective: To observe the effect of acupuncture,tuina and rehabilitation therapy on the quality of life in the patients with post-stroke spastic paralysis. Methods: 100 patients with post-stroke spastic paralysis were divided into the rehabilitation training group( n = 38),the acupuncture group( n = 30) and the tuina group( n = 32) according to their own will. All the three groups were also treated with conventional medications. The course of the treatment was 4 weeks. The degree of spasm,activities of daily living and quality of life were evaluated with the Ashworth spasm( MAS) scale,Barthel index( BI) and patient reported outcome( PRO)scale. Results: The total effective rate was 90. 63% in the tuina group,which was significantly higher than65. 79% in the rehabilitation training group and 66. 67% in the acupuncture group( P < 0. 05). After the treatment,there was no significant difference in MAS scores of upper and lower limbs between the rehabilitation training group and the acupuncture group( P > 0. 05),which were both higher than those in the tuina group( P < 0. 05). In terms of BI scores,there was no statistical difference between the rehabilitation training group and the tuina group( P > 0. 05),which were both higher than those in the acupuncture group( P < 0. 05). In terms of PRO scores,there was no statistical difference between the rehabilitation training group and the acupuncture group( P > 0. 05),which were both higher than those in the tuina group( P < 0. 05). Conclusion: In terms of relieving post-stroke limb spasm,tuina therapy has the best effect,and acupuncture therapy is similar to rehabilitation training. In terms of improving the activities of daily living,rehabilitation training is similar to tuina,which are both superior to acupuncture. Among the three therapies,effects of tuina is best in improving the life quality of the patients.
引文
[1]王宁,李志峰,吴海红.火针疗法治疗中风后痉挛性偏瘫的临床疗效观察[J].针刺研究,2015,40(4):304-308.
[2]徐雪松.早期康复联合针刺拮抗肌对痉挛性偏瘫患者肌张力的影响[J].世界中医药,2016,11(1):140-142.
[3]陈健安,余康潮,钟正,等.针刺董氏奇穴和康复训练对脑卒中后上肢痉挛性偏瘫患者的效果[J].中国康复理论与实践,2015,21(3):330-333.
[4]付露,潘文宇.中风后痉挛性瘫痪的针灸推拿及康复治疗现状[J].现代中西医结合杂志,2016,25(10):1137-1140.
[2]中华医学会神经病学分会脑血管病学组急性缺血性脑卒中诊治指南撰写组.中国急性缺血性脑卒中诊治指南2010[J].中华神经科杂志,2010,2(2):16-19.
[6]卫生部疾病控制司,中华医学会神经病学分会.中国脑血管病防治指南(节选)[J].中国现代神经疾病杂志,2007,7(2):200.
[7]郭铁成,卫小梅,陈小红.改良Ashworth量表用于痉挛评定的信度研究[J].中国康复医学杂志,2008,23(10):906-909.
[8]蔡业峰,贾真,李伟峰,等.中文版Barthel指数对多中心测评缺血性卒中患者预后的研究[J].中国脑血管病杂志,2007,4(11):486-490.
[9]张艳宏,刘保延,何丽云,等.基于中风痉挛性瘫痪患者报告的临床结局评价量表的信度、效度分析[J].中医杂志,2009,12(13):698-700.
[10]郑筱萸.中药新药临床研究指导原则(试行)[M].北京:中国医药科技出版社,2002:146.
[11] Gui BS. Effect of rehabilitational sliding machine and ergometer bicycle training on patients with hemiplegia[J]. Journal of Physical Therapy Science,2015,27(3):755-757.
[12]魏海棠,彭涛,杨露,等.肉毒素局部注射联合康复训练对脑卒中后偏瘫痉挛性足下垂的治疗效果观察[J].山东医药,2017,57(27):55-57.
[13]王锦.手指屈指运动联合综合康复训练对脑卒中后偏瘫患者手指活动度和上肢功能的影响[J].中国全科医学,2017,20(S1):180-182.
[14]李青松,谢道俊,周磊.脑卒中后痉挛状态的中西医诊治[J].中医药临床杂志,2015,27(2):163-165.
[15]金栋.《内经》中风病病症名探讨[J].世界中西医结合杂志,2009,4(10):694-695.
[16]桂树虹,黄东勉,李俊驹.针刺联合井穴麦粒灸治疗急性脑卒中后痉挛性偏瘫临床观察[J].中国中医急症,2016,25(6):1114-1116.
[17]马鑫,励建安,朱毅,等.推拿治疗脑卒中后痉挛性瘫痪的经穴特点[J].中国康复理论与实践,2015,21(3):358-361.
[18]郝建波,王云翠.拮抗肌推拿结合Bobath疗法治疗中风痉挛性偏瘫的临床观察[J].湖北中医药大学学报,2016,18(3):98-100.
[19]郭遂怀,陈绪池,张鹏,等.中医推拿在“医养结合”模式下脑卒中康复方案中的可行性分析[J].实用心脑肺血管病杂志,2017,25(1):87-90.
[20]霍新慧,赵百孝,周钰,等.艾灸结合康复治疗对中风后痉挛性偏瘫患者生存质量的影响[J].辽宁中医杂志,2013,40(12):2566-2567.
[2]徐雪松.早期康复联合针刺拮抗肌对痉挛性偏瘫患者肌张力的影响[J].世界中医药,2016,11(1):140-142.
[3]陈健安,余康潮,钟正,等.针刺董氏奇穴和康复训练对脑卒中后上肢痉挛性偏瘫患者的效果[J].中国康复理论与实践,2015,21(3):330-333.
[4]付露,潘文宇.中风后痉挛性瘫痪的针灸推拿及康复治疗现状[J].现代中西医结合杂志,2016,25(10):1137-1140.
[2]中华医学会神经病学分会脑血管病学组急性缺血性脑卒中诊治指南撰写组.中国急性缺血性脑卒中诊治指南2010[J].中华神经科杂志,2010,2(2):16-19.
[6]卫生部疾病控制司,中华医学会神经病学分会.中国脑血管病防治指南(节选)[J].中国现代神经疾病杂志,2007,7(2):200.
[7]郭铁成,卫小梅,陈小红.改良Ashworth量表用于痉挛评定的信度研究[J].中国康复医学杂志,2008,23(10):906-909.
[8]蔡业峰,贾真,李伟峰,等.中文版Barthel指数对多中心测评缺血性卒中患者预后的研究[J].中国脑血管病杂志,2007,4(11):486-490.
[9]张艳宏,刘保延,何丽云,等.基于中风痉挛性瘫痪患者报告的临床结局评价量表的信度、效度分析[J].中医杂志,2009,12(13):698-700.
[10]郑筱萸.中药新药临床研究指导原则(试行)[M].北京:中国医药科技出版社,2002:146.
[11] Gui BS. Effect of rehabilitational sliding machine and ergometer bicycle training on patients with hemiplegia[J]. Journal of Physical Therapy Science,2015,27(3):755-757.
[12]魏海棠,彭涛,杨露,等.肉毒素局部注射联合康复训练对脑卒中后偏瘫痉挛性足下垂的治疗效果观察[J].山东医药,2017,57(27):55-57.
[13]王锦.手指屈指运动联合综合康复训练对脑卒中后偏瘫患者手指活动度和上肢功能的影响[J].中国全科医学,2017,20(S1):180-182.
[14]李青松,谢道俊,周磊.脑卒中后痉挛状态的中西医诊治[J].中医药临床杂志,2015,27(2):163-165.
[15]金栋.《内经》中风病病症名探讨[J].世界中西医结合杂志,2009,4(10):694-695.
[16]桂树虹,黄东勉,李俊驹.针刺联合井穴麦粒灸治疗急性脑卒中后痉挛性偏瘫临床观察[J].中国中医急症,2016,25(6):1114-1116.
[17]马鑫,励建安,朱毅,等.推拿治疗脑卒中后痉挛性瘫痪的经穴特点[J].中国康复理论与实践,2015,21(3):358-361.
[18]郝建波,王云翠.拮抗肌推拿结合Bobath疗法治疗中风痉挛性偏瘫的临床观察[J].湖北中医药大学学报,2016,18(3):98-100.
[19]郭遂怀,陈绪池,张鹏,等.中医推拿在“医养结合”模式下脑卒中康复方案中的可行性分析[J].实用心脑肺血管病杂志,2017,25(1):87-90.
[20]霍新慧,赵百孝,周钰,等.艾灸结合康复治疗对中风后痉挛性偏瘫患者生存质量的影响[J].辽宁中医杂志,2013,40(12):2566-2567.