八段锦对脑卒中患者运动功能恢复影响的临床研究
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摘要
目的运用中医八段锦对脑卒中后6个月内患者进行康复干预,观察评价其对肢体运动、平衡功能的康复疗效。方法 2018年7月—2019年3月符合纳入标准的脑卒中患者40例,随机分成八段锦组(八段锦结合常规康复)20例、对照组(常规康复)20例。八段锦组在进行常规康复的同时再给予八段锦训练,对照组给予常规康复训练。治疗时间为3周,在治疗前、后采用Fugl-Meyer运动功能量表、6分钟步行测试、Berg平衡量表、坐站平衡测试仪、Barthel指数评估两组患者干预前后的运动功能、平衡能力和日常生活能力。结果八段锦组和对照组在干预后,Fugl-Meyer运动功能量表、6分钟步行测试、Berg平衡量表、坐站平衡测试仪、Barthel指数评估患者运动功能、平衡能力、日常生活能力皆有明显改善(P<0.05);与对照组比较,八段锦组Fugl-Meyer运动功能量表、Barthel指数、Berg平衡量表及6分钟步行测试评分均显著增加[(72.25±20.91)vs.(57.90±20.25)分,(89.75±12.08)vs.(77.75±15.68)分,(53.25±5.74)vs.(47.80±9.77)分,(251.03±79.43)vs.(186.92±100.09)m;P<0.05],而坐-站-坐平衡中站立位的重心轨迹总长度、重心摆动平均速度、重心单位面积轨迹长度均显著降低[(235.86±76.08)vs.(303.60±123.01)cm,(11.67±3.37)vs.(15.76±7.05)cm/s,(2.53±0.99)vs.(3.40±1.28)cm/cm2;P<0.05],坐-站-坐平衡中坐位的重心轨迹总长度、重心摆动平均速度、重心单位面积轨迹长度也显著降低[(246.59±98.79)vs.(334.05±155.87)cm,(7.69±2.29)vs.(11.13±6.41)cm/s,(4.10±1.38)vs.(6.25±4.21)cm/cm2;P<0.05]。结论常规康复训练及在此基础上增加八段锦训练对脑卒中患者的运动功能、平衡功能、日常生活能力均有改善,常规康复联合八段锦训练的治疗效果优于常规康复训练。
Objective To observe the effect of Baduanjin on the motor function and balance function in patients within 6 months after stroke. Methods Between July 2018 and March 2019, a total of 40 stroke patients were randomly divided into the Baduanjin group and the control group. Twenty patients in the Baduanjin group received the treatment of Baduanjin training and conventional rehabilitation, while the other 20 patients in the control group were treated with conventional rehabilitation only. The duration of the treatment was 3 weeks; then the motor function, balance ability and the ability of daily life in the two groups were assessed by the Fugl-Meyer Assessment(FMA), the 6-minute Walking Test(6 MWT), the Berg Balance Scale(BBS), the balance tester and the Barthel Index(BI) respectively before and after treatment. Results After the 3-week treatment, the motor function, balance ability and the ability of daily life assessed by FMA, 6 MWT, BBS, the balance tester, and BI were improved significantly in both groups(P<0.05). The post-treatment scores of FMA, BI, BBS and 6 MWT distance in the Baduanjin group were more than those in the control group[72.25±20.91 vs. 57.90±20.25, 89.75±12.08 vs. 77.75±15.68, 53.25±5.74 vs. 47.80±9.77,(251.03±79.43) vs.(186.92±100.09) m;P<0.05]. In the sit-to-stand balance test, compared with those in the control group, the total trajectory length of center of gravity, average swing speed of center of gravity, and unit area trajectory length of center of gravity in standing stance in the Baduanjin group reduced significantly [(235.86±76.08) vs.(303.60±123.01) cm,(11.67±3.37) vs.(15.76±7.05) cm/s,(2.53±0.99) vs.(3.40±1.28) cm/cm~2; P<0.05], and the total trajectory length of center of gravity, average swing speed of center of gravity, and unit area trajectory length of center of gravity in sitting stance in the Baduanjin group also reduced significantly [(246.59±98.79) vs.(334.05±155.87) cm,(7.69±2.29) vs.(11.13±6.41) cm/s,(4.10±1.38) vs.(6.25±4.21)cm/cm~2; P<0.05]. Conclusion Conventional rehabilitation with or without Baduanjin can improve the motor function,balance function and the ability of daily life in patients after stroke, but the effect of rehabilitation with Baduanjin is better than conventional rehabilitation.
Objective To observe the effect of Baduanjin on the motor function and balance function in patients within 6 months after stroke. Methods Between July 2018 and March 2019, a total of 40 stroke patients were randomly divided into the Baduanjin group and the control group. Twenty patients in the Baduanjin group received the treatment of Baduanjin training and conventional rehabilitation, while the other 20 patients in the control group were treated with conventional rehabilitation only. The duration of the treatment was 3 weeks; then the motor function, balance ability and the ability of daily life in the two groups were assessed by the Fugl-Meyer Assessment(FMA), the 6-minute Walking Test(6 MWT), the Berg Balance Scale(BBS), the balance tester and the Barthel Index(BI) respectively before and after treatment. Results After the 3-week treatment, the motor function, balance ability and the ability of daily life assessed by FMA, 6 MWT, BBS, the balance tester, and BI were improved significantly in both groups(P<0.05). The post-treatment scores of FMA, BI, BBS and 6 MWT distance in the Baduanjin group were more than those in the control group[72.25±20.91 vs. 57.90±20.25, 89.75±12.08 vs. 77.75±15.68, 53.25±5.74 vs. 47.80±9.77,(251.03±79.43) vs.(186.92±100.09) m;P<0.05]. In the sit-to-stand balance test, compared with those in the control group, the total trajectory length of center of gravity, average swing speed of center of gravity, and unit area trajectory length of center of gravity in standing stance in the Baduanjin group reduced significantly [(235.86±76.08) vs.(303.60±123.01) cm,(11.67±3.37) vs.(15.76±7.05) cm/s,(2.53±0.99) vs.(3.40±1.28) cm/cm~2; P<0.05], and the total trajectory length of center of gravity, average swing speed of center of gravity, and unit area trajectory length of center of gravity in sitting stance in the Baduanjin group also reduced significantly [(246.59±98.79) vs.(334.05±155.87) cm,(7.69±2.29) vs.(11.13±6.41) cm/s,(4.10±1.38) vs.(6.25±4.21)cm/cm~2; P<0.05]. Conclusion Conventional rehabilitation with or without Baduanjin can improve the motor function,balance function and the ability of daily life in patients after stroke, but the effect of rehabilitation with Baduanjin is better than conventional rehabilitation.
引文
1王陇德,王金环,彭斌,等.《中国脑卒中防治报告2016》概要.中国脑血管病杂志,2017, 15(4):217-224.
2 Fens M, van Heugten CM, Beusmans GA, et al. Effect of a strokespecific follow-up care model on the quality of life of stroke patients and caregivers:a controlled trial. J Rehabil Med, 2014,46(1):7-15.
3刘洪.早期加强中医康复治疗对脑卒中患者预后的影响.河南中医,2018, 38(12):1849-1851.
4全国第四届脑血管病学术会议.各类脑血管疾病诊断要点.中华神经科杂志,1996, 29(6):379-380.
5王玉龙.康复功能评定学.3版.北京:人民卫生出版社,2018:90,228-231, 288-290, 427-430.
6张雪冰,吴生元.经典火神派与卢氏火神派的比较研究.时珍国医国药,2017, 28(2):419-421.
7叶涛,朱路文,阮野,等.头穴丛刺联合八段锦锻练对脑卒中恢复期患者下肢运动能力及平衡功能的影响.世界中西医结合杂志,2018,13(3):403-406.
8戴维西弗.物理医学与康复医学.厉建安,译.北京:科学出版社,2018:271-339.
9胡永善.新编康复医学.上海:复旦大学出版社,2005:11-12.
10马英,郭鹤.八段锦的中医养生原理.辽宁中医杂志,2018, 45(7):1403-1405.
11郑秀琴,胡军.传统功法在慢,性心功能不全早期心脏康复中的运用.上海中医药大学学报,2018, 32(5):92-96.
12都文渊,苏书贞,赵玉斌,等.八段锦改善老年人平衡功能及步态的临床观察.河北中医,2018, 40(7):987-990.
13薛广伟,冯淬灵,姚小芹,等.健身气功八段锦在慢性阻塞性肺疾病稳定期肺康复中的疗效评价.北京中医药大学学报,2015,38(2):139-144.
14刘晓云,尹兵祥.八段锦运动疗法预防社区老年人跌倒的应用及效果.护理研究,2016, 30(4):423-425.
15刘晓云,高静,柏丁兮,等.八段锦对社区老年人跌倒效能的影响研究.护理研究,2015,29(1):90-93.
16马欣,张杰.健身气功八段锦对中老年人平衡能力的影响.山东体育科技,2016, 38(1):58-61.
17王大方,刘天威,王健.八段锦、太极拳、广场舞、健身行走预防老年人跌倒的效果.上海医药,2017, 38(8):55-57.
18 Kim K, Kim YM, Kang DY. Repetitive sit-to-stand training with the step-foot position on the non-paretic side, and its effects on the balance and foot pressure of chronic stroke subjects. J Phys Ther Sci, 2015, 27(8):2621-2624.
19张瑶,李丽.八段锦结合平衡训练治疗脑卒中患者平衡功能障碍31例.山东中医杂志,2016, 35(8):716-718.
20白艳杰,毛海燕,郭健,等.八段锦结合功能训练改善脑卒中患者平衡功能的研究.中医学报,2011,45(10):1231-1232.
21林秋.45例老年脑卒中恢复期患者八段锦联合中医措施康复效果的应用分析.辽宁中医杂志,2018, 45(2):302-304.
22高天昊,吴毅,陆蓉蓉,等.健康人坐-站-坐运动中姿势图参数的重测信度研究.中运动医学杂志,2017, 36(7):605-609.
23杨伟,王红,徐洋凡,等.BALANCE评定与训练系统对脑卒中患者早期躯干控制能力疗效观察.康复学报,2017, 27(2):17-21.
24徐泉,潘钰,杨晓辉,等.有氧运动联合常规康复治疗对卒中偏瘫患者心肺运动功能及康复效果的影响.中国脑血管病杂志,2017, 14(9):465-469.
25 D'Isabella NT, Shkredova DA, Richardson JA, et al. Effects of exercise on cardiovascular risk factors following stroke or transient ischemic attack:a systematic review and meta-analysis. Clin Rehabil, 2017,31(12):1561-1572.
26杨慧馨,虞定海,赵影.中老年人简化太极拳锻炼的气体代谢与能量消耗研究.中国运动医学杂志,2012, 31(2):106-108.
27刘遂心.冠心病康复/二级预防中国专家共识//中国康复医学会.中国康复医学会心血管病专业委员会换届暨学科发展高峰论坛会议资料.北京:中国康复医学会,2012:23.
28杨慧馨,刘晓蕾.太极拳和八段锦对脑卒中患者偏瘫下肢运动功能和表面肌电的效果.中国康复理论与实践,2019, 25(1):101-106.
2 Fens M, van Heugten CM, Beusmans GA, et al. Effect of a strokespecific follow-up care model on the quality of life of stroke patients and caregivers:a controlled trial. J Rehabil Med, 2014,46(1):7-15.
3刘洪.早期加强中医康复治疗对脑卒中患者预后的影响.河南中医,2018, 38(12):1849-1851.
4全国第四届脑血管病学术会议.各类脑血管疾病诊断要点.中华神经科杂志,1996, 29(6):379-380.
5王玉龙.康复功能评定学.3版.北京:人民卫生出版社,2018:90,228-231, 288-290, 427-430.
6张雪冰,吴生元.经典火神派与卢氏火神派的比较研究.时珍国医国药,2017, 28(2):419-421.
7叶涛,朱路文,阮野,等.头穴丛刺联合八段锦锻练对脑卒中恢复期患者下肢运动能力及平衡功能的影响.世界中西医结合杂志,2018,13(3):403-406.
8戴维西弗.物理医学与康复医学.厉建安,译.北京:科学出版社,2018:271-339.
9胡永善.新编康复医学.上海:复旦大学出版社,2005:11-12.
10马英,郭鹤.八段锦的中医养生原理.辽宁中医杂志,2018, 45(7):1403-1405.
11郑秀琴,胡军.传统功法在慢,性心功能不全早期心脏康复中的运用.上海中医药大学学报,2018, 32(5):92-96.
12都文渊,苏书贞,赵玉斌,等.八段锦改善老年人平衡功能及步态的临床观察.河北中医,2018, 40(7):987-990.
13薛广伟,冯淬灵,姚小芹,等.健身气功八段锦在慢性阻塞性肺疾病稳定期肺康复中的疗效评价.北京中医药大学学报,2015,38(2):139-144.
14刘晓云,尹兵祥.八段锦运动疗法预防社区老年人跌倒的应用及效果.护理研究,2016, 30(4):423-425.
15刘晓云,高静,柏丁兮,等.八段锦对社区老年人跌倒效能的影响研究.护理研究,2015,29(1):90-93.
16马欣,张杰.健身气功八段锦对中老年人平衡能力的影响.山东体育科技,2016, 38(1):58-61.
17王大方,刘天威,王健.八段锦、太极拳、广场舞、健身行走预防老年人跌倒的效果.上海医药,2017, 38(8):55-57.
18 Kim K, Kim YM, Kang DY. Repetitive sit-to-stand training with the step-foot position on the non-paretic side, and its effects on the balance and foot pressure of chronic stroke subjects. J Phys Ther Sci, 2015, 27(8):2621-2624.
19张瑶,李丽.八段锦结合平衡训练治疗脑卒中患者平衡功能障碍31例.山东中医杂志,2016, 35(8):716-718.
20白艳杰,毛海燕,郭健,等.八段锦结合功能训练改善脑卒中患者平衡功能的研究.中医学报,2011,45(10):1231-1232.
21林秋.45例老年脑卒中恢复期患者八段锦联合中医措施康复效果的应用分析.辽宁中医杂志,2018, 45(2):302-304.
22高天昊,吴毅,陆蓉蓉,等.健康人坐-站-坐运动中姿势图参数的重测信度研究.中运动医学杂志,2017, 36(7):605-609.
23杨伟,王红,徐洋凡,等.BALANCE评定与训练系统对脑卒中患者早期躯干控制能力疗效观察.康复学报,2017, 27(2):17-21.
24徐泉,潘钰,杨晓辉,等.有氧运动联合常规康复治疗对卒中偏瘫患者心肺运动功能及康复效果的影响.中国脑血管病杂志,2017, 14(9):465-469.
25 D'Isabella NT, Shkredova DA, Richardson JA, et al. Effects of exercise on cardiovascular risk factors following stroke or transient ischemic attack:a systematic review and meta-analysis. Clin Rehabil, 2017,31(12):1561-1572.
26杨慧馨,虞定海,赵影.中老年人简化太极拳锻炼的气体代谢与能量消耗研究.中国运动医学杂志,2012, 31(2):106-108.
27刘遂心.冠心病康复/二级预防中国专家共识//中国康复医学会.中国康复医学会心血管病专业委员会换届暨学科发展高峰论坛会议资料.北京:中国康复医学会,2012:23.
28杨慧馨,刘晓蕾.太极拳和八段锦对脑卒中患者偏瘫下肢运动功能和表面肌电的效果.中国康复理论与实践,2019, 25(1):101-106.
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