醒脑开窍针刺联合穴位注射治疗缺血性卒中上肢痉挛性瘫痪气虚血瘀证的效果

doi:10.3760/cma.j.issn.1007-1245.2024.24.004

国际医药卫生导报 ›› 2024, Vol. 30 ›› Issue (24): 4083-4086.DOI: 10.3760/cma.j.issn.1007-1245.2024.24.004

醒脑开窍针刺联合穴位注射治疗缺血性卒中上肢痉挛性瘫痪气虚血瘀证的效果

熊垚方长琳

安康市中医医院针灸康复中心，安康　725000

收稿日期:2024-05-06 出版日期:2024-12-15 发布日期:2024-12-21
通讯作者: 方长琳，Email：xiaofangtx001@126.com
基金资助:
陕西省中医药管理局项目（2021-ZZ-LC034）

Curative effect of Xingnaokaiqiao acupuncture combined with acupoint injection on patients with Qi deficiency and blood stasis syndrome of spastic upper limb paralysis after ischemic stroke

Xiong Yao, Fang Changlin

Acupuncture Rehabilitation Center, Ankang Hospital of Traditional Chinese Medicine, Ankang 725000, China

Received:2024-05-06 Online:2024-12-15 Published:2024-12-21
Contact: Fang Changlin, Email: xiaofangtx001@126.com
Supported by:
Project of Traditional Chinese Medicine Administration of Shaanxi Province (2021-ZZ-LC034)

摘要/Abstract

摘要：

目的　研究醒脑开窍针刺联合穴位注射治疗缺血性卒中（IS）上肢痉挛性瘫痪气虚血瘀证患者的效果。方法　本研究为随机对照试验。选取2021年12月至2023年9月安康市中医医院收治的100例IS上肢痉挛性瘫痪气虚血瘀证患者作为研究对象。采用随机数字表法，将患者分为观察组（50例）和对照组（50例）。观察组因2型糖尿病退出研究1例，因肺炎退出研究1例，对照组因高血压病退出研究1例，最终纳入97例。观察组男25例，女23例；年龄41～76（58.54±8.29）岁，病程（1.63±0.27）个月。对照组男22例，女27例；年龄40～74（57.06±8.73）岁，病程（1.52±0.31）个月。对照组采用规范化卒中康复治疗，观察组在对照组基础上采用醒脑开窍针刺联合穴位注射治疗。两组均治疗2周。比较两组临床疗效，治疗前后痉挛程度［改良Ashworth量表（MAS）］、运动功能［Fugl-Meyer运动功能评定量表（FMA）］和骨骼肌（肱二头肌、肱三头肌、肱桡肌）超声剪切波速度（SWV）。采用独立样本t检验、配对t检验和χ²检验进行统计学分析。结果　观察组治疗总有效率高于对照组［89.58%（43/48）比73.47%（36/49）］（P<0.05）。治疗后，观察组MAS评分低于对照组，FMA评分高于对照组［（1.02±0.26）分比（1.44±0.25）分、（28.13±5.53）分比（20.29±5.01）分］（均P<0.05）；观察组肱二头肌、肱三头肌与肱桡肌SWV均低于对照组［（1.59±0.19）m/s比（1.93±0.22）m/s、（1.61±0.20）m/s比（1.97±0.19）m/s、（1.54±0.15）m/s比（1.86±0.22）m/s］（均P<0.05）。结论　醒脑开窍针刺联合穴位注射治疗可改善IS上肢痉挛性瘫痪气虚血瘀证患者临床症状，降低患肢痉挛程度，改善患肢活动度。

关键词:

缺血性卒中, 痉挛性瘫痪, 醒脑开窍针刺, 穴位注射

Abstract:

Objective　To study the efficacy of Xingnaokaiqiao acupuncture combined with acupoint injection on patients with Qi deficiency and blood stasis syndrome of spastic upper limb paralysis after ischemic stroke (IS). Methods　This study was a randomized controlled trial. A total of 100 patients with Qi deficiency and blood stasis syndrome of spastic upper limb paralysis after IS treated in Ankang Hospital of Traditional Chinese Medicine from December 2021 to September 2023 were selected as the study objects. The patients were divided into an observation group (50 cases) and a control group (50 cases) by the random number table method. The observation group withdrew 1 case due to type 2 diabetes, 1 case due to pneumonia, and the control group withdrew 1 case due to hypertension. Finally, 97 cases were included. In the observation group, there were 25 males and 23 females, aged 41-76 (58.54±8.29) years, and the duration of disease was (1.63±0.27) months. In the control group, there were 22 males and 27 females, aged 40-74 (57.06±8.73) years, and the duration of disease was (1.52±0.31) months. The control group was given standardized stroke rehabilitation treatment, and the observation group was given Xingnaokai acupuncture combined with acupoint injection based on the control group. Both groups were treated for 2 weeks. The clinical efficacy and spasmodic degree [modified Ashworth Scale (MAS)], motor function [Fugl-Meyer Motor Function Assessment (FMA)], and ultrasonic shear wave velocity (SWV) of skeletal muscle (biceps, triceps, and brachioradialis) before and after treatment were compared between the two groups. Independent sample t test, paired t test, and χ² test were used for statistical analysis. Results　The total effective rate of the observation group was higher than that of the control group [89.58% (43/48) vs. 73.47% (36/49)] (P<0.05). After treatment, the MAS score in the observation group was lower than that in the control group, and the FMA score was higher than that in the control group [(1.02±0.26) points vs. (1.44±0.25) points, (28.13±5.53) points vs. (20.29±5.01) points] (both P<0.05). The SWV of biceps, triceps, and brachioradialis in the observation group were lower than those in the control group [(1.59±0.19) m/s vs. (1.93±0.22) m/s, (1.61±0.20) m/s vs. (1.97±0.19) m/s, (1.54±0.15) m/s vs. (1.86±0.22) m/s] (all P<0.05). Conclusion　Xingnaokaiqiao acupuncture combined with acupoint injection can improve the clinical symptoms in patients with Qi deficiency and blood stasis syndrome of spastic upper limb paralysis after IS, reduce the degree of spasm of the affected limb, and improve the mobility of the affected limb.

Key words:

Ischemic stroke, Spastic paralysis, Xingnaokaiqiao acupuncture, Acupoint injection

熊垚方长琳.

醒脑开窍针刺联合穴位注射治疗缺血性卒中上肢痉挛性瘫痪气虚血瘀证的效果 [J]. 国际医药卫生导报, 2024, 30(24): 4083-4086.

Xiong Yao, Fang Changlin.

Curative effect of Xingnaokaiqiao acupuncture combined with acupoint injection on patients with Qi deficiency and blood stasis syndrome of spastic upper limb paralysis after ischemic stroke [J]. International Medicine and Health Guidance News, 2024, 30(24): 4083-4086.

参考文献

[1] Ma Q, Li R, Wang L, et al. Temporal trend and attributable risk factors of stroke burden in China, 1990-2019: an analysis for the global burden of disease study 2019[J]. Lancet Public Health, 2021, 6(12):e897-e906. DOI: 10.1016/S2468-2667(21)00228-0.
[2] 张利丹,谢雁鸣,高阳,等.2558例缺血性脑卒中患者中医证候与体质的相关性[J].中医杂志,2021,62(16):1416-1420.DOI:10.13288/j.11-2166/r.2021.16.009.
[3] 中华医学会神经病学分会,中华医学会神经病学分会脑血管病学组.中国急性缺血性脑卒中诊治指南2018[J].中华神经科杂志,2018,51(9):666-682.DOI:10.3760/cma.j.issn.1006-7876.2018.09.004.
[4] 廖欧萍,黄馨云,王慈,等.当代不同针灸流派治疗中风后痉挛性瘫痪特色概览[J].中国针灸,2023,43(9):1081-1085.DOI:10.13703/j.0255-2930.20220905-k0002.
[5] 中华神经科学会,中华神经外科学会.各类脑血管疾病诊断要点[J].中华神经科杂志,1996,29(6):60-61.
[6] 张伯礼,薛博瑜.中医内科学[M].2版.北京:人民卫生出版社,2012:113-121.
[7] 李平,吴钟璇,张云如,等.中风病诊断与疗效评定标准(试行)[J].北京中医药大学学报,1996,19(1):55-56.DOI:10.3321/j.issn:1006-2157.1996.01.022.
[8] 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.DOI:10.3969/j.issn.1001-1242.2008.10.013.
[9] 许光旭,高晓阳,陈文红.Fugl-Meyer运动功能评分的敏感性及实用性[J].中国康复,2001,16(1):18-19.DOI:10.3870/j.issn.1001-2001.2001.01.008.
[10] 曾慧娴,杨之雨,柳东红,等.医学研究中常见统计分析方法的应用[J].上海预防医学,2023,35(8):831-839.DOI:10.19428/j.cnki.sjpm.2023.22771.
[11] Kelly-Hayes M, Beiser A, Kase CS, et al. The influence of gender and age on disability following ischemic stroke: the Framingham study[J]. J Stroke Cerebrovasc Dis, 2003, 12(3):119-126. DOI: 10.1016/S1052-3057(03)00042-9.
[12] Rodgers H, Bosomworth H, Krebs HI, et al. Robot assisted training for the upper limb after stroke (RATULS): a multicentre randomised controlled trial[J]. Lancet, 2019, 394(10192):51-62. DOI: 10.1016/S0140-6736(19)31055-4.
[13] AFFINITY Trial Collaboration. Safety and efficacy of fluoxetine on functional outcome after acute stroke (AFFINITY): a randomised, double-blind, placebo-controlled trial[J]. Lancet Neurol, 2020, 19(8):651-660. DOI: 10.1016/S1474-4422(20)30207-6.
[14] 黄飞,吕晓琳,梁吉,等.针刺治疗中风后上肢痉挛的研究进展[J].中国中医急症,2023,32(3):548-551.DOI:10.3969/j.issn.1004-745X.2023.03.045.
[15] 何达,余嘉伟,黄钰蘅,等.«石学敏针灸验案特辑»中治疗中风中经络期偏瘫用穴规律[J].甘肃中医药大学学报,2024,41(1):106-112.DOI:10.16841/j.issn1003-8450. 2024. 01.20.
[16] 张苗.武连仲教授"极泉刺"治疗中风偏瘫学术经验探幽[J].浙江中医药大学学报,2023,47(1):25-28.DOI:10.16466/j.issn1005-5509.2023.01.005.
[17] 夏玉,袁爱红,解鸿宇.基于神经电生理与调控探讨针灸治疗中风后呃逆的选穴规律[J].云南中医药大学学报,2023,46(2):52-57.DOI:10.19288/j.cnki.issn.1000-2723.2023. 02.012.
[18] 蒋璐瑶,吕祺美,胡江飚,等."合谷刺法"联合镜像疗法对脑卒中恢复期患者手功能的影响[J].浙江临床医学,2024,26(1):42-44.
[19] 孟建标,刘昊,赖志珍,等.电针尺泽、上巨虚对急性呼吸窘迫综合征患者血清血管生成素-1、2的影响[J].浙江中西医结合杂志,2024,34(4):331-334.DOI:10.3969/j.issn.1005-4561.2024.04.009.
[20] 周亮,鲍春龄,石程,等.东贵荣教授"阴阳调衡运动针法"诊治中风上肢瘫痪机制探析[J].中国医药导报,2021,18(34):117-120,134.
[21] 陶然,尹洪娜,刘双岭,等.恢刺治疗脑卒中后痉挛期膝过伸的疗效及对神经生化标志物和炎性因子的影响[J].中西医结合心脑血管病杂志,2021,19(9):1569-1572.DOI:10.12102/j.issn.1672-1349.2021.09.032.
[22] 陈丽雄,王俊斌,李艳艳,等.实验猕猴瘫痪的诊治初探[J].上海畜牧兽医通讯,2020,(3):62-63.DOI:10.14170/j.cnki.cn31-1278/s.2020.03.025.
[23] 甘红霞.黄芪甲苷调控RhoA通路促进神经突起生长的机制研究[D].恩施:湖北民族大学,2022.DOI:10.27764/d.cnki.ghbmz.2022.000034.
[24] Taljanovic MS, Gimber LH, Becker GW, et al. Shear-wave elastography: basic physics and musculoskeletal applications[J]. Radiographics, 2017, 37(3):855-870. DOI: 10.1148/rg.2017160116.
[25] Lai SJ, Huang YC, Chen PC, et al. The sonoelastography and functional outcome of upper extremity after kinesiotaping on the spastic forearm in patients with subacute stroke[J]. Biomed Res Int, 2023, 2023:1730491. DOI: 10.1155/2023/1730491.

醒脑开窍针刺联合穴位注射治疗缺血性卒中上肢痉挛性瘫痪气虚血瘀证的效果

Curative effect of Xingnaokaiqiao acupuncture combined with acupoint injection on patients with Qi deficiency and blood stasis syndrome of spastic upper limb paralysis after ischemic stroke

可视化

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 3

编辑推荐

Metrics

[1]	王海玲黄文通杨洁徐祉君王宗耀. 芩葶清肺汤联合双侧足三里穴位注射、穴位敷贴治疗痰热淤肺证AECOPD患者的疗效评价[J]. 国际医药卫生导报, 2022, 28(22): 3212-3216.
[2]	张少朋. 西医方案与益气扶正解毒汤+足三里穴位注射治疗晚期胃癌患者的临床效果[J]. 国际医药卫生导报, 2022, 28(21): 3032-3036.
[3]	于超生于锋邓海燕李军政黄昌锦李慧. 电针法、穴位注射法治疗突发性聋的临床疗效研究[J]. 国际医药卫生导报, 2022, 28(18): 2522-2527.