世界中医药

作者	单位
余兆安1，刘民权1，潘江1，叶晓红2，常小荣1，章，薇1	1 湖南中医药大学第一附属医院针灸推拿科，长沙，410007； 2 长沙市中医医院针灸科，长沙，410007

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中文摘要:

目的：评价张力平衡针法对脑卒中痉挛状态患者肢体运动功能及表面肌电的影响。方法：选取2016年1月至2018年12月湖南中医药大学第一附属医院收治的脑卒中痉挛状态患者60例作为研究对象，按照随机数字表法随机分为观察组和对照组，每组30例，观察组采用张力平衡针刺疗法，对照组采用常规针刺疗法，2组针刺治疗10次为1个疗程，并观察2个疗程。比较2组治疗前后的改良Ashworth痉挛量表（MAS）、Fugl-Meyer运动功能（F-M）评分、NDS整体评分、总体临床疗效及表面肌电测试RMS值。结果：1）观察组总有效率为86.67%，对照组总有效率为73.33%，2组疗效比较，差异无统计学意义（P>0.05）。2）治疗后，2组MAS的评分均有明显降低，差异有统计学意义（P<0.05）；治疗后组间比较，观察组MAS的评分较对照组有明显降低，差异有统计学意义（P<0.05）。3）2组均能有效改善脑卒中痉挛状态患者的简化F-M评分；与治疗前比较，2组治疗后简化F-M评分均有不同程度的升高，差异有统计学意义（P<0.01）；观察组治疗后改善F-M评分优于对照组，观察组的简化F-M评分在治疗后高于对照组，差异有统计学意义（P<0.01）。4）观察组治疗后NDS整体评分低于对照组，差异有统计学意义（P<0.05）；与治疗前较，2组治疗后NDS整体评分均有不同程度的降低，差异有统计学意义（P<0.05），2种治疗方法均能改善NDS整体评分，且观察组于整体临床神经功能缺损程度方面优于对照组。5）与治疗前比较，2组治疗后肱二头肌、股四头肌RMS值均有不同程度的降低，差异有统计学意义（P<0.05），且观察组治疗后肱二头肌、股四头肌RMS值低于对照组，差异有统计学意义（P<0.05），2种治疗方法均能改善肱二头肌、股四头肌RMS值，且观察组优于对照组。结论：1）张力平衡针法和常规针刺法治疗脑卒中痉挛状态疗效良好。2）张力平衡针法和常规针刺法均能降低神经功能缺损的影响以及改善脑卒中痉挛状态患者的肢体运动功能，且观察组疗效优于对照组。

English Summary:

To evaluate the effects of tension balance needling on limb motor function and surface electromyography in patients with spastic state of stroke. Methods:A total of 60 patients with spastic state of stroke were included from the First Affiliated Hospital of Hunan University of Traditional Chinese Medicine from January 2016 to December 2018，and randomly divided into observation group(30 cases)and control group(30 cases). In the 2 groups，a course of treatment consisted of 10 times of acupuncture treatment，and 2 courses of treatment were observed. Before and after treatment，the Modified Ashworth Spasm Scale(MAS)，Fugl-Meyer Motor Function(F-M)score，NDS overall score，overall clinical efficacy and RMS value of surface electromyography were compared between the 2 groups. Results:1)The total effective rate of the observation group was 86.67%，and that of the control group was 73.33%. The curative effects of the 2 groups were compared(P>0.05). 2)After treatment，the scores of MAS in both groups were significantly decreased(P<0.05); after treatment，the score of MAS in the observation group was significantly lower than that in the control group(P<0.05). 3)The simplified F-M score of patients with spastic state of stroke in both groups can be effectively improved. Compared with the simplified F-M score before treatment，the score of the 2 groups increased in different degrees after treatment(P<0.01). The improved F-M score of the observation group was better than that of the control group after treatment，and the simplified F-M score of the observation group was higher than that of the control group after treatment(P<0.05). 4)After treatment，the overall score of NDS in the observation group was lower than that in the contrl group(P<0.05); compared with before treatment，the overall score of NDS in the 2 groups decreased in varying degrees after treatment(P<0.05). Both treatments could improve the overall score of NDS，and the observation was superior to the control group in terms of the degree of overall clinical neurological deficits. 5)Compared with before treatment，the RMS values of biceps brachii and quadriceps femoris in the 2 groups decreased in different degrees after treatment(P<0.05)，and the RMS values of biceps brachii and quadriceps femoris in the observation were lower than those in the control group(P<0.05). Both treatments could improve the RMS values of biceps brachii and quadriceps femoris，and the observation group was better than the control group. Conclusion:1)Tension balance needling and routine needling are effective in treating spastic state of stroke. 2)Both tension balance needling and routine needling can reduce the influence of neurological deficit and improve limb motor function in patients with spastic stroke，and the long-term effect of the observation group is better than that of control group.

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