摘要
目的观察运动再学习联合针刺法对脑梗死患者下肢痉挛的影响。方法选取脑梗死患者50例，按照随机数字表法将其分为阳明经针刺组和综合法针刺组，每组25例。2组均给予神经内科常规药物治疗及运动再学习康复训练，阳明经针刺组在此基础上加用阳明经针刺法治疗，综合法针刺组在此基础上加用综合针刺法治疗。治疗前、治疗4周后（治疗后），采用表面肌电图仪记录患侧膝屈曲和踝背伸最大等长收缩（MIVC）时主动肌及拮抗肌的肌电活动，采用Holden步行功能分级（FAC）、Fugl—Meyer量表（FMA）下肢部分及综合痉挛量表（CSS）评定患者的下肢运动功能。结果与组内治疗前比较，2组患者FAC、FMA及CSS评分均较治疗前有所改善，差异有统计学意义（P〈0．05）。与阳明经针刺组治疗后[（2．15±0．16）分]比较，综合法针刺组FAC评分[（3．87±0．99）分]显著较高，差异有统计学意义（P〈0．05）。与组内治疗前比较，2组患者治疗后膝屈曲肌群MIVC时的股直肌积分肌电值（iEMG）、膝屈曲协同收缩率（CO）、健侧与患侧CO比值均有不同程度的变化，差异有统计学意义（P〈0．05）。与阳明经针刺组治疗后[（35．25±4．47）mV·s]比较，综合法针刺组治疗后股直肌iEMG[（30．32±3．98）mV·s]较低，差异有统计学意义（P〈0．05）。与组内治疗前比较，2组患者腓肠肌iEMG、踝背伸CO、健侧与患侧CO比值具有不同程度的变化，差异有统计学意义（P〈0．05）。综合法针刺组治疗后胫前肌iEMG[（31．32±3．68）mV·s]与组内治疗前[（29．36±4．51）mV·S]比较，差异无统计学意义（P〉0．05）。综合法针刺组与阳明经针刺组治疗后各指标比较，差异均无统计学意义（P〉0．05）。结论运动再学习联合综合针刺法较运动再学习联合传统阳明经针刺法更能有效降低脑卒中患者下肢的痉�
Objective To observe the effects of motor relearning when combined with acupuncture on lower limb spasms after cerebral infarction. Methods Fifty patients with cerebral infarction were selected and randomly divided into a Yangming meridian acupuncture group （YG） and a spasm-prevented acupuncture group （SG） using a random number table, each of 25 cases. Both groups received conventional drug therapy and followed the same motor relearning programme. The myoelectric activity of the agonist and antagonist muscles during maximum isometric voluntary contractions （MIVCs） of the knee flexors and ankle dorsiflexors was recorded using surface electromyography. Lower limb motor function was evaluated using the Fugl-Meyer motor scale （FMS） , the Composite Spasticity scale （CSS） and functional ambulation categories （FACs） before the treatment and 4 weeks after the therapy had finished. Results Both groups showed significant improvement in their average FAC, FMA and CSS results after treatment, but the average FAC score in the SG was significantly higher than in the YG. A significant difference before and after treatment was also observed in the electromyographs of the leg rectus muscles and in the co-contraction ratio （CO） of both sides during MIVC of the knee buckling muscles in both groups. Compared with YG, the average potential observed in the leg rectus muscles of the SG group after treatment was significantly lower. In both groups the potentials of the gastrocnemius and CO on both sides during ankle dorsiflexion showed significant changes between before and after treatment. In the SG there was no significant difference in the readings from the pretibial muscles between before and after treatment. After treatment, all the indicators had improved but without significant differences between the two groups. Conclusion Rehabilitation training can be more helpful in reducing lower limb spasm, enhancing walking and improving the motor function of the lower limbs when combined with acupuncture.
出处
《中华物理医学与康复杂志》
CAS
CSCD
北大核心
2015年第4期280-284,共5页
Chinese Journal of Physical Medicine and Rehabilitation
基金
温州市2010年第四期科技计划项目（Y20100259）
关键词
脑卒中
肌张力
防痉挛针刺
表面肌电图
运动功能
Motor relearning
Acupuncture
Cerebral infarction
Muscular tension
Motor function
Activities of daily living
