项腹针治疗脑卒中后偏瘫痉挛状态的随机对照研究

Randomized controlled study on effects of acupoints in nape-abdomen on spasticity after stroke

关键词:  脑卒中后偏瘫痉挛状态  针灸疗法  项腹针法

Key words:  spasticity after stroke  acupuncture  acupoint in nape-abdomen

摘要:

[目的] 评价项腹针治疗脑卒中后偏瘫痉挛状态的临床疗效。[方法] 采用多中心、随机对照的方法，将300例脑卒中后偏瘫痉挛状态患者按照随机数字表法分为观察组和对照组，对照组参照《新世纪全国高等中医药院校规划教材·针灸学·中风》取肩髃、臂臑、曲池、手三里、外关、合谷、环跳、伏兔、阳陵泉、足三里、承山、绝骨、太冲，观察组在对照组取穴基础上加用项腹针，取风府、大椎、风池、天柱、百劳、滑肉门、天枢、外陵、中脘、关元，两组均每日治疗2次，共治疗6周。以改良的Ashworth量表、痉挛指数、Fugl-Meyer评定法、临床神经功能缺损评定、肌电图等进行临床疗效评定。[结果] 项腹针不仅能改善患肢Ashworth分级评分和Fugel-Meyer评分，降低痉挛指数和神经功能缺损程度，而且对病理性神经活动有良好的调整作用，与对照组比较差异有统计学意义（P<0.05～0.01）.[结论] 项腹针法是治疗脑卒中后偏瘫痉挛状态的有效方法，可有效地缓解肌张力增高、腱反射活跃或亢进，从而改善患者肢体活动功能，并能抑制脊髓前角细胞的兴奋性，对病理性神经活动有良好的调整作用。

Abstract:

[Objective] To explore the clinical therapeutic effect of acupoints in nape-abdomen on spasticity after stroke. [Methods] Using multi-central, randomized, controlled and blind methods, we divided 300 patients with spasticity after stroke into observation group and controlled group. In control group, acupoints on Jianyu, Binao, Quchi, Shousanli, Waiguan, Hegu, Huantiao, Futu, Yanglingquan, Zusanli, Chengshan, Juegu and Taichong were acupunctured by referencing Chinese medicine planning material of new contrary national advanced institution acupuncture stroke and in the observation group the patients were treated by acupuncturing the next acupoints in nape-abdomen, including Fengfu, Dazhui, Fengchi, Tianzhu, Bailao, Huaroumen, Tianshu, Wailing, Zhongwan, Guanyuan in addition to the acupoints used in the control group. The treatment was given twice a day for 6 weeks totally. The clinical therapeutic effects were assessed according to modified Ashworth scale, clinic spasm index, Fugl-Meyer assessment, clinic evaluation of nervous functional deficiency, electromyogram. [Results] The acupuncturing on acupoints in nape-abdomen could not only improve the scores of ill limb, decline the clinic spasm index and deficiency degree of the nerve function but also possesses some good regulating effect on the pathological nerve activity. The observation group had significant or very significant difference(P<0.05～0.01)compared with controlled group. [Conclusion] Acupuncture on acupoints at nape-abdomen is an effective therapeutic method in treating hemiplegia and spasticity after stroke, which can effectively relive the muscular hypertonia, hyperactivity and accentuation of the muscular reflex in order to improve the functional activity of ill limb. It can also inhibit the excitability of anterior born cells of myelon, having excellent regulating effect on the pathologic nerve movement.