电针腹部腧穴对单纯性肥胖患者血脂和血清脂联素的影响

目的:观察电针腹部腧穴对单纯性肥胖患者血脂和血清脂联素含量的影响。方法:106例病例随机分为两组,治疗组54例采用电针腹部腧穴疗法,对照组52例采用电针传统体穴疗法,测量两组患者治疗前后的身高、体重,计算体重指数(BMI);测量腰围、臀围,计算腰臀比值;检测血脂、血清脂联素含量。结果:与对照组比较,治疗组腰围、腰臀比降低,总胆固醇、甘油三酯显著下降(P0.05,P0.01),高密度脂蛋白胆固醇明显升高(P0.05)。两组治疗后血清脂联素均明显升高,但治疗组上升尤为明显。结论:电针腹部腧穴较电针传统体穴治疗单纯性肥胖患者有显著优势,适于临床推广应用。     

Risk factors for liver transplant waitlist dropout in patients with hepatocellular carcinoma

Loco‐regional therapy has been developed to reduce waitlist dropout in patients with hepatocellular carcinoma (HCC) awaiting liver transplantation. We evaluated the probability of transplantation and waitlist dropout, and analyzed risk factors for waitlist dropout, in 76 patients with HCC from September 2004 to August 2006. Seventy‐three (96.1%) patients received one or more preoperative loco‐regional treatments and 55 (72.3%) received an orthotopic liver transplantation with a median wait time of seven months (range, 2–26 months). There were 11 dropouts (14.5%) associated with tumor progression or hepatic decompensation (median waiting time; 5.4 months and range, 0.4–13 months). Cumulative probabilities of transplantation at three, six, nine, 12, 15, and 18 months were 5.4%, 35.4%, 67.5%, 78.8%, 80.7%, and 80.7%, respectively and those of waitlist dropout at three, six, nine, 12, 15, and 18 months were 3.9%, 8.7%, 12.8%, 22.9%, 29.3%, and 29.3%, respectively. A laboratory model for end‐stage liver disease (MELD) score >15 or multiple tumors at the time of UNOS listing were significant risk factors for waitlist dropout (p = 0.006 and 0.026, respectively). Patients with HCC being managed with loco‐regional therapy who have a laboratory MELD score >15 or multiple tumors should be considered for earlier access to liver transplantation to prevent waitlist dropout.     

动态超声联合电针治疗眩晕的疗效观察

目的：观察动态超声波联合电针治疗后循环缺血（PCI）单发性眩晕的临床疗效。方法：PCI单发性眩晕患者105例,随机分为3组各35例,超声波组给予超声治疗,电针组给予电针治疗,联合组采用以上两种方法治疗。治疗前后采用经颅多普勒扫描仪（TCD）探测双侧椎动脉（VA）和基底动脉（BA）的收缩期峰值流速（Vs）、舒张期血流速度（Vd）的变化并评价临床疗效。结果：治疗18d后,3组BA、LVA、RVA的 Vs和 Vd均较治疗前明显提高（P＜0．05）,且联合组更高于超声波组及电针组（P＜0．05）,超声波组与电针组间比较差异无统计学意义。联合组的治愈率及总有效率均明显高于超声波组及电针组（均 P＜0．05）,超声波组与电针组间比较差异无统计学意义。结论：超声波联合电针治疗PCI单发性眩晕的临床效果明显优于单纯的超声波和电针治疗。     

针刺结合低频电刺激治疗脑梗死后吞咽障碍的疗效观察

目的：观察针刺结合低频电刺激治疗脑梗死后吞咽障碍的疗效。方法：脑梗死后吞咽障碍患者120例,随机分为针刺组、电刺激组及综合组各40例。3组均按常规对症支持治疗。针刺组加用针刺治疗,电刺激组加用电刺激治疗,综合组联合以上两种方法治疗。采用洼田饮水实验、脑卒中患者神经功能缺损程度评分标准中的吞咽困难亚量表进行评定临床疗效。结果：治疗1及2周后,3组洼田氏饮水试验评分均较治疗前呈逐渐下降趋势（P〈0.01）,且各时间点综合组评分更低于针刺组及电刺激组（P〈0.01）,针刺组与电刺激组评分各时间点比较均差异无统计学意义;治疗1及2周后,3组吞咽困难亚量表吞咽障碍程度评分均较治疗前呈逐渐上升趋势（P〈0.01）,且各时间点综合组评分更高于针刺组及电刺激组（P〈0.01）,针刺组与电刺激组评分各时间点比较均差异无统计学意义;治疗2周后,3组临床疗效比较,综合组总有效率均明显高于针刺组及电刺激组（P〈0.01）,针刺组与电刺激组比较差异无统计学意义。结论：针刺结合低频电刺激法明显提高脑梗死后吞咽障碍患者的吞咽功能。     

Effects of Spray and Stretch on Postneedling Soreness and Sensitivity After Dry Needling of a Latent Myofascial Trigger Point

Objectives

To investigate (1) the effect of spray and stretch versus control on reducing postneedling soreness of 1 latent myofascial trigger point (MTrP) and (2) whether higher levels of psychological distress are associated with increased postneedling pain intensity.

Design

A 72-hour follow-up, single-blind randomized controlled trial.

Setting

University community.

Participants

Healthy volunteers (N=70; 40 men, 30 women) aged 18 to 36 years (mean age, 21±4y) with latent MTrP in 1 upper trapezius muscle.

Intervention

All subjects received a dry needling application over the upper trapezius muscle. Then, participants were randomly divided into 2 groups: an intervention group, which received spray and stretch over the needled trapezius muscle, and a control group, which did not receive any intervention.

Main Outcome Measures

Visual analog scale (at postneedling, posttreatment, and 6, 12, 24, 48, and 72h after needling), pressure pain threshold (at preneedling, postneedling, and 24 and 48h after needling). Psychological distress was evaluated by using the Symptom Checklist-90-Revised.

Results

Repeated-measures analysis of variance demonstrated a significant interaction between group and time (F_3,204.8=3.19; P<.05; η_p²=.04) for changes in postneedling soreness. Between-group differences were significant only immediately after intervention (P=.002), and there were no differences found between groups after 6 hours of the intervention (P>.05). Repeated measures of covariance showed that none of the psychological covariates affected these results. Somatization, anxiety, interpersonal sensitivity, and hostility were significantly correlated (P<.05) with postneedling pain intensity. Repeated-measures analysis of variance did not show a significant effect of spray and stretch on mechanical hyperalgesia (F_2.6,175=1.9; P=.131; η_p²=.02).

Conclusions

The spray and stretch had a short-term (<6h) effect in reducing postneedling soreness of a latent MTrP. Pressure pain threshold did not significantly change after spray and stretch. Psychological factors are related to postneedling pain.     

Efficacy of low-level laser therapy applied at acupuncture points in knee osteoarthritis: a randomised double-blind comparative trial

Objective

To evaluate the efficacy of low-level laser therapy (LLLT) applied to acupuncture points on the knee joint in combination with exercise and advice in patients with knee osteoarthritis.

Design

Randomised, double-blind, comparative clinical trial.

Participants

Forty-nine patients with knee osteoarthritis were assigned at random into two groups: active laser group (n = 26) and placebo laser group (n = 23).

Intervention

Using a gallium aluminium arsenide laser device, patients received either active or placebo LLLT at five acupuncture points on the affected knee during nine sessions.

Outcome measures

Patients were assessed using a visual analogue scale (VAS) and the Saudi Knee Function Scale (SKFS) at baseline, the fifth treatment session, the last treatment session, 6 weeks post intervention and 6 months post intervention.

Results

VAS scores showed a significant improvement in the active laser group compared with the placebo laser group at 6 weeks post intervention [mean difference −1.3, 95% confidence interval (CI) of the difference −2.4 to −0.3; P = 0.014] and 6 months post intervention (mean difference −1.8, 95% CI of the difference −3.0 to −0.7; P = 0.003) using the independent samples test. SKFS scores also showed a significant improvement in the active laser group compared with the placebo laser group at the last treatment session (median difference −15, 95% CI of the difference −27 to −2; P = 0.035) and 6 months post intervention (median difference −21, 95% CI of the difference −34 to −7; P = 0.006) using the Mann–Whitney U test.

Conclusions

The results demonstrate that short-term application of LLLT to specific acupuncture points in association with exercise and advice is effective in reducing pain and improving quality of life in patients with knee osteoarthritis.     

针刺穴位联合康复训练治疗急性脑梗死 上肢运动功能障碍并功能磁共振研究

目的:观察针刺穴位联合康复训练治疗急性脑梗死上肢运动功能障碍的疗效,并借助功能磁共振探讨对神经功能重塑的影响。方法:选取急性脑梗死上肢运动功能障碍患者60例,随机分为对照组及治疗组,各30例。对照组行常规药物治疗和运动康复训练,治疗组在对照组的基础上给予针刺穴位治疗;均治疗3个月。于治疗前、后,对2组患者行美国国立卫生院脑卒中量表(NIHSS)评分、Fugl-Meyer上肢运动量表(FMA-UE)评分、患肢的食指轻叩试验检查、握力测量及运动任务态的功能磁共振扫描。结果:治疗后,2组的NIHSS评分、FMA-UE评分、患肢食指轻叩试验及握力测量均较治疗前改善(均P<0.01),且治疗组改善程度较对照组明显(均P<0.01)。治疗前,2组患者左手握拳运动可稳定激活对侧初级运动区(M1)及辅助运动区(SMA);治疗后,2组患者左手握拳运动时,对侧M1区及双侧SAM区较治疗前激活增强(P<0.01),且治疗组较对照组激活增强明显(P<0.01)。结论:针刺穴位联合康复训练治疗急性脑梗死上肢运动功能障碍疗效肯定,促进对侧M1及双侧SAM脑区的激活、调节神经功能重塑可能是其机制之一。     

肌肉牵伸模式下的电针拮抗法治疗脑卒中足下垂的临床观察

目的：观察痉挛肌牵伸模式下的电针拮抗法治疗脑卒中足下垂患者的临床疗效。方法：选取病程≤3个月的首次脑卒中偏瘫患者40例,随机分成对照组和观察组各20例。2组均给予常规康复治疗,在此基础上,对照组给予常规电针拮抗法,观察组则给予痉挛肌牵伸模式下的“电针拮抗法”,疗程为3周。利用下肢简式Fugl-Meyer运动评分量表（FMA）、改良Ashworth痉挛评定量表（MAS）及表面肌电（iEMG）技术分别评估患者的患侧下肢运动功能、小腿三头肌痉挛程度及踝背屈时胫骨前肌与小腿三头肌的协同收缩率(CR)。结果：治疗后2组FMA评分较治疗前均有明显提高（P<0.01）,MAS分级优于治疗前（P<0.01）;与对照组比较,观察组的FMA评分提高则更为显著（P<0.05）,观察组MAS分级更优于对照组（P<0.05）。治疗后,2组患者胫骨前肌和小腿三头肌iEMG 均高于治疗前（均P<0.05）、踝背屈CR低于治疗前（均P<0.05）,治疗后观察组患者胫骨前肌和小腿三头肌iEMG 均高于对照组（均P<0.05）、踝背屈CR 低于对照组（均P<0.05）。结论：痉挛肌牵伸模式下的电针拮抗法治疗能有效地降低小腿三头肌张力,改善脑卒中偏瘫患者踝背屈功能,促进下肢运动的改善。     

反复促通技术联合针灸对脑梗死患者功能恢复及生存质量的影响分析

目的：观察反复促通技术（RFE）联合针灸治疗对脑梗死患者功能恢复及生存质量的影响。方法：选取符合标准的60例脑梗死患者,随机分为针灸组、RFE组、联合组3组各20例。3组均进行常规康复治疗,针灸组增加针灸治疗,RFE组增加反复促通技术治疗,联合组增加针灸联合反复促通技术治疗,每周5次,共治疗4周。于治疗前后比较3组患者的Barthel日常生活指数（BI）、Fugl-Meyer运动功能评分（FMA）以及脑卒中专用生存质量评分（SS-QOL）。结果：治疗4周后,3组患者的BI、FMA、SS-QOL评分均较治疗前显著提高（均P＜0.01）,且联合组BI、FMA及SS-QOL评分均高于其余两组（均P＜0.05）,针灸组和RFE组比较差异无统计学意义。结论：对于脑梗死患者,在常规康复训练基础上运用反复促通技术联合针灸可以显著改善其运动功能及日常生活活动能力,提高患者的生存质量。     

冲击波疗法结合针刺对脑卒中后上肢痉挛状态的疗效分析

目的:观察体外冲击波疗法(ESWT)联合针刺对脑卒中后上肢肌肉痉挛状态的疗效和安全性。方法:伴上肢肌肉痉挛的脑卒中患者70例,随机分为对照组和ESWT组各35例。2组均予常规康复训练方法及针刺治疗,ESWT组增加上肢肱二头肌EWST治疗,每周1次,治疗4周。采用改良Ashworth量表(MAS)、上肢简化的Fugl-Meyer评分(U-FMA)、改良Barthel指数(MBI)及基于卒中病患者报告的临床结局评价量表(PRO)分别于治疗前、治疗4周后对2组患者进行评估,并且应用PRO量表在治疗结束3月时评价远期临床结局疗效。结果:治疗4周后,2组患者MAS、U-FMA、MBI评分及PRO较组内治疗前均有显著改善(P0.05),ESWT组MAS、U-FMA、MBI评分及PRO评分较对照组明显改善(P0.05)。治疗结束3月时随访,2组的PRO积分较治疗前均有提高(P0.05),ESWT组的PRO积分明显高于对照组(P0.05)。结论:ESWT结合针刺治疗可改善脑卒中后上肢痉挛,有效地提高患者的运动功能和日常生活能力,且有一定远期临床疗效。