不同强度针刺对脑卒中后痉挛肌影响的研究

目的：研究不同刺激量针刺对偏瘫屈肘痉挛肌表面肌电信号的影响。方法：脑卒中偏瘫患者56例,随机分为低频捻转针刺组和高频捻转针刺组,每组28例。两组均所取穴位相同,患侧上肢臂臑、臑会针刺时斜刺进针1.5～2 cm,以针至肱三头肌肌腹为度,得气后进行捻转手法操作。低频捻转手法针刺捻转频率每分钟50～60转、捻转幅度360°～720°;高频捻转手法针刺捻转频率每分钟180～240转、捻转幅度90°～180°,两组均操作2 min,留针20 min,其余穴位常规针刺得气后留针20 min,不进行手法操作。针刺前、针刺2周（5次/周）后分别测定痉挛肌肱二头肌肌腹处的表面肌电均方根值（RMS）及患者Barthel指数评分。结果：治疗前两组在RMS值及Barthel指数评分方面经两样本均数t检验均无显著差异（P〉0.05）,采用配对资料t检验,针刺治疗2周后两组RMS值与Barthel指数评分与治疗前比较均改善明显（P〈0.05）,治疗后高频捻转针刺组RMS值与低频捻转针刺组比较下降更为明显（P〈0.05）。结论：高频率、小幅度捻转针刺能更好地降低痉挛肌肌张力。

Study of the Effect about Different Intensity of Acupuncture on Antagonistic Muscles After Stroke

Objective： To study the effect of acupuncture with different amount stimulation on antagonistic muscles of hemiplegic limb.Methods： 56 cases of cerebral infarction patients were randomly divided into the low frequency twisting acupuncture group of 28 cases and the high frequency twisting acupuncture of 28 cases. The two groups were taken from the same point,upper limbs Bi＇ nao,Naohui oblique acupuncture needle at 1. 5- 2 cm,with the needle to the triceps muscle belly for the degree,and twisting after needling manipulation arrival of qi. 50- 60 turn per minute of low frequency twisting acupuncture group. Twisting amplitude 360°- 720°. At the same time,the frequency of high frequency twisting acupuncture is 180- 240 turn per minute. Twisting amplitude 90°- 180°. Both groups were operated for two minutes. And 20 minutes later,the needles were taken. The RMS values of Biceps surface electromyography and Barthel index of ADL（ Activities of Daily Living Assessment） were measured respectively before the acupuncture and 2 weeks later（ 5times per week）. Results： Before treatment,there were no difference of RMS values and Barthel index between the two groups（ P〈0. 05）. After treatment,RMS values of the two groups were decreased obviously compared with the previous（ P〈0. 05）,Barthel index of the two groups were increased obviously compared with the previous（ P〈0. 05）. Two weeks later,RMS values of high frequency groups were decreased obviously compared with the low frequency groups（ P〈0. 05）. Conclusion： The acupuncture manipulation of high frequency and small increment can reduce the tension of spastic muscle better.