针刺治疗脑卒中后上肢痉挛疗效观察

目的：观察根据康复医学理论选穴的针刺方法治疗脑卒中后上肢痉挛的疗效。方法：将60例患者随机分为针刺组和电刺激组,各30例。针刺组针刺患肢对侧头部运动区,患肢屈肌侧极泉、尺泽、大陵及伸肌侧肩髃、天井、阳池等穴;电刺激组采用痉挛肌电刺激。2组患者均同时给予必要的药物治疗和抗痉挛康复运动训练,疗程为3周。采用改良的Ashworth痉挛量表（MAS）、简化的Fugl-Meyer运动功能评定量表（FMA）、改良Barthel指数（MBI）进行疗效的评定。结果：2组患者治疗后痉挛程度、上肢运动功能及日常生活活动能力明显改善（P〈0.01）,其中针刺组MBI改善优于电刺激组（P〈0.001）。针刺组总有效率为93.3%,电刺激组为86.7%,2组之间差异无显著性意义。结论：适宜的针刺是治疗脑卒中后肢体痉挛的有效方法,对上肢轻、中度痉挛疗效较显著。

Observation on clinical therapeutic effect of acupuncture on upper limb spasticity in the patient of poststroke

OBJECTIVE: To observe therapeutic effect of acupuncture at acupoints selected according to rehabilitation medical theory on upper limb spasticity in the patient of poststroke. METHODS: Sixty cases were randomly divided into an acupuncture group and an electro-stimulation group, 30 cases in each group. The acupuncture group were treated by acupuncture at the contralateral scalp motor region of the affected limb, Jiquan (HT 1), Chize (LU 5), Daling (PC 7) on the flexor side and Jianyu (LI 15), Tianjing (TE 10), Yangchi (TE 4) on the extensor muscle side of the affected limb; the electro-stimulation group were treated by electric stimulation. The two groups also were treated with necessary medical treatment and anti-spasm rehabilitation motor training. The course was 3 weeks. Modified Ashworth Scale for muscle spasm (MAS), modified Fugl-Meyer Assessment (FMA) for upper limb motor function, and Modified Barthel Index (MBI) for ability of daily living were used for assessment of the therapeutic effect. RESULTS: After treatment, the spasm was significantly alleviated, the motor function of the upper limb and daily living ability were significantly increased (P<0.01) in the two groups; after treatment, BMI scores in the acupuncture group was very significantly superior to that in the electro-stimulation group. The total effective rate was 93.3% in the acupuncture group and 86.7% in the electro-stimulation group, with no significant difference between the two groups. CONCLUSION: Proper acupuncture is an effective method for upper limb spasm in the patient of poststroke, and the therapeutic effect is better for mild-moderate spasm of the upper limb.