补土针灸法联合热敏灸治疗脑卒中后肢体痉挛性瘫痪临床研究

目的：观察补土针灸法联合热敏灸治疗脑卒中后肢体痉挛性瘫痪的临床疗效。方法：选择124例脑卒中后肢体痉挛性瘫痪患者，以随机数字表法分为常规治疗组及针灸联合治疗组各62例。常规治疗组给予西药联合康复训练治疗，针灸联合治疗组在常规治疗组基础上给予补土针灸法联合热敏灸治疗。2组均治疗3个月。比较2组临床疗效、临床痉挛指数（CSI）评分、改良Ashworth量表（MAS）评分、Fugl-Meyer运动功能量表（FMA）评分、脑卒中患者姿势评定量表（PASS）评分、肌电图指标[患侧胫骨前肌和腓肠肌屈伸最大等长收缩时表面肌电图积分肌电值（iEMG）、患肢M波最大波幅（Mmax）和H波最大波幅（Hmax）]、三维步态参数（步频、步速、支撑相、摆动相）及Kelch样环氧氯丙烷相关蛋白-1 (Keap1)/核因子E2相关因子2 (Nrf2)/抗氧化反应元件（ARE）信号通路。结果：治疗后，针灸联合治疗组总有效率96.77%，高于常规治疗组82.26%(P<0.05)。2组CSI、MAS评分均较治疗前降低（P<0.05），针灸联合治疗组CSI、MAS评分均低于常规治疗组（P<0.05）。2...

Clinical Study on Earth-Nourishing Acupuncture and Moxibustion Method Combinedwith Heat-Sensitive Moxibustion for Spastic Paralysis of Limbs After Stroke

Abstract：Objective：To observe the clinical effect of Earth-Nourishing Acupuncture and MoxibustionMethod combined with heat- sensitive moxibustion on spastic paralysis of limbs after stroke. Methods：Atotal of 124 cases of patients with spastic paralysis of limbs after stroke were divided into the routinetreatment group and the acupuncture and moxibustion group according to the random number table method， with 62 cases in each group. The routine treatment group was treated with western medicinecombined with rehabilitation training， the acupuncture and moxibustion group was treated with EarthnourishingAcupuncture and Moxibustion Method combined with heat-sensitive moxibustion based on thetreatment of the routine treatment group. Both groups were treated for 3 months. The clinical effects，thescores of Clinical Spasticity Index (CSI)， Modified Ashworth Scale (MAS)， Fugl- Meyer Assessment(FMA)， Postural Assessment Scale for Stroke (PASS)， electromyographic indicators [surfaceelectromyographic integral electromyographic values (iEMG) of the affected tibialis anterior muscle andgastrocnemius muscle during maximum isometric contraction， as well as the maximum amplitude of Mwave (Mmax) and maximum amplitude of H wave (Hmax) of the affected limb]， three- dimensional gaitparameters (stride frequency， stride speed， support phase， swing phase)， Kelch- like epichlorohydrinrelatedprotein-1 (Keap1)/nuclear factor E2-related factor 2 (Nrf2)/and antioxidant response element (ARE)signaling pathway were compared between the two groups. Results：After treatment，the total effectiverate was 96.77% in the acupuncture and moxibustion group， higher than that of 82.26% in the routinetreatment group (P＜0.05). The scores of CSI and MAS in the two groups were decreased when comparedwith those before treatment (P＜0.05)，and the scores of CSI and MAS in the acupuncture and moxibustiongroup were lower than those in the routine treatment group (P＜0.05). The iEMG of tibialis anterior muscleand gastrocnemius muscle in the two groups were increased when compared with those before treatment(P＜0.05)， and the iEMG of tibialis anterior muscle and gastrocnemius muscle in the acupuncture andmoxibustion group were higher than those in the routine treatment group (P＜0.05). The values of Mmaxand Hmax in the two groups were decreased when compared with those before treatment (P＜0.05)，andthe values of Mmax and Hmax in the acupuncture and moxibustion group were lower than those in theroutine treatment group (P＜0.05). The stride frequency，stride speed and support phase in the two groupswere increased when compared with those before treatment (P＜0.05)，and stride frequency，stride speedand support phase in the acupuncture and moxibustion group were higher than those in the routinetreatment group (P＜0.05). The swing phase in the two groups were decreased when compared with thosebefore treatment (P＜0.05)， and the swing phase in the acupuncture and moxibustion group was lowerthan that in the routine treatment group (P＜0.05). The scores of FMA and PASS in the two groups wereincreased when compared with those before treatment (P＜0.05)，and the scores of FMA and PASS in theacupuncture and moxibustion group were higher than those in the routine treatment group (P＜0.05). Thelevels of Nrf2 and ARE in the two groups were increased when compared with those before treatment (P＜0.05)，and the levels of Nrf2 and ARE in the acupuncture and moxibustion group were higher than those inthe routine treatment group (P＜0.05). The Keap1 levels in the two groups were decreased when comparedwith those before treatment (P＜0.05)，and the Keap1 level in the acupuncture and moxibustion group waslower than that in the routine treatment group (P＜0.05). Conclusion：Earth- Nourishing Acupuncture andMoxibustion Method combined with heat- sensitive moxibustion for spastic paralysis of limbs after strokecan regulate the Keap1/Nrf2/ARE signaling pathway， inhibit the excitability of spinal cord motor neurons，improve muscle tension， spasticity and three- dimensional gait parameters， and further improve clinicaleffects.