经筋刺法治疗脑卒中后痉挛状态的疗效评估:随机分组的对照

背景脑卒中后痉挛状态与弛缓状态有质的区别,其针灸治疗方法亦应不同.目的探讨脑卒中后肢体痉挛状态的有效治疗方法.设计以患者为研究对象的随机对照观察.单位一所中医学院的针灸推拿系.对象全部病例均来源于2002-01/2003-12湖南中医学院第一附属医院针灸科病房收治的57例住院患者.方法按照患者住院的先后顺序编号,再查随机数字表分为两组.在关刺、恢刺、燔针劫刺的基础上形成经筋刺法,治疗脑卒中痉挛状态患者24例,设立独取阳明为对照组24例,并运用现代康复医学有关痉挛状态的评定方法SIASA、Ashworth和等力测时法等进行了疗效对比观察.主要观察指标①SIAS积分.②痉挛状态Ashworth分级.③等力测时法量化评定痉挛状态比较.结果根据康复评定的结果,其中经筋组SIAS积分治疗前后分别为(6.98±3.52),12.59±3.36)分,阳明组分别为(7.12±3.38),(8.75±3.42)分,差异有显著性意义(P＜0.01).两组痉挛状态Ashworth分析及等力测时法量化评定痉挛状态比较差异也有显著性意义(P＜0.05或P＜0.01).结论痉挛状态应归属于"十二经筋"病候,而不属于"十二正经"病候,宜从经筋论治.经筋刺法是针灸治疗脑卒中后痉挛状态一种疗效确切的针刺方法.

Evaluation of therapeutic effect of muscle region needling for post-stroke spasticity a randomized controlled trial

BACKGROUND: For spasticity and flaccidity after stroke are different between each other qualitatively,the treatments of them with acupuncture are various.OBJECTIVE: To probe into the effective therapeutic methods for limb spasticity after stroke.DESIGN: A randomized controlled observation based on patients.SETTING: Department of acupuncture and massage in a college of traditional Chinese medicine.PARTICIPANTS: All of the cases were originated from 57 in-patients collected from the ward of Department of Acupuncture and Moxibustion of First Affiliated Hospital of Hunan College of Traditional Chinese Medicine from January 2002 to December 2003.METHODS: According to the admission sequence of patients,two groups were divided by the random number table. Muscle-region acupuncture was formed on the basis of joint needling( guan ci),relaxing needling( hui ci)and fire needling(fanzhen jie ci) and was used to treat 24 cases of spasticity of stroke. In addition,the control of 24 cases was designed treated by the points only on yangming meridian. The comparative observation on therapeutic effects was carried on with Ashworth and SIAS,the relevant evaluation methods on spasticity in modern rehabilitation medicine,and with isodynamic time-measuring method as well.MAIN OUTCOME MEASURES: ① SIAS integrals; ② Ashworth grades of spasticity; ③ Isodynamic time-measuring method.RESULTS: SIAS integrals before and after treatment were 6.98 ± 3.52,12.59 ± 3.36 in muscle region group,and 7. 12 ± 3.38,8.75 ± 3.42 in yangming group,indicating significant difference( P ＜ 0. 01). The differences were also significant in Ashworth analysis and quantitative evaluation with isodynamic time-measuring method on spasticity in two groups ( P＜0.05 or P ＜ 0.01).CONCLUSION: Muscle region needling is a kind of method with definite therapeutic effect on spasticity after stroke in acupuncture and moxibustion.