针刺与推拿分别联合康复训练对老年脑卒中后痉挛性偏瘫患者的疗效分析

  目的  探究针刺、推拿分别联合康复训练对老年脑卒中后痉挛性偏瘫患者疗效及Ashworth、日常生活活动能力(ADL)、神经功能缺损量表(NDS)评分的影响。  方法  回顾性分析2018年10月—2020年8月温州医科大学附属第一医院收治100例脑卒中后痉挛性偏瘫患者，根据治疗方式不同分为针刺组(40例)、推拿组(30例)和康复组(30例)。其中康复组仅给予康复训练治疗，针刺组给予康复训练联合针刺治疗，推拿组给予康复训练联合推拿治疗。比较3组患者临床疗效及治疗前后上、下肢Ashworth、ADL和NDS评分变化情况。  结果  针刺组总有效率(92.50%，37/40)高于康复组(63.33%, 19/30，χ2=10.513，P＜0.05)；但康复组与推拿组(86.67%, 26/30)、推拿组与针刺组比较差异无统计学意义(均P＞0.05)。治疗前，3组患者上、下肢Ashworth评分、ADL评分及NDS评分比较差异均无统计学意义(F=0.062、0.118、0.025、0.002，均P＞0.05)；相较于治疗前，3组治疗后上、下肢Ashworth及NDS评分均显著降低，ADL评分显著升高，且康复组、推拿组、针刺组依次更优(F=16.303、21.294、18.291、36.720，均P＜0.05)。  结论  针刺和推拿分别联合康复训练治疗老年脑卒中后痉挛性偏瘫效果较好，且针刺联合康复训练疗效更佳，可有效缓解肢体痉挛，提高日常生活能力。 

Effect of acupuncture and massage combined with rehabilitation training on elderly patients with spastic hemiplegia after stroke

  Objective  To probe into the effect of acupuncture and massage combined with rehabilitation training on elderly patients with spastic hemiplegia after stroke and the influence of Ashworth, activities of daily living (ADL), and neurological deficit scale (NDS) scores.  Methods  From October 2018 to August 2020, 100 patients with spastic hemiplegia after stroke admitted to the First Hospital Affiliated to Wenzhou Medical University were analysed retrospectively. According to the different treatment methods, they were divided into 40 cases in the acupuncture group, 30 cases in the massage group, and 30 cases in the rehabilitation group. The rehabilitation group was given only rehabilitation training, the acupuncture group was given rehabilitation training combined with acupuncture, and the massage group was given rehabilitation training combined with massage. The clinical effect and the changes in Ashworth score of upper and lower limbs, as well as the ADL and NDS scores before and after treatment, were compared.  Results  The total effective rate in the acupuncture group was 92.50% (37/40), which was higher than 63.33% (19/30) in the rehabilitation group (χ2=10.513, P < 0.05), but no significant difference existed between the rehabilitation group and the massage group (86.67%, 26/30), and between the massage and acupuncture groups (all P>0.05). Before treatment, no significant difference existed in Ashworth scores of upper and lower limbs and ADL and NDS scores amongst the three groups (F=0.062, 0.118, 0.025, 0.002, all P>0.05). Compared with before treatment, the Ashworth score and NDS score of upper and lower limbs in the three groups significantly decreased, ADL score significantly increased (all P < 0.05), and the rehabilitation, massage, and acupuncture groups were better in turn (F=16.303, 21.294, 18.291, 36.720, all P < 0.05).  Conclusion  Acupuncture and massage combined with rehabilitation training exert a better effect on spastic hemiplegia after stroke in the elderly. Acupuncture combined with rehabilitation training have the best effect, effectively relieving limb spasm and improving the ability of daily life.