文献类型：期刊文献

中文题名：中风后偏瘫中西医结合优化康复方案的临床研究

英文题名：Clinical research on post-stroke hemiplegia treated with the optimized rehabilitation program of integrated Chinese and western medicine

作者：张小丽[1];齐瑞[1];严隽陶[1]

第一作者：张小丽

机构：[1]甘肃中医学院针灸推拿学院,兰州743000

第一机构：甘肃中医药大学针灸推拿学院

年份：2013

卷号：33

期号：12

起止页码：1113

中文期刊名：中国针灸

外文期刊名：Chinese Acupuncture & Moxibustion

收录：MEDLINE(收录号：24617243);CSTPCD;;Scopus;北大核心:【北大核心2011】；CSCD:【CSCD2013_2014】；PubMed;

基金：上海市科学委员会科研计划项目:10DZ 1950900

语种：中文

中文关键词：脑梗死;康复;推拿;针刺疗法

外文关键词：cerebral infarction; rehabilitation; massage; acupuncture therapy

摘要：目的:探寻中风恢复期偏瘫的康复优化方案。方法:采用随机对照原则,将60例患者分为康复推拿组、康复针刺组,每组30例。两组均采用Bobath运动疗法及功能训练,康复推拿组配合推拿疗法,于患侧施法、掌擦法,按揉弹拨肩髎、肩贞、曲池、环跳、委中、承山、足三里等穴,点掐十二井穴;康复针刺组配合针刺疗法,穴取百会、肩髎、曲池、手三里、环跳、阳陵泉、解溪等穴。两组均每天治疗1次,每周治疗5天,3周后评定疗效。采用Fugl-Meyer评定量表、Barthel指数(BI)评分、改良Rankin量表、生活质量量表(SS-QOL)对两组患者治疗前后的肢体运动功能、日常生活活动(ADL)能力、独立生活水平、生活质量进行评定。并根据两组患者治疗后的总费用和效益,进行卫生经济学评价。结果:两组均可改善患者的肢体运动功能[康复推拿组26.00(22)vs37.00(33);康复针刺组30.50(21)vs 39.50(36)]、独立生活水平、日常生活活动能力(康复推拿组43.50±22.25vs 57.50±22.25;康复针刺组52.83±16.59vs 66.67±12.82)、生活质量(康复推拿组122.23±30.00vs 145.50±28.14;康复针刺组132.43±23.87vs 151.47±22.37),两组各项评分治疗前后差异均有统计学意义(均P<0.05),且两组疗效相当,治疗后各项评分组间差异均无统计学意义(均P>0.05)。卫生经济学方面,康复推拿组BI指数每提高5分较康复针刺组少花费688.48元。结论:康复推拿与康复针刺治疗中风后恢复期偏瘫疗效相当。康复推拿方案在改善患者日常生活活动能力方面更加经济,具有简、便、廉优势。
Objective To explore the optimized rehabilitation program in the treatment of post-stroke hemiplegia at the recovery stage. Methods Based on the randomized controlled principle, 60 patients were randomized into an rehabilita- tion ＋ massage group （group A） and an rehabilitation ＋ acupuncture group （group B）, 30 cases in each one. Bobath sport therapy and functional training were adopted in the two groups. In the group A, the massage therapy was added. The rolling method and palm-rubbing method were used on the affected side, the pressing, kneading and plucking methods were applied to Jianliao （LI 15）, Jianzhen （SI 9）, Quchi （LI 11）, Huantiao （GB 30）, Weizhong （BL 40）, Chengshan （BL 57）, Zusanli （ST 36） and the other acu points; and the nipping method was adopted at the twelve Jing-well points. In the group B, acupuncture was applied to Baihui （BL 20）, Jianliao （LI 15）, Quchi （LI 11）, Shousanli （LI 10）, Huan- tiao （GB 30）, Yanglingquan （GB 34）, Jiexi （ST 41） and the other acupoints. The treatment was given once a day, 5 treatments a week in the two groups. The efficacy was evaluated in 3 weeks. Fugl-Meyer scale, Barthel index （BI） score, modified Rankin scale and stroke-specific quality of life （SS-QOL） were used to assess the limb motor function, the activity of daily life （ADL）, independent activity of life and the quality of life of the patients in the two groups before and after treatment. Based on the total cost and benefit, the health economics evaluation was conducted in the patients of the two groups. Results The treatments all improved the limb motor function （group A： 26.00（22） vs 37.00（33） ; group B： 30.50（21） vs 39.50（36））, the independent activity of life, ADL （group A： 43.50±22.25 vs 57.50±22.25; group B.. 52.83±16.59 vs 66.67±12.82） and the quality of life （group A： 122.23±30. 00 vs 145.50±28. 14; group B： 132.43±23.87 vs 151.47±22.37） in the patients of the two groups. The differences in all the indices were significant statistically before and after treatment in the two groups （all P〈0.05）. Above indices after treatment were not different obviously between the two groups （all P〉0.05）. In terms of health economics, the expense was decreased by RMB 688.48 while BI was increased by every 5 score in group A in comparison with the group B. Conclusion Both the rehabilitationand massage therapy and the rehabilitation and acupuncture therapy improve the limb motor function and the quali ty of life in the patients of post-stroke hemiplegia. The therapeutic efficacies are similar between the two therapeu tic programs. The program of rehabilitation and massage is more economical in the aspects of ADL improvement, being advantageous at simple operation and low cost.