摘要
目的:应用美国国立卫生研究院卒中量表、功能独立性评定量表、Barthel指数评估针刺治疗、推拿、功能训练前后脑梗死患者神经功能、日常生活活动能力变化。方法:①选择2003-09/2004-06重庆医科大学附属第二医院神经内科脑梗死住院患者37例,男16例,女21例。均对治疗方案知情同意。②所有病例均采用西医对症治疗,同时进行针刺、推拿治疗和功能训练。③针刺方法:头针:前顶透刺百会,患肢对侧的风池穴,患肢对侧的顶颞前斜线。体针:参照Brunnstrom六阶段分期对患侧取穴。软瘫期(Ⅰ～Ⅱ期):上肢以肢体外侧穴位为主,臂腨、手三里、外关、神门。下肢以内外侧穴位兼顾,风市、血海、足三里、阴陵泉、三阴交、涌泉。得气后行平补平泻手法,间歇提插捻转,强刺激。痉挛期(Ⅲ～Ⅳ期):上肢完全以外侧穴位为主,即去掉神门。下肢完全以内侧和后侧穴位为主,即去掉风市、足三里、涌泉、加承山。得气后行平补平泻手法,间歇提插捻转,中小刺激。恢复期(Ⅴ～Ⅵ期):取穴及针刺手法、强度同痉挛期。每次留针30min,周1～周5治疗,1次/d,5次为1个疗程。④推拿治疗:每次在针刺治疗后进行。先从患侧肢体的远端开始,逐渐到肢体的近端;以拿揉法为主,兼顾点穴和活动关节。30min/次,周1～周5治疗,1次/d,5次为1个疗程。⑤功能训练:软瘫期:强调保持良好的功能体位,并由简单的卧位训练到肢体的训练,开始肢体被动(床上体位变换、仰靠坐位训练和关节活动的训练)和主动运动(Bobath握手,桥式运动等)。痉挛期:进行抑制肌张力的训练,如降低躯干肌张力、抑制痉挛的训练,抑制上肢屈肌、下肢伸肌痉挛的训练,促进随意运动和分离运动的训练,以及提高肢体自主运动的训练。恢复期:进行改善立位平衡、提高立位稳定的训练和下肢各关节分离运动训练。一般2次/d,每次30min。⑥在针刺治疗前,第20,40次针刺治疗后采用美国国立卫生研究院卒中量表评分(0～31分;分值越大,症状越重)、功能独立性评定量表评分(18～126分,126分=完全独立,18分=完全依赖)和Barthel指数(0～100分,<20分:日常生活需要完全帮助,100分:患者的日常生活不需要照顾,可以自理)评估患者神经功能和日常生活活动能力。⑦计量资料差异比较采用方差分析,数据间相关性处理采用直线相关分析。结果:脑梗死患者37例均进入结果分析。①美国国立卫生研究院卒中量表评分在针刺治疗前,第20,40次针刺治疗后依次降低(P<0.01),功能独立性评定量表评分、Barthel指数依次升高(P<0.01)。②美国国立卫生研究院卒中量表评分与功能独立性评定量表评分呈显著负相关(r=-0.93,P<0.01),与Barthel指数呈显著负相关(r=-0.94,P<0.01);功能独立性评定量表评分与Barthel指数呈显著正相关(r=0.90,P<0.01)。结论:①联合应用美国国立卫生研究院卒中量表、功能独立性评定量表、Barthel指数评估脑梗死患者神经功能、日常生活活动能力效果好。②针刺治疗、推拿和功能训练可明显改善脑梗死患者神经功能和日常生活活动能力,且随着治疗时间的延长,效果更加明显。
AIM： To observe the Changes of neurological function and activities of daily living （ADL） of patients with cerebral infarction before and after acupuncture, massage and functional training with the National Institutes of Health Stroke Scale （NIHSS）, the Function Independence Measure （FIM）, and the Barthel Index.
METHODS： ①Totally 37 cases including 16 males and 21 females were selected from the Neurological Department of the Second Hospital aiffiliated to Chongqing University of Medical Sciences between Semptember 2003 and June 2004. The plans of treatment were known and agreed. ② All cases were treated with western medicine and combined with acupuncture, massage and functional training. ③ Acupuncture method： Head： To acupuncture from Qianding （DU21） to Baihui （DU20）, Fengchi （GB20） of opposite paralysis side, temporoantefior line of opposite paralysis side from Hanyan （GB4） to Xuardi （GB6）. Brunnstrom （Ⅰ - Ⅱ ）： Upper limb by body flank acupuncture point primarily, Binao （L114）, Shouaanli （L111）, Wa/guan （SJS）, Shenmen （HT8）.In lower limb flank acupuncture point proper attention to all Fenshi （GB31）, Xueha/ （SP9）, Zuaanli （ST36）, Yinlingquan （SP9）, Sanyinjiao （SP6）, Yon.gquan （K11）. Brings about the desired sensation next evenly makes up evenly flows swiftly the technique, the intermittence raises inserts twists the extension, strong stimulates. Brnnnstrom （Ⅲ -Ⅳ ）： Upper limb by the flank acupuncture point primarily, namely removes Shenmen （HT8）. Lower limb completely by the inside and the latter side acupuncture point primarily, namely removes Fenshi （GB31）, Zuaanli （ST36）, yongquan （K11）, add Cheagshan （BL57）.Brings about the desired sensation next evenly makes up evenly flows swiftly the technique, the intermittence raises inserts twists the extension, center slightly stimulates. Brnnnstrom （Ⅴ- Ⅵ）： Takes the points and the acupuncture technique as the same as before time. Each time keeps needle 30 minutes, from the first week to the 5^th week, once a day and 5 times as 1 course. ④ Massage treatment： Each time carries on after the acupuncture treatment. First from paralysis side body far-end start, gradually to body near end by knead primarily, the proper attention to beth finger-pressing and moves the joint, 30 minutes, from the first week to the fifth week, once a day, 5 times as 1 course. ⑤ Functional training： Brunnstrom （Ⅰ- Ⅱ ）： The emphasis maintains the good function body posture, and trains from the simple decubitus to the body training, starts the body to be passive （bed upper body position transformation, supinely depends on training which seat training and joint moves） and the initiative movement （Bobath shakes hand, bridge type movement and so on）. Brunnstrom （Ⅲ-Ⅳ）： Carries on suppresses the myo-tensity the training, like reduces the torso tensely, the suppression convulsion training, suppresses the upper limb flexor, the lower limb extenson convulsion training, the promotion at＇will movement and the separation movement training, as well as enhances the body independent movement the training. Brunnstrom （Ⅴ-Ⅵ）： Carries on the improvement to set up the position balances the enhaneetnent sets up the position .stable training and the lower limb various joints separation movement training, twice a each time for 30 minutes. ⑥ Before the acupuncture treatment, after the 20^th and the 40^th acupuncture treatments uses the NIHSS （the 0-31 points, the higher points, the severer the symptoms）, the FIM （the 18-126 points, 126 points = completely independent, 18 points = total dependence） and the Barthel index （the 0-100 points, the 〈 20 points. The daily life needs to help completely, 100 points; Patient＇s daily life does not need to look after, may take care of oneself） appraises the patient neurology function and the daily life energy. ⑦ Measurement data were compared with analysis of variance, and the data relevant processing were compared with straight line correlation analysis.
RESULTS： All 37 cases with cerebral infarction entered the final analysis. ① Scores of NIHSS were decreased before treatment and after the 20^th and 40^th acupuncture treatments （P 〈 0.01）, but scores of FIM and Barthel Index were increased （P 〈 0.01）. ② NIHSS scale was remarkably negative correlation with FIM scale （r=-0.93, P 〈 0.01） and negative correlation with Barthel Index （r=-0.94, P 〈 0.01）, but FIM score was positive correlation with Barthel Index （r=0.90, P 〈 0.01）.
CONCLUSION： ① It has good effect on evaluating neurological function and ADL with NIHSS, FIM and Barthel Index. ② With prolonging time, the effect of acupuncture, massage and functional training on neurological function and ADL is well.
出处
《中国临床康复》
CSCD
北大核心
2006年第11期1-4,共4页
Chinese Journal of Clinical Rehabilitation
