路悦,王玉宇,陈罗西
LU Yue,WANG Yuyu,CHEN Luoxi

• 1:常州市武进中医医院
• 2:四川省骨科医院康复科

摘要(Abstract)：

目的 探讨火针联合皮肤针对脑卒中后痉挛性偏瘫患者肢体运动功能及日常生活活动能力的影响。方法 收集脑卒中后痉挛性偏瘫患者109例的临床资料，随机数字表法分为观察组(n=55,火针联合皮肤针)和对照组(n=54,常规针刺),连续治疗4周时根据Ashworth痉挛量表评估两组临床疗效；于治疗前、连续治疗4周时采用FMA量表评估肢体运动功能，Barthel指数(BI)量表评估日常生活能力，健康状况调查问卷(SF-36)量表评估生活质量，肌电图刺激仪记录两组患者M波最大振幅(M)、H反射最大振幅(H)波最大值及M/H的变化情况，酶联免疫法检测血清超敏C反应蛋白(hs-CRP)、同型半胱氨酸(Hcy)水平等炎症状态指标。结果 连续治疗4周时，观察组的总有效率高于对照组，差异有统计学意义(P<0.05);连续治疗4周时，两组患者Ashworth分级较治疗前均有所降低，且观察组Ash worth分级降低程度明显优于对照组(P<0.05);连续治疗4周时，两组FMA评分及SF-36量表各维度评分较治疗前均有所增高，观察组高于对照组(P<0.05);连续治疗4周时，两组患者Mmax较治疗前明显增高，Hmax、M/H明显下降、且观察组Mmax高于对照组，Hmax和M/H低于对照组(P<0.05);连续治疗4周时两组患者血清hs-CRP、Hcy水平下降，且观察组低于对照组(P<0.05)。结论 火针联合皮肤针治疗脑卒中后痉挛性偏瘫患者效果显著，可减轻炎症状态，改善患者痉挛状态，提高其肢体运动功能、日常生活活动能力及生活质量。
Objective To explore the effect of fire needle combined with skin needle tapping therapy on limb motor function and daily living activities in patients with post-stroke spastic hemiplegia. Methods Clinical data of 109 patients with post-stroke spastic hemiplegia were collected. They were randomly divided into an observation group(n=55, combined with fire needle and skin needle tapping) and a control group(n=54, conventional acupuncture) using a random number table method. After 4 weeks of continuous treatment, the clinical efficacy of two groups was evaluated using the Ashworth spasticity scale. FMA scale was applied to evaluate limb motor function before treatment and at 4 weeks of continuous treatment. Barthel Index(BI) was used to evaluate daily living ability. Short-form 36 health survey questionnaire(SF-36) was performed to assess quality of life. An electromyography stimulator was used to record the maximum amplitudeof M wave(Mmax), maximum amplitudeof H reflex(Hmax), and changes in M/H ratio in two groups. Enzyme-linked immunosorbent assay(EMSA)was used to measure inflammatory status indicators such as serum high-sensitivity C-reactive protein(hs-CRP) and homocysteine(Hcy). Results After 4 weeks of continuous treatment, the total effective rate of observation group was higher than that of control group(P<0.05). After 4 weeks of continuous treatment, Ashworth grades in both groups of patients were lower than those before treatment, and the degree of decrease in Ash worth grade was significantly better in observation group than that in control group(P<0.05). After 4 weeks of continuous treatment, FMA scores, and SF-36 scale scores of both groups were increased when compared to before treatment, and they were higher in observation group than those in control group(P<0.05). After 4 weeks of continuous treatment, the Mmax of both groups of patients was significantly increased when compared to before treatment, while Hmax and M/H ratio significantly were decreased. Moreover, Mmax of observation group was higher than that of control group, while Hmax and M/H ratio in observation group were lower than those of control group(P<0.05). After 4 weeks of continuous treatment, the levels of serum hs-CRP and Hcy in both groups of patients were decreased, and they were lower in observation group than those in control group(P<0.05). Conclusion Fire needle combined with and skin needle tapping therapy exhibits a significant effect on treating patients with post-stroke spastic hemiplegia, which can reduce inflammatory status, improve spasticity, enhance limb motor function and improve daily living activities and quality of life.

关键词(KeyWords)： 脑卒中;痉挛性偏瘫;火针;皮肤针;肢体运动功能
stroke;spastic hemiplegia;fire needle;skin needle tapping;limb motor function

Abstract:

Keywords:

基金项目(Foundation): 常州市武进区科技项目(WS201933);; 四川省中医药管理局课科技研究项目课(2020LC0178)

作者(Author): 路悦,王玉宇,陈罗西
LU Yue,WANG Yuyu,CHEN Luoxi

DOI: 10.19367/j.cnki.2096-8388.2023.12.024

参考文献(References)：

• [1] 张小英，安军明.火针疗法联合温阳通络汤对中风后痉挛性偏瘫患者肢体功能的影响[J].针灸临床杂志，2018,34(7):35-38.
• [2] VAES A W,DELBRESSINE J M L,MESQUITA R,et al.The impact of pulmonary rehabilitation on activities of daily living in patients with COPD[J].Journal of Applied Physiology,2018,26(6):932-935.
• [3] YARLAS A,MERLINI G,WHITE M K,et al.Impact of inotersen on functioning and activities of daily living for patients with hereditary ttr amyloidosis:results from a double-blind placebo-controlled trial[J].Blood,2018,132(Suppl_1):4812-4812.
• [4] 龚海洋，陶瑛瑛.功能性伸展运动联合巴氯芬、重复经颅磁刺激对脑卒中后下肢痉挛性偏瘫患者的临床疗效[J].神经损伤与功能重建，2018,13(12):612-615.
• [5] 王锐卿，吕九亨，贾春生.基于数据挖掘的皮肤针疗法临床应用病种规律和特点[J].河北中医药学报，2020,35(3):25-29.
• [6] 高长玉，吴成翰，赵建国，等.中国脑梗死中西医结合诊治指南(2017)[J].中国中西医结合杂志，2018,38(2):136-144.
• [7] 翁国盛，蔡凛，邱松，等.皮肤针放血拔罐联合极超短波治疗髌骨软骨病的临床效果[J].辽宁中医杂志，2018,45(12):2621-2623.
• [8] 鞠露，任超，陈士炯，等.基于数据挖掘技术探讨针灸治疗脑卒中后痉挛性偏瘫的选穴特点[J].世界中西医结合杂志，2021,16(4):628-634.
• [9] GORECKA M A,FURGALA A,KRYGOWSKA W A,et al.Activities of daily living and their relationship to health-related quality of life in patients with parkinson disease after subthalamic nucleus deep brain stimulation[J].World Neurosurgery,2019,125(16):2547-2549.
• [10]ROGENHOFER N,MAHNER S,HASSELBACH Y L V,et al.Effects of intralipid infusions on anti-trophoblast antibody (ATAb)-activities in patients with recurrent pregnancy loss:an observational report[J].American Journal of Reproductive Immunology,2021,19( 4):308-312.
• [11]BUNCHUAILUA W,SAMPRASIT N,KOTIRUM S,et al.Impact of pharmacist activities in patients with depression:a systematic review and meta-analysis of randomized controlled trials[J].Annals of Pharmacotherapy,2022,56(5):556-564.
• [12]刘峻，周鸿飞，张威，等.毫火针针刺夹脊穴治疗中风后上肢痉挛性瘫痪的临床研究[J].广州中医药大学学报，2018,35(3):430-435.
• [13]韩莹，周钰，袁红丽.子午流注择时皮肤针疗法治疗特应性皮炎的临床对照研究[J].新疆医科大学学报，2021,44(9):1036-1040.
• [14]厚晓昀.火针散刺联合抗痉挛康复治疗中风后下肢痉挛患者疗效及对下肢运动功能和步行功能影响[J].针灸临床杂志，2018,34(2):43-46.
• [15]王继坤，宋长红，姜玥.针刺治疗脑卒中后感觉障碍研究进展[J].辽宁中医药大学学报，2019,21(8):188-191.
• [16]金鑫.心理护理联合火针治疗中风后伴肌肉痉挛患者临床体会[J].辽宁中医药大学学报，2021,23(9):215-217.
• [17]陈园园，楚佳梅，包烨华，等.火针治疗脑卒中后痉挛性偏瘫的研究进展[J].广州中医药大学学报，2019,36(10):1675-1678.
• [18]刘初容，莫昊风，黄根胜，等.触发点毫火针治疗对脑卒中后痉挛性瘫痪患者步态的影响[J].中医药导报，2020,26(8):24-26.
• [19]向伟，杨娇，申治富，等.皮肤针结合体针在治疗多发性神经病上的应用[J].四川中医，2018,36(3):52-54.
• [20]李丹，罗朝斤，黄程.火针与电针配合康复训练治疗脑卒中后偏瘫痉挛临床研究[J].陕西中医，2020,41(8):1155-1158.
• [21]KANDA M,TATEISHI K,NAKAGOMI A,et al.Relationship of early intensive- or coronary care unit admission and post-discharge performance of activities of daily living in patients with acute decompensated heart failure[J].European Heart Journal,2021,142(5):110-112.
• [22]KROM M D,KALMET P,JAGTENBERG E M,et al.Medium-term patient-reported quality of life and activities of daily living in surgically treated trauma patients with pelvic,acetabular or combined pelvic and acetabular fractures in a retrospective single-center study[J].Journal of Orthopaedic Trauma,2021,35(1):457-459.
• [23]周婷，花嵘，陈令东，等.Hcy、Cys C、hs-CRP浓度在评估缺血性脑卒中患者功能预后中的价值[J].临床急诊杂志，2021,22(5):347-351.
• [24]刘燕，周晓飞.老年急性缺血性脑卒中患者血清HCY、hs-CRP与颈动脉狭窄的相关性研究[J].中国实验诊断学，2021,25(2):159-162.

文章评论(Comment)：