目的 探究循手阳明经铜灸联合运动疗法对脑卒中后上肢偏瘫患者康复中的应用效果。方法 68例脑卒中后上肢偏瘫患者经随机数表法分为两组,其中对照组34例患者接受常规药物治疗和运动疗法,观察组34例患者在对照组基础上加用循手阳明经铜灸,两组均治疗4周。比较两组临床疗效、中医证候积分、上肢运动功能、日常生活能力、表面肌电信号及关节活动度。结果 观察组治疗总有效率为88.24%（30/34）,明显高于对照组的67.65%（23/34）（P<0.05）。与治疗前比较,两组治疗后上肢偏瘫无力、肢体麻木、言语謇涩评分、肱二头肌肘部伸展积分肌电值、肱二头肌及肱三头肌的协同收缩率均降低,Fugl-Meyer评定量表上肢运动功能评分、Barthel指数、患肢肱二头肌肘部屈曲IEMG值、肱二头肌肘部屈曲/伸展IEMG值、肩、肘、腕、手关节的活动度均升高,且观察组优于对照组（P<0.05）。结论 循手阳明经铜灸联合运动疗法可有效改善脑卒中后上肢偏瘫患者上肢运动功能,调节肌肉协同收缩模式,提升日常生活能力。
Abstract
Objective To explore the influences of along the hand yangming meridian copper moxibustion combined with exercise therapy on rehabilitation effect of upper limb hemiplegia after stroke. Methods According to random number table method, 68 patients with upper limb hemiplegia after stroke were divided into control group (routine drugs treatment and exercise therapy, 4 weeks) and observation group (along the hand yangming meridian copper moxibustion on basis of control group, 4 weeks), 34 cases in each group. The clinical curative effect, scores of traditional Chinese medcine (TCM) syndromes, upper limb motor function, activities of daily living, surface electromyographic signals and range of motion in the two groups were compared. Results The total response rate of treatment was significantly higher in observation group than control group [88.24% (30/34) vs 67.65% (23/34), P<0.05]. After treatment, scores of TCM syndromes (upper limb hemiplegia and weakness, limb numbness, dysphasia), integrated electromyogram (IEMG) of biceps under elbow extension state and co-contraction ratio (CR) of biceps/triceps were decreased, while scores of Fugl-Meyer Assessment-Upper Extremity (FMA-UE) and Barthel index (BI), IEMG of affected biceps under elbow flexion state, IEMG of biceps under elbow flexion/extension states and range of motion (shoulder, elbow, wrist and hand joints) were increased in both groups, and the above indexes were better in observation group than control group (P<0.05). Conclusion The along the hand yangming meridian copper moxibustion combined with exercise therapy can effectively improve upper limb motor function, regulate co-contraction pattern of muscles and improve activities of daily living in patients with upper limb hemiplegia after stroke.
关键词
脑卒中后上肢偏瘫 /
循手阳明经铜灸 /
运动疗法 /
上肢功能 /
日常生活能力
Key words
upper limb hemiplegia after stroke /
along the hand yangming meridian copper moxibustion /
exercise therapy /
upper limb function /
activity of daily living
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基金
2022年度南通市卫生健康委科研课题（指导性）项目 “循手阳明经铜灸联合八邪操在上肢偏瘫患者中的应用研究”（MSZ2022074）; 江苏省中医药科技发展计划项目“基于真实世界的‘腰痹速通方’治疗急性期腰椎间盘突出症的多中心双向队列研究”（MS2023111）
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