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目的:探讨拘挛方热敷联合康复训练治疗同水平上肢痉挛脑卒中的临床疗效。方法:将100例同水平上肢痉挛脑卒中患者以随机数字表法分为对照组和研究组各50例,对照组给予常规康复训练,研究组在此基础上加用拘挛方热敷,4周为1个疗程,共治疗2个疗程,比较两组治疗效果,采用改良Ashworth量表(MAS)评定治疗前、疗程结束后两组上肢肌张力分级、痉挛程度的变化;以简化Fugl-Meyer运动功能评分表(FMA)、改良Barthel指数评定量表(MBI)及脑卒中专用生活质量量表(SS-QOL)评定治疗前、治疗3个月两组运动能力、日常生活能力及生活质量的变化。结果:研究组治疗疗效分级、肌张力分级及痉挛程度分级均优于对照组,差异具有统计学意义(P<0.05);治疗3个月后,研究组FMA评分、MBI评分、SS-QOL评分均高于对照组,差异具有统计学意义(P<0.05)。结论:拘挛方热敷联合康复训练治疗同水平上肢痉挛脑卒中疗效优于单独康复训练治疗,可改善患者肌张力及肌痉挛程度,提升运动能力、日常生活能力,改善生活质量。
Abstract：Objective :To investigate the effect of Juluan Formula ( 拘挛方 ) hot compress combined with rehabilitation training on upper limb spasm at the same level in stroke. Methods:One hundred of patients with upper limb spasm at the same level in stroke were numbered according to the sequence of admission,and were divided into control group and experimental group by a random number table,50 patients in each group. The control group was given conventional rehabilitation training,and the experimental group was given Juluan Formula hot compresses besides the treatment in the control group. Four weeks were a treatment course,and the treatment lasted for 2 treatment courses. The treatment effects of the two groups were compared. The modified Ashworth scale(MAS) was applied to evaluate the changes of the upper limb muscle tone classification and the spasm degree before and after the treatment. Before and 3 months after the treatment,simplified Fugl-Meyer motor function rating scale( FMA), and modified Barthel index rating scale( MBI) and the stroke-specific quality of life scale(SS-QOL) were used to evaluate the changes in exercise capacity,activity of daily living and quality of life in the two groups. Results:The treatment effect classification,muscle tone classification and spasm degree classification in the experiment group were better than those in the control group,with statistical difference(P<0.05);after 3 months of treatment,FMA score,MBI score,and SS-QOL score in the experimental group were all higher than those in the control group,with statistical difference(P <0.05). Conclusion:The curative effect of Juluan Formula hot compress combined with rehabilitation training is better than that of rehabilitation training alone in the treatment of upper limb spasm at the same level in stroke. It can improve the muscle tone and the degree of muscle spasm,improve exercise capability,activity of daily living,and the life quality in patients.
[1]谢晶军，孙琦，李金霞.电针拮抗肌腧穴结合康复训练对卒中后上肢痉挛状态患者的影响[J].中国康复医学杂志，2017,32(12):1417-1419.
[2]幸冰峰，洪敏，周歆，等.电针分区治疗配合康复训练对脑卒中后上肢痉挛功能障碍疗效评价[J].中医药学报，2019,47(3):70-73.
[3]何金华，覃蓉，王益梅，等. A型肉毒毒素注射配合作业疗法对痉挛型偏瘫脑瘫患儿上肢功能的影响[J].神经损伤与功能重建，2019,14(10):531-532,537.
[4]吴野，巩尊科，李新剑，等.不同模式经颅磁刺激对痉挛型偏瘫脑性瘫痪患儿上肢运动功能的影响[J].中国康复医学杂志，2019,34(11):1368-1370.
[5]王健，包永欣，相永梅，等.通经解痉针刺法联合康复训练治疗中风后上肢痉挛性瘫痪疗效观察[J].现代中西医结合杂志，2018,27(7):699-702.
[6]丁潇，张虎，张大尉，等.抗痉挛中药热敷法治疗脑卒中上肢痉挛疗效观察[J].四川中医，2016,34(11):153-155.
[7]王薇薇，王新德.第六届全国脑血管病学术会议纪要[J].中华神经科杂志，2004,37(4):346-348.
[8]国家中医药管理局脑病急症协作组.中风病诊断与疗效评定标准（试行）[J].北京中医药大学学报，1996,19(1):55-56.
[9]中华医学会神经病学分会，中华医学会神经病学分会脑血管病学组.中国急性缺血性脑卒中诊治指南2018[J].中华神经科杂志，2018,51(9):666-682.
[10]张尚，李晓捷，郭爽，等.神经发育学疗法应用于脑性瘫痪的循证医学研究进展[J].中国康复医学杂志，2019,34(7):865-869.
[11]吴跃迪，李放，熊莉.改良Ashworth量表及改良Tardieu量表应用于卒中患者屈肘肌评估的信度比较[J].中国康复医学杂志，2013,28(12):1151-1152.
[12] SULLIVAN K J,TILSON J K,CEN S Y,et al. Fugl-Meyer assessment of sensorimotor function after stroke[J]. Stroke,2011,42(2):427-432.
[13]闵瑜，吴媛媛，燕铁斌.改良Barthel指数（简体中文版）量表评定脑卒中患者日常生活活动能力的效度和信度研究[J].中华物理医学与康复杂志，2008,30(3):185-188.
[14] SILVA S M,CORRêA F I,PEREIRA G S,et al. Construct validity of the items on the Stroke Specific Quality of Life(SS-QOL)questionnaire that evaluate the participation component of the International Classification of Functioning,Disability and Health[J]. Disabil Rehabil,2018,40(2):225-231.
[15]奚马利，周国平，罗梦，等.刺络拔罐辅助治疗脑卒中恢复期上肢痉挛疗效观察[J].中国针灸，2018,38(11):1145-1149.
[16]黄志强，赵宁，苏昭元，等.刺络拔罐联合康复训练对脑卒中后上肢屈肘痉挛状态及肌电积分值的临床研究[J].中国针灸，2018,38(2):119-124.
[17]李峰，陈劲松，涂美，等.温针灸配合康复训练治疗脑卒中后痉挛性偏瘫的疗效分析[J].针灸临床杂志，2019,35(2):14-17.
[18] WILSON R D,PAGE S J,DELAHANTY M,et al. Upperlimb recovery after stroke:A randomized controlled trial comparing EMG-triggered,cyclic,and sensory electrical stimulation[J]. Neurorehabil Neural Repair,2016,30(10):978-987.
[19] QI L L,HAN Z X,ZHOU Y X,et al. Dynamic scalp acupuncture combined with PNF therapy for upper limb motor impairment in ischemic stroke spastic hemiplegia[J].Chinese Acupuncture&Moxibustion,2018,38(3):234-238.
[20]顾云龙，施婕妤，孙萍萍，等.推拿点穴疗法治疗脑梗死后上肢痉挛性偏瘫的临床疗效观察[J].上海中医药杂志，2018,52(6):50-52.
[21]张大尉，丁潇，杨阳，等.中药热熨敷疗法对脑卒中后上肢痉挛病人肢体功能恢复的疗效观察[J].中西医结合心脑血管病杂志，2019,17(2):272-274.
[22]张哲，车戬，肖程予，等.愈瘫汤联合穴位贴敷、艾灸对卒中后偏瘫患者的康复疗效观察[J].河北中医，2019,41(8):1189-1192,1197.
[23]黄聪，彭伟，牟茂婷，等.基于“肢节痹病”的桂枝芍药知母汤的现代药理作用探讨[J].时珍国医国药，2019,30(4):949-950.
[24]单衍丽，刘敬花，孙良伟，等.刺络拔罐治疗卒中患者上肢痉挛的疗效观察[J].上海针灸杂志，2019,38(3):270-274.
[25]刘丹丹，马子兴，张晓菲，等.草乌药理毒理作用的研究进展[J].国际中医中药杂志，2018,40(2):186-189.
[26]孙萍萍，齐瑞，马玉玺，等.针刺联合隔药灸经筋结点法治疗脑卒中后上肢痉挛性瘫痪疗效观察[J].上海针灸杂志，2019,38(1):50-54.
[27]高森，刘琪，苏鑫童，等.论以经筋理论指导中风后上肢痉挛性瘫痪的中医康复治疗[J].中医药学报，2019,47(5):75-77.
基本信息:
DOI：10.16295/j.cnki.0257-358x.2021.06.010
中图分类号:R277.7
引用信息:
[1]丁潇,邹忆怀.拘挛方热敷联合康复训练治疗脑卒中上肢痉挛疗效观察[J],2021,40(06):594-599.DOI:10.16295/j.cnki.0257-358x.2021.06.010.
基金信息:
北京市医院管理中心培育项目（编号：PZ2018008）