针刺治疗中风后下肢痉挛状态的临床观察
【摘要】：研究背景
中风后痉挛是中风常见的后遗症,有多种不同的临床表现,包括肢体运动能力丧失,关节挛缩变形,并严重影响患者行走功能及日常活动。缓解肢体痉挛状态对于中风患者来说非常重要。许多研究报道表明针灸能够有效控制痉挛,但是没有数据化指标来证实疗效。
材料与方法
本研究将60例中风患者随机分为针灸组(治疗组)和康复训练组(对照组)2组。两组患者每周均治疗5次,疗程4周。观察指标：改良的Ashworth量表(MAS),临床痉挛指数量表(CSI),Barthel量表(B1),足印分析,及患者自我评价量表(PRO)。所有患者均来自北京中医药大学东直门医院。
研究结果
治疗4周后,两组治疗后较治疗前CSl分值显著降低(P0.005),但是针灸组与康复组CSl分值变化的组间比较有显著性差异(P0.05),针灸组优康复组。
下肢Ashworth量表评分明显下降,针灸治疗组,踝关节Ashworth评分由治疗前的2.73±0.82降至治疗后的1.86±0.81；膝关节Ashworth评分由治疗前2.33±0.66降至治疗后的1.6±0.49。针灸组与康复组组间有显著性差异,针灸组优于康复组(P0.05)。
两组Brathel量表评分均提高,针灸组较康复组提高显著(P0.05)。足印分析表明：两组患者患侧与健侧步长差均显著缩小,针灸组疗效更加显著(P0.05)。针灸组更有效改善足长与矫正步角(P0.05)。针灸组仅治疗1周患者步长与步角就出现改善,且改善明显优于康复组(P0.05)。
针灸组与康复组在步宽的改善上不明显。针灸组与康复组均使患者行走速度加快,但两组间没有显著性差异。针灸组有50%患者对治疗结果非常满意,康复组仅有6.7%对疗效非常满意,康复组有53%患者对疗效比较满意。
结论
针灸可显著改善中风后肢体痉挛状态,改善行走功能,和步态参数。可作为安全有效的治疗手段推荐给中风患者。足印分析是经济、有效的临床评价方法。
【关键词】：痉挛 中风后 针灸 康复 足印 【学位授予单位】：北京中医药大学
【学位级别】：博士
【学位授予年份】：2010
【分类号】：R246.6
【目录】：
- Abstract7-8
- 中文摘要8-9
- 1-Introduction9-22
- 1.1-Definition and classification of stroke10
- 1.2-Epidemiology of stroke10-11
- 1.3-Stroke in Chinese medicine11
- 1.4-Definition of spasticity11-13
- 1.4.1-Description of spasticity12
- 1.4.2-Clinical patterns and problems of spasticity12-13
- 1.4.3-Clinical assessment and management of spasticity in clinical practice13
- 1.4.4-Rheological changes in the spastic muscle13
- 1.5-Pathophysiology,assessment and treatment of spasticity in conventional medicine13-19
- 1.5.1-The pathophysiology of spasticity13-14
- 1.5.2-How do you measure spasticity?14
- 1.5.3-Assessment of activity and participation after stroke14-15
- 1.5.4-Spastic gait in post stroke patients15
- 1.5.5-Treatments15-19
- 1.6-Spasticity from the point of view of Chinese medicine19
- 1.7-Treatment of spasticity by acupuncture19-21
- 1.7.1-Definition and mechanism of acupuncture19-20
- 1.7.2-Acupuncture in managing spasticity20-21
- 1.8-Prevalence of spasticity after stroke21
- 1.8.1-Costs of Stroke Survivors with Spasticity21
- 1.9-Why should we do this research?21-22
- 2-Review of the literature22-41
- 2.1-Acupuncture in the treatment of post stroke spasticity23-32
- 2.2-Physical therapy in treatment of spasticity of stroke patients32-34
- 2.3-The effect of acupuncture in stroke rehabilitation34-35
- 2.4-measurment of post-stroke spasticity,foot print and gait analysis35-39
- 2.5-Other therapeutic methods to treatment post stroke spasticity39-40
- 2.6-summary of Literature Review40-41
- 3-Methods and Materials41-53
- 3.1-Objectives42-45
- 3.1.1-General objective42
- 3.1.2-Specific objectives42-43
- 3.1.3-Hypothesis of research43-44
- 3.1.4-Questions of research44-45
- 3.2-Study design45-47
- 3.2.1-Title #39 Clinical study of the effect of acupuncture treatment in post stroke leg spasticity45
- 3.2.2-Kind of research45
- 3.2.3-Type of study45
- 3.2.4-Method45-47
- 3.3-Outcome and variables assessment scales47-49
- 3.4-Ethical issues49
- 3.5-Data analysis method49-50
- 3.6-Materials(Therapeutic methods)50-53
- 4-Results53-85
- 4.1-characteristics of patients54-57
- 4.2-Response to the treatment57-83
- 4.3-Correlations83-85
- 5-Discussion85-96
- 5.1 Describing the results and analysis of the statistics86-93
- 5.2 Assessment of similarities and differences with other studies93-95
- 5.3 advantage and shortcoming of this study95
- 5.4 Recommendations for future study95-96
- 6-Conclusion96-98
- 7-References98-107
- 8-Acknowledgment107-111
- 9-Research Algorithm111-116
- 10-Questionnaire116-122
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