【作者】 黄维媚；

【导师】 庄礼兴；

【作者基本信息】 广州中医药大学 ， 中医学， 2009， 硕士

【摘要】 研究目的:中风(stroke)相当于西医学的急性脑血管病(acute cerebrovascular disease),本病具有高死亡率、高复发率及高致残率等特点,是严重威胁人类生命及影响生活质量的疾病。据统计,约有80%的脑卒中患者遗留有不同程度的功能障碍,其中偏瘫(hemiplegia)发生率最高,是直接影响患者生存质量的主要因素。“靳三针”疗法(Jin’s three-needle therapy)为岭南针灸新学派,因其稳定、可靠的临床疗效而被广泛应用。本研究旨在通过随机、对照的临床研究方法,遵循循证医学的原则,对靳三针疗法和康复疗法治疗中风后偏瘫的临床疗效进行客观的评价和验证;观察两种疗法治疗中风后偏瘫的神经功能缺损程度和运动功能的改变;探讨靳三针治疗该病的临床价值及推广意义,提出针刺治疗中风后偏瘫的优化方案和临床指南。方法:收集脑梗塞(cerebral infarction)发病2周-3个月的遗留偏瘫的患者共60例,按照随机对照的原则,分为靳三针治疗组和康复对照组,每组30例。靳三针治疗组和康复对照组均根据Brunnstrom分期具体制定弛缓期和痉挛期的治疗方案。两组疗程均为4周。在治疗前、治疗14天后、治疗28天后分别采用神经功能缺损评分(NDS)、运动功能(四肢简化Fugl-Meyer)评分量表等进行疗效评价。结果:(1)按照神经功能缺损评分(NDS)情况,靳三针组治疗28天后,基本痊愈4例(13.33%),显效19例(63.33%),有效6例(20%),无效1例(3.33%),总有效率为96.67%。康复组基本痊愈1例(3.33%),显效5例(16.67%),有效22例(73.33%),无效2例(6.67%),总有效率为93.33%。两组疗效存在统计学差异。(2)按运动功能(四肢简化Fugl-Meyer)评分情况,靳三针组治疗28天后,基本痊愈15例(50%),显效2例(6.67%),有效11例(36.67%),无效2例(6.67%)。康复组基本痊愈5例(16.67%),显效1例(3.33%),有效22例(73.33%),无效2例(6.67%),总有效率为93.33%。两组疗效存在统计学差异。(3)治疗28天后,无论靳三针治疗组还是康复对照组,其神经功能缺损评分(NDS)和运动功能(四肢简化Fugl-Meyer)评分都有明显改善,与治疗前存在统计学差异。(4)靳三针组与康复组组间治疗前神经功能缺损评分(NDS)和运动功能(四肢简化Fugl-Meyer)评分无差别,治疗28天后均出现统计学差异。结论:靳三针治疗和康复治疗均可改善脑梗塞后偏瘫患者的神经功能缺损评分(NDS)、运动功能(四肢简化Fugl-Meyer)评分,即对偏瘫具有临床疗效,但靳三针疗法疗效优于康复疗法。更多还原

【Abstract】 Objective:Stroke,a proper noun of traditional Chinese medicine,means acute cerebrovascular disease in Western medicine.It has the characteristics of high death rate,high recurrence rate and high mutilating rate,and it is one of the diseases that severely threaten human life and influent life quality. According to some researches,among the people who has ever suffered from stroke,about 80%of them remain functional impairment to different extent. The incidence rate of hemiplegia is the highest,so it is the most important factor that directly influents patients life quality.Jin’ s three-needle therapy represents a new school of acupuncture in China.It is generally applied in clinic as it has stable and significant therapeutic effect.Basing on the random and contrast method and the principle of evidence-based medicine, firstly,this research try to estimate and validate the objective effect of two different therapies:Jin’ s three-needle therapy and rehabilitation therapy.Secondly,it is aim at observing the changes of neurologic impairment and motor function after two therapies respectively.Finally,it wants to approach the clinical founction and generalizing value of Jin’ s three-needle therapy for hemiplegia after stroke,then propose the prioritization scheme and clinical manual of acupuncture for hemiplegia after stroke.Method:There are sixty hemiplegic patients who are attacked by stroke for two weeks to three months,divide them into Jin’s three-needle therapy group and rehabilitation therapy group,each group has thirty patients.According to the staging principle of Brunnstrom,the exact scheme of both groups include two parts,one for flaccid plegia and the other for spasm plegia.The therapeutic course lasts for four weeks in total.We need to estimate the therapeutic effect before the treatment,fourteen days after treatment and twenty-eight days after treatment.The measuring scales are neurologic damage scale(NDS) and motor function scale(Fugl-Meyer).Result:(1)According to the neurologic damage scale(NDS),twenty-eight days after treatment,Jin’ s three-needle therapy group:4 cases healed(13.33%), nineteen cases have significant effect(63.33%),six cases have effect(20%), one case has no effect(3.33%) and the effective rate is 96.67%.Rehabilitation therapy group:one case healed(3.33%),five cases have significant effect(16.67%),twenty-two cases have effect(73.33%),two cases have no effect(6.67%) and the effective rate is 93.33%.There are statistic differences between the therapeutic effect of two groups.(2) According to the motor function scale(Fugl-Meyer),twenty-eight days after treatment,Jin’ s three-needle therapy group:fifteen cases healed(50%), two cases have significant effect(6.67%),eleven cases have effect(36.67%), two cases have no effect(6.67%) and the effective rate is 93.33%. Rehabilitation therapy group:five cases healed(16.67%),one case has significant effect(3.33%),twenty-two cases have effect(73.33%),two cases have no effect(6.67%) and the effective rate is 93.33%.There are statistic differences between the therapeutic effect of two groups.(3) Twenty-eight days after treatment,the neurologic damage scale(NDS) and motor function scale(Fugl-Meyer) of both groups are improved,having statistic differences with the situation before treatment.(4) The neurologic damage scale(NDS) has no difference between Jin’ s three-needle therapy group and rehabilitation therapy group before treatment, yet statistic differences show up twenty-eight days after treatment.It is the same with motor function scale(Fugl-Meyer).Conclusion:both Jin’ s three-needle therapy and rehabilitation therapy improve the situation of neurologic damage scale(NDS) and motor function scale(Fugl-Meyer) of the hemiplegic patients after cerbral infarction,which means both therapies are effective for hemiplegia.But all in all,the therapeutic effect of Jin’ s three-needle therapy is better than the rehabilitation therapy.更多还原