摘要目的 观察不同针刺方法结合运动再学习法(MRP)早期干预对脑梗死患者肌张力及功能恢复的疗效差异.方法 符合纳入标准的脑梗死患者90例按随机数字表法分成阳明经针刺加MRP组(A组)、防痉挛针刺加MRP组(B组)和单纯MRP维(C组),每组患者30例.3组患者均采用相同方案的药物治疗和MRP训练.A组患者在药物治疗和MRP训练的基础上,增加阳明经针刺法；B组在药物治疗和MRP训练的基础上,增加防痉挛针刺法；C组患者不增加任何方法治疗.3组患者均于在治疗前及治疗4周后(治疗后)采用美国国立卫生研究院脑卒中量表(NIHSS)、简式Fugl-Meyer运动功能评定量表(FMA)、Fugl-Meyer平衡量表(FM-B)、综合痉挛量表(CSS)以及改良的Barthel指数(MBI),分别评估其神经功能缺损程度、运动功能、平衡功能、肌张力、日常生活活动(ADL)能力.结果 治疗后,3组患者各项评分与组内治疗前比较,差异均有统计学意义(P＜0.05).B组治疗后仅NIHSS评分与C组治疗后的差异有统计学意义(P＜0.05),其FMA评分、FM-B评分、CSS评分、MBI评分方面与C组治疗后比较,差异均无统计学意义(P ＞0.05).A组患者治疗后,除FM-B评分与C组治疗后比较差异无统计学意义(P＞0.05),其余各项评分与C组治疗后比较,差异均有统计学意义(P＜0.05),且A组治疗后的FMA和CSS评分与B组治疗后比较,差异亦有统计学意义(P＜0.05).A组患者治疗前后的NIHSS、FMA、CSS和MBI评分差值与B组和C组的比较,差异均有统计学意义(P＜0.05)；B组仅NIHSS、FMA的评分差值与C组的比较,差异有统计学意义(P＜0.05).结论 针刺结合MRP法早期干预能有效地改善脑梗死患者的运动功能和肌张力,不同的针刺方法其疗效存在差别,而防痉挛针刺在改善运动功能的同时,可有效地控制肌张力,有利于MRP训练.

abstractsObjective To observe the effects of a motor relearning programme (MRP) combined with different early acupuncture interventions on muscle tension and motor function recovery after cerebral infarction. Methods A total of 90 patients with cerebral infarction who met the inclusion criteria were divided into three groups at random:a YANGMING meridian acupuncture and MRP group ( group A),an anti-spasm acupuncture and MRP group ( group B),and an MRP group ( group C ).All of the patients in all three groups were treated with routine medication.The National Institute of Health stroke scale (NIHSS),the composite spasticity scale (CSS),Fugl-Meyer assessment (FMA),the Fugl-Meyer balance scale (FM-B) and the modified Barthel index (MBI) were used to measure performance before treatment and after 4 weeks of treatment.Another comparison was intra-group between before and after treatment. Results There were significant differences in the assessment results in all of the groups after treatment compared with those before treatment.After treatment,group B was superior to group C only in terms of NIHSS scores.There was no significant NIHSS score difference between groups A and C.The FMA,CSS and MBI results revealed significant differences among all three groups,with the scores of group A consistently the highest.The average FMA score in group B was significantly higher than in group C but there was no statistically significant difference in FM-B scores among the three groups. Conclusion MRP therapy combined with early acupuncture intervention can improve motor function and muscular tension after cerebral infarction.Anti-spasm acupuncture can improve motor function and control muscular tension effectively at the same time,making it beneficial for MRP training.