醒脑开窍针刺法联合加味芍药汤治疗中风后肢体痉挛的临床疗效

陆军伟; 王云; 周淼; 任梦蕾; 王芳; 於力

doi:10.14148/j.issn.1672-0482.2023.1129

醒脑开窍针刺法联合加味芍药汤治疗中风后肢体痉挛的临床疗效

doi: 10.14148/j.issn.1672-0482.2023.1129

陆军伟^1, ,,
王云²,
周淼¹,
任梦蕾¹,
王芳¹,
於力¹

1.
江阴市中医院针灸科, 江苏江阴 214400
2.
江苏省荣军医院中医科，江苏无锡 214026

基金项目:

无锡市中医药管理局科技项目 ZYKJ202127

详细信息

通讯作者:
陆军伟，男，副主任中医师，主要从事针灸治疗脑血管疾病的临床研究，E-mail: 550429983@qq.com

中图分类号: R255.2
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- 被引次数: 0
出版历程
- 收稿日期: 2023-05-23
- 网络出版日期: 2023-11-24
- 发布日期: 2023-11-10

The Efficacy of Xingnao Kaiqiao Acupuncture Combined with Modified Shaoyao Decoction in The Treatment of Limb Spasm in Patients with Post-Stroke

1.
Department of Acupuncture and Moxibustion, Jiangyin Hospital of Traditional Chinese Medicine, Jiangyin 214400, China
2.
Department of TCM, Jiangsu Rongjun Hospital, Wuxi 214026, China

摘要

摘要: 目的观察醒脑开窍针刺法结合加味芍药汤治疗中风后肢体痉挛患者的疗效。方法选择符合纳入标准的中风后肢体痉挛患者70例, 采用随机数字表法分为观察组和对照组各35例, 对照组予常规康复训练及加味芍药汤治疗, 观察组在对照组治疗基础上联合醒脑开窍针刺法治疗，疗程均为8周。观察2组患者治疗前后中医证候积分、临床疗效、临床痉挛指数量表(CSI)、简易Fugl-Meyer评分(FMA)、改良Barthel指数(MBI)的变化情况。结果治疗后，2组中医证候积分均显著下降(P < 0.05，P < 0.01), 观察组优于对照组(P < 0.05，P < 0.01)；观察组临床疗效优于对照组(P < 0.05)；2组FMA和MBI评分均显著上升(P < 0.01), CSI评分明显下降(P < 0.05), 观察组均优于对照组(P < 0.05，P < 0.01)。治疗期间2组均未发生明显不良反应。结论醒脑开窍针刺法联合加味芍药汤可改善患者肢体痉挛、肢体活动功能等临床症状, 提高患者的日常生活能力。
- 醒脑开窍针刺法 /
- 加味芍药汤 /
- 中风 /
- 肢体痉挛
Abstract: OBJECTIVE To observe the efficacy of Xingnao Kaiqiao acupuncture combined with modified Shaoyao decoction in the treatment of post-stroke limb spasm. METHODS 70 patients with post-stroke limb spasticity who met the inclusion criteria were selected and divided into an observation group and a control group with 35 cases each using the random number table method. The control group received routine rehabilitation training and modified Shaoyao decoction, while the observation group was treated with Xingnao Kaiqiao acupuncture on the basis of the treatment of the control group. The course of treatment was 8 weeks for both groups. The traditional Chinese medicine (TCM) syndrome scores, clinical efficacy, clinical spasm index (CSI), simple Fugl-Meyer assessment (FMA), modified Barthel index (MBI) in the two groups of patients before and after treatment were observed. RESULTS After treatment, the TCM syndrome scores of both groups decreased significantly (P < 0.05, P < 0.01), and the observation group was better than the control group (P < 0.05, P < 0.01); the curative effect in the observation group was better than that in the control group (P < 0.05); the FMA and MBI scores of both groups increased significantly (P < 0.01), and the CSI score decreased significantly (P < 0.05), the observation group was better than the control group (P < 0.05, P < 0.01). No obvious adverse reactions occurred in either group during the treatment period. CONCLUSION Xingnao Kaiqiao acupuncture combined with Jiawei Shaoyao decoction can improve the patients' limb spasticity, limb activity function and clinical symptoms, and improve the patients' daily living ability.
- Xingnao kaiqiao acupuncture /
- Jiawei Shaoyao decoction /
- stroke /
- limb spasm

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表 1 2组患者基线资料比较(x±s, n=35)

Table 1. Comparison of baseline information between the two groups of patients(x±s, n=35)

组别	性别		年龄/岁	病程/d	患侧
组别	男	女	年龄/岁	病程/d	左侧	右侧
观察组	19	16	65.03±10.46	46.95±7.66	21	14
对照组	15	20	63.87±9.62	48.28±6.97	18	17

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表 2 2组患者治疗前后中医证候积分比较(x±s, n=35)

Table 2. Comparison of TCM syndrome scores before and after treatment between the two groups of patients(x±s, n=35)

组别	时间	半身不遂	头晕目眩	气短乏力	口舌歪斜	言语謇涩	总分
观察组	治疗前	2.12±0.25	1.63±0.31	1.94±0.36	1.96±0.35	1.68±0.33	9.33±1.21
	治疗后	1.37±0.15^**##	0.83±0.44^**	0.76±0.15^**##	0.87±0.22^*#	0.81±0.19^**##	4.24±0.85^**##
对照组	治疗前	2.08±0.31	1.72±0.29	1.92±0.34	2.06±0.49	1.64±0.31	9.42±1.38
	治疗后	1.93±0.24^*	1.01±0.31^*	0.88±0.21^**	1.02±0.26^*	0.97±0.25^**	4.98±1.17^**
注: 组内比较, ^P < 0.05, ^*P < 0.01;组间比较, ^#P < 0.05, ^##P < 0.01。

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表 3 2组患者临床疗效比较(n=35)

Table 3. Comparison of clinical curative effect between the two groups(n=35)

组别	痊愈	显效	有效	无效	有效率/%
观察组	18	9	6	2	94.29^*
对照组	11	10	5	9	74.29
注: 组间比较, χ²=5.28, ^*P < 0.05。

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表 4 2组患者治疗前后FMA、CSI和MBI评分比较(x±s, n=35)

Table 4. Comparison of FMA, CSI, MBI scores before and after treatment between the two groups(x±s, n=35)

组别	时间	FMA评分	MBI评分	CSI评分
观察组	治疗前	38.26±6.82	35.71±7.95	12.62±1.88
	治疗后	66.42±5.03^**##	57.62±10.14^**##	8.19±2.35^**#
对照组	治疗前	39.17±7.13	36.24±6.72	12.54±1.62
	治疗后	53.71±6.85^**	45.48±8.69^**	9.78±2.81^**
注: 组内比较, ^**P < 0.01;组间比较, ^#P < 0.05, ^##P < 0.01。

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参考文献(16)

[1]	COLETTI RH. The ischemic model of chronic muscle spasm and pain[J]. Eur J Transl Myol, 2022, 32(1): 10323.
[2]	李为成, 石挺丽, 高中, 等. 磁圆梅针联合康复训练对缺血性中风后肢体痉挛患者神经及血管功能损伤的调节作用[J]. 世界科学技术-中医药现代化, 2021, 23(11): 4344-4350. https://www.cnki.com.cn/Article/CJFDTOTAL-SJKX202111056.htm LI WC, SHI TL, GAO Z, et al. Regulation of round magnetic needle tapping combined with rehabilitation training on neural and vascular dysfunction in the ischemic post-stroke spasticity[J]. Mod Tradit Chin Med Mater Med World Sci Technol, 2021, 23(11): 4344-4350. https://www.cnki.com.cn/Article/CJFDTOTAL-SJKX202111056.htm
[3]	户鹏祥. 醒脑开窍针刺配合通络汤治疗中风后下肢痉挛观察[J]. 实用中医药杂志, 2022, 38(6): 928-930. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYAO202206019.htm HU PX. Observation on the treatment of lower limb spasm after stroke with Xingnao Kaiqiao acupuncture combined with Tongluo Decoction[J]. J Pract Tradit Chin Med, 2022, 38(6): 928-930. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYAO202206019.htm
[4]	庞青民, 赵欲晓, 邵素菊, 等. 醒脑开窍针刺法通过调控mTOR-EAAT2通路影响脑卒中后痉挛大鼠大脑皮层神经递质代谢[J]. 中国病理生理杂志, 2021, 37(11): 2001-2007. https://www.cnki.com.cn/Article/CJFDTOTAL-ZBLS202111012.htm PANG QM, ZHAO YX, SHAO SJ, et al. Xingnao-Kaiqiao acupuncture affects neurotransmitter metabolism in cerebral cortex of rats with spasticity after stroke by regulating mTOR-EAAT2 signaling pathway[J]. Chin J Pathophysiol, 2021, 37(11): 2001-2007. https://www.cnki.com.cn/Article/CJFDTOTAL-ZBLS202111012.htm
[5]	黄麟荇, 蒋海龙, 岳增辉, 等. 电针结合加味芍药汤电针结合加味芍药汤对脑卒中肢体痉挛大鼠海马GABAa及PSD-95表达的影响[J]. 时珍国医国药, 2021, 32(11): 2777-2781. https://www.cnki.com.cn/Article/CJFDTOTAL-SZGY202111065.htm HUANG LX, JIANG HL, YUE ZH, et al. Effect of electroacupuncture combined with Jiawei Shaoyao Decoction on the expression of GABAa and PSD-95 in hippocampus of rats with stroke limb spasm[J]. Lishizhen Med Mater Med Res, 2021, 32(11): 2777-2781. https://www.cnki.com.cn/Article/CJFDTOTAL-SZGY202111065.htm
[6]	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: 666-682. https://www.cnki.com.cn/Article/CJFDTOTAL-XDJB201911024.htm Neurology Branch of Chinese Medical Association, Cerebrovascular Disease Group of the Neurology Branch of Chinese Medical Association. Chinese guidelines for diagnosis and treatment of acute ischemic stroke 2018[J]. Chin J Neurol, 2018, 51: 666-682. https://www.cnki.com.cn/Article/CJFDTOTAL-XDJB201911024.htm
[7]	饶明俐. 中国脑血管病防治指南[M]. 北京: 人民卫生出版社, 2007: 21-24. RAO ML. Chinese Guidelines for Cerebrovascular Disease Prevention and Treatment[M]. Beijing: People's medical publishing house, 2007: 21-24.
[8]	国家中医药管理局. 中医病证诊断疗效标准[M]. 北京: 中国医药科技出版社, 2012: 34-35. National Administration of Traditional Chinese Medicine. Criteria for Diagnosis and Curative Effect of TCM Diseases[M]. Beijing: China medical science and technology press, 2012: 34-35.
[9]	中药新药临床研究指导原则: 试行[M]. 北京: 中国医药科技出版社, 2002: 99-102. Guidance Principle of Clinic Study on New Drug of Traditional Chinese Medicine: Trial Implementation[M]. Beijing: Chinese medical and science press, 2002: 99-102.
[10]	唐强. 临床康复学[M]. 上海: 上海科学技术出版社, 2009: 12-24. TANG Q. Clinical Rehabilitation[M]. Shanghai: Shanghai scientific and technical publishers, 2009: 12-24.
[11]	陈莉琳, 黄牡丹, 郑海清. 卒中后肢体痉挛治疗的研究进展[J]. 中国卒中杂志, 2020, 15(7): 720-727. https://www.cnki.com.cn/Article/CJFDTOTAL-ZUZH202007006.htm CHEN LL, HUANG MD, ZHENG HQ. Advances in the treatment of limb spasticity after stroke[J]. Chin J Stroke, 2020, 15(7): 720-727. https://www.cnki.com.cn/Article/CJFDTOTAL-ZUZH202007006.htm
[12]	潘润仪, 曾华武, 蔡东纯, 等. 新Bobath技术联合透穴针刺治疗脑卒中后偏瘫肢体痉挛患者的康复效果[J]. 中外医学研究, 2023, 21(2): 117-120. https://www.cnki.com.cn/Article/CJFDTOTAL-YJZY202302030.htm PAN RY, ZENG HW, CAI DC, et al. Rehabilitation effect of new bobath technique combined with point-through acupuncture in the treatment of patients with hemiplegia and limb spasm after stroke[J]. Chin Foreign Med Res, 2023, 21(2): 117-120. https://www.cnki.com.cn/Article/CJFDTOTAL-YJZY202302030.htm
[13]	YUE XY, FENG ZQ, YU XY, et al. Fire-needle acupuncture for upper limb spastic paralysis after stroke: Study protocol for a randomized controlled trial[J]. J Integr Med, 2019, 17(3): 167-172.
[14]	宋扬扬, 张新昌, 张加英, 等. 醒脑开窍针刺法对脑梗死患者rt-PA静脉溶栓安全性的影响: 随机对照试验[J]. 中国针灸, 2022, 42(9): 961-965. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGZE202209001.htm SONG YY, ZHANG XC, ZHANG JY, et al. Effect of Xingnao Kaiqiao acupuncture on safety of rt-PA intravenous thrombolysis in patients with cerebral infarction: A randomized controlled trial[J]. Chin Acupunct Moxibustion, 2022, 42(9): 961-965. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGZE202209001.htm
[15]	胡建琴, 何健. 醒脑开窍针刺法联合熄风化痰通络扶正汤治疗急性脑梗死后痉挛型偏瘫的效果研究[J]. 实用心脑肺血管病杂志, 2021, 29(8): 89-94. https://www.cnki.com.cn/Article/CJFDTOTAL-SYXL202108021.htm HU JQ, HE J. Effect of Xingnao Kaiqiao acupuncture combined with Xifeng Huatan Tongluo fuzheng decoction internal treatment on spastic hemiplegia after acute cerebral infarction[J]. Pract J Card Cereb Pneumal Vasc Dis, 2021, 29(8): 89-94. https://www.cnki.com.cn/Article/CJFDTOTAL-SYXL202108021.htm
[16]	刘未艾, 岳增辉, 付磊, 等. 经筋刺法结合加味芍药甘草汤治疗脑卒中后肢体痉挛的效果[J]. 中国康复理论与实践, 2018, 24(3): 323-327. https://www.cnki.com.cn/Article/CJFDTOTAL-ZKLS201803018.htm LIU WA, YUE ZH, FU L, et al. Effect of acupuncture at muscle tendon and supplemented peony-licorice decoction on spasticity after stroke[J]. Chin J Rehabil Theory Pract, 2018, 24(3): 323-327. https://www.cnki.com.cn/Article/CJFDTOTAL-ZKLS201803018.htm