督脉电针治疗脑卒中后上肢痉挛的临床疗效和表面肌电图特征研究

关键词：脑卒中  痉挛  日常生活活动  表面肌电图

Keywords:stroke  spasticity  daily activity  surface electromyography

摘要：

      摘要 目的：研究督脉电针治疗脑卒中后上肢痉挛的临床疗效和表面肌电图特征。 方法：入组的90例脑卒中偏瘫患者，根据随机数字表法，随机分为康复组、电针组、督脉电针组，康复组给予常规康复治疗，电针组在常规康复治疗的基础上给予常规电针，督脉电针组在常规康复治疗的基础上给予督脉电针治疗，30min/次，1次/天，5次/周，共8周。分别在治疗前后进行患侧上肢肱二头肌、肱三头肌表面肌电图测试、改良Ashworth肌张力评定、Fugl-Meyer上肢运动功能评定，改良Barthel指数评定。 结果：治疗后3组患者上肱二头肌、肱三头肌RMS值、改良Ashworth肌张力评估较治疗前均有所降低（P<0.05）、Fugl-Meyer上肢运动功能评分、改良Barthel指数评分均较治疗前有所增加（P<0.05），差异具有显著性意义；电针组、督脉电针组较康复组RMS(root mean square)值和改良Ashworth（MAS）均有所有所降低（P<0.05），Fugl-Meyer和改良 Barthel 指数评分均有所增加（P<0.05）；督脉电针组较电针组RMS值和MAS均有所有所降低（P<0.05）、Fugl-Meyer和改良Barthel指数评分均有所增加（P<0.05）；3组协同收缩率在治疗前后以及治疗后3组之间的比较均无明显差异（P>0.05）。 结论：督脉电针可明显降低脑卒中后偏瘫患者肱二头肌、肱三头肌RMS值，对两者之间的协同收缩率影响不明显，同时显著改善患者患侧上肢肘关节的痉挛程度、运动功能以及日常生活自理能力。

Abstract:

      Abstract Objective：To study the clinical and sEMG effect of electro-acupuncture at Du meridian in stroke patients with upper-extremity spasticity. Method：Ninety patients were randomly assigned by random number table into rehabilitation (C) group, electro-acupunctrure (EAP) group and electro-acupunctrure at Du meridian (DMEAP) group. Rehabilitation therapy was used in the three groups. At the same time, electro-acupunctrure was applied in EAP group, DMEAP group was treated with electro-acupunctrure at Du meridian. The indexes were observed before and after treatment, including RMS and co-contraction ratio of sEMG of biceps and triceps , modified Ashworth scale (MAS), simple Fugl-Meyer assessment of upper-extremity (FMA), and modified Barthel index (MBI). Result：In the three groups, RMS and MAS were both lower after treatment than before (P<0.05), FMA, MBI were upper (P<0.05). RMS and MAS in EAP and DMEAP groups were decreased compared with C group, but FMA and MBI were increased (P<0.05) .There was no significant difference of co-contraction ratio of biceps and triceps after and before treatment at the three groups(P>0.05). Conclusion：RMS of biceps and tricep decreased at stroke patients with limb spasticity, movement function and daily activity improved, but no difference about co-contraction ratio.