悬吊推拿运动对脑卒中恢复期上肢痉挛的效果

doi:10.3969/j.issn.1006-9771.2022.11.003

《中国康复理论与实践》 ›› 2022, Vol. 28 ›› Issue (11): 1252-1258.doi: 10.3969/j.issn.1006-9771.2022.11.003

• 专题脑卒中上肢功能康复 • 上一篇下一篇

悬吊推拿运动对脑卒中恢复期上肢痉挛的效果

李泽文¹,张沛潇²,李丽²()

1.山东中医药大学康复医学院，山东济南市 250355
2.山东中医药大学第二附属医院，山东济南市 250001

收稿日期:2022-09-01 修回日期:2022-10-28 出版日期:2022-11-25 发布日期:2022-12-20
通讯作者: 李丽 E-mail:lily.jinan@163.com
作者简介:李泽文(1997-)，女，汉族，山东泰安市人，硕士研究生，主要研究方向：脑卒中的中西医结合康复。|李丽(1962-)，女，汉族，山东济南市人，硕士，教授、主任医师，主要研究方向：脑卒中中西医结合康复、颈肩腰腿痛的防治。
基金资助:
1.山东省重点研发计划项目(2017GSF19114);2.山东省中医药科技发展计划项目(2019-1064);3.山东省中医药科技项目(2021M006)

Effect of sling-massage exercise on upper limb spasticity for stroke patients at recovery stage

LI Zewen¹,ZHANG Peixiao²,LI Li²()

1. College of Rehabilitation, Shandong University of Traditional Chinese Medicine, Ji'nan, Shandong 250355, China
2. The Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Ji'nan, Shandong 250001, China

Received:2022-09-01 Revised:2022-10-28 Published:2022-11-25 Online:2022-12-20
Contact: LI Li E-mail:lily.jinan@163.com
Supported by:
Shandong Key R & D Program(2017GSF19114);Shandong Science and Technology Development Program of Traditional Chinese Medicine(2019-1064);Shandong Science Program of Traditional Chinese Medicine(2021M006)

摘要/Abstract

摘要：

目的探讨悬吊推拿运动对脑卒中恢复期上肢痉挛的作用。

方法 2021年3月至2022年1月，山东中医药大学第二附属医院脑卒中恢复期上肢痉挛偏瘫患者60例，随机分为对照组(n = 30)和试验组(n = 30)。两组均行常规治疗，此外，对照组接受牵伸训练，试验组接受悬吊推拿运动训练，共4周。治疗前后采用改良Ashworth量表(MAS)、Fugl-Meyer评定量表上肢部分(FMA-UE)、改良Barthel指数(MBI)和神经电生理(H反射潜伏期、Hmax/Mmax)进行评定，采用表面肌电图测量患侧肱二头肌、肱三头肌、腕屈肌和腕伸肌的均方根值(RMS)和积分肌电值(iEMG)。

结果治疗后，两组各项指标均改善(|t| > 2.411, |Z| > 4.441, P < 0.05)，试验组部分肌群MAS评分、FMA-UE评分、MBI评分、H反射潜伏期、RMS以及部分受检肌iEMG优于对照组(|t| > 2.149, |Z| > 2.037, P < 0.05)。

结论悬吊推拿运动可改善脑卒中恢复期上肢痉挛，重建上肢肌肉平衡，提高患者上肢运动功能和日常生活独立水平。

关键词: 脑卒中, 偏瘫, 痉挛, 悬吊运动, 推拿, 交互抑制

Abstract:

Objective To explore the clinical efficacy of sling-massage exercise on upper limb spasticity for stroke patients.

Methods From March, 2021 to January, 2022, 60 patients with hemiplegia and spasticity from the Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine were randomly divided into control group (n= 30) and experimental group (n= 30). Both groups accepted conventional therapy; additionally, the control group accepted stretching training, while the experimental group accepted sling-massage exercise, for four weeks. They were assessed with modified Ashworth Scale (MAS), Fugl-Meyer Assessment-Upper Extremities (FMA-UE), modified Barthel Index (MBI), H-reflex latency and the Hmax/Mmax ratio before and after treatment; while the root mean square (RMS) and integrated electromyography (iEMG) of the affected biceps brachii, triceps brachii, wrist flexor and wrist extensor were measured with surface electromyography.

Results All the indexes improved after treatment in both groups (|t| > 2.411, |Z| > 4.441, P< 0.05), and the MAS scores of some muscles, FMA-UE score, MBI score, H-reflex latency, RMS and the iEMG of some muscles improved more in the experimental group than in the control group (|t| > 2.149, |Z| > 2.037, P< 0.05).

Conclusion Sling-massage exercise could improve upper limb spasticity, upper limb motor function and activities of daily living for stroke patients.

Key words: stroke, hemiplegia, spasm, sling exercise, massage, reciprocal inhibition

中图分类号:

R743.3

李泽文,张沛潇,李丽. 悬吊推拿运动对脑卒中恢复期上肢痉挛的效果[J]. 《中国康复理论与实践》, 2022, 28(11): 1252-1258.

LI Zewen,ZHANG Peixiao,LI Li. Effect of sling-massage exercise on upper limb spasticity for stroke patients at recovery stage[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2022, 28(11): 1252-1258.

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组别	n	性别(男/女)/n	年龄/岁	病程/周	卒中类型(缺血/出血)/n	偏瘫侧(左/右)/n
对照组	30	16/14	59.93±7.15	9.30±4.55	19/11	12/18
试验组	30	18/12	60.27±6.14	8.97±4.14	16/14	13/17
χ²/t值		0.271	-0.194	0.297	0.617	0.069
P值		0.602	0.847	0.768	0.432	0.793

组别	n	治疗前	治疗后	Z值	P值
对照组	30	3(3, 4)	1(1, 2)	-4.615	< 0.001
试验组	30	3(3, 4)	1(0, 1)	-4.672	< 0.001
Z值		-0.645	-2.145
P值		0.519	0.032

组别	n	治疗前	治疗后	Z值	P值
对照组	30	3(3, 4)	2(1, 2)	-4.815	< 0.001
试验组	30	3(3, 4)	1(1, 2)	-4.617	< 0.001
Z值		-0.761	-2.037
P值		0.446	0.042

组别	n	治疗前	治疗后	Z值	P值
对照组	30	3(3, 4)	2(1, 2)	-4.441	< 0.001
试验组	30	3(3, 4)	1(1, 2)	-4.765	< 0.001
Z值		-0.564	-1.746
P值		0.573	0.081

组别	n	治疗前	治疗后	t值	P值
对照组	30	28.67±8.05	41.83±7.15	-8.283	< 0.001
试验组	30	27.80±7.46	47.20±6.24	-11.677	< 0.001
t值		0.432	-3.096
P值		0.667	0.003

悬吊推拿运动对脑卒中恢复期上肢痉挛的效果

Effect of sling-massage exercise on upper limb spasticity for stroke patients at recovery stage

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组别	n	治疗前	治疗后	t值	P值
对照组	30	39.50±11.19	63.73±11.12	-9.121	< 0.001
试验组	30	40.63±11.42	72.07±10.87	-11.913	< 0.001
t值		-0.388	-2.936
P值		0.699	0.005

组别	n	治疗前	治疗后	t值	P值
对照组	30	26.97±12.03	12.94±7.15	9.956	< 0.001
试验组	30	27.65±11.27	8.75±4.81	11.964	< 0.001
t值		-0.226	2.660
P值		0.822	0.010

组别	n	治疗前	治疗后	t值	P值
对照组	30	13.25±5.30	7.35±3.96	7.894	< 0.001
试验组	30	12.82±5.61	5.36±2.11	7.452	< 0.001
t值		0.305	2.431
P值		0.761	0.018

组别	n	治疗前	治疗后	t值	P值
对照组	30	23.27±11.12	10.36±4.22	7.833	< 0.001
试验组	30	23.57±11.64	7.22±2.78	8.399	< 0.001
t值		-0.099	3.404
P值		0.922	0.001

组别	n	治疗前	治疗后	t值	P值
对照组	30	10.25±3.64	6.54±2.72	5.288	< 0.001
试验组	30	9.98±3.26	4.82±2.16	7.920	< 0.001
t值		0.313	2.698
P值		0.755	0.009

组别	n	治疗前	治疗后	t值	P值
对照组	30	30.94±9.19	40.08±10.46	-18.317	< 0.001
试验组	30	29.88±8.42	45.29±10.37	-30.568	< 0.001
t值		0.466	-1.933
P值		0.643	0.058

组别	n	治疗前	治疗后	t值	P值
对照组	30	35.32±9.77	40.13±8.43	-8.400	< 0.001
试验组	30	34.92±10.04	45.25±9.73	-23.276	< 0.001
t值		0.159	-2.179
P值		0.874	0.033

组别	n	治疗前	治疗后	t值	P值
对照组	30	47.35±10.47	61.13±8.48	-21.928	< 0.001
试验组	30	51.07±11.59	68.28±11.44	-23.994	< 0.001
t值		-1.305	-2.750
P值		0.197	0.008

组别	n	治疗前	治疗后	t值	P值
对照组	30	65.75±11.92	84.89±13.05	-36.647	< 0.001
试验组	30	69.47±11.84	92.35±13.85	-25.952	< 0.001
t值		-1.212	-2.149
P值		0.230	0.036

组别	n	治疗前	治疗后	t值	P值
对照组	30	25.21±1.72	26.20±0.58	-3.130	0.004
试验组	30	24.87±1.51	26.87±0.62	-7.566	< 0.001
t值		0.799	-4.360
P值		0.427	< 0.001

组别	n	治疗前	治疗后	t值	P值
对照组	30	0.195±0.047	0.168±0.061	2.411	0.022
试验组	30	0.216±0.065	0.146±0.057	6.635	< 0.001
t值		-1.422	1.390
P值		0.160	0.170

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