目的 评价经皮穴位电刺激对脑卒中后手功能障碍者的康复疗效。方法 2013年3月至2015年6月,56例脑卒中手功能障碍者分成A组(n=28)和B组(n=28),A组接受基础康复训练,B组接受经皮穴位电刺激和基础康复训练,共6周。治疗后采用Brunnstrom偏瘫手功能分级、徒手肌力检查(MMT)、Fugl-Meyer评定(FMA)手指运动功能部分、运动功能状态量表(MSS)、改良Ashworth量表(MAS)、美国国立卫生院脑卒中量表(NIHSS)、手运动功能状态评分和Barthel指数(BI)进行评定。结果 治疗后,B组FMA评分、Brunnstrom上肢和手分级、MMT腕关节掌屈肌力、MSS评分、MAS评分及BI评分均高于A组(t>2.2527, P<0.05),NIHSS评分显著低于A组(t=3.5559, P<0.001);手运动功能评分和MMT腕关节背屈肌力两组间无显著性差异(t<0.3095, P>0.05)。结论 经皮穴位电刺激能促进脑卒中后手功能恢复,提高脑卒中患者的日常生活活动能力。
Objective To observe the effects of transcutaneous electrical acupoint stimulation (TEAS) on hand dysfunction after stroke. Methods From March, 2013 to June, 2015, 56 cases of stroke with hand dysfunction were divided into group A (n=28) and group B (n=28). Both groups received basic rehabilitation, while group B received TEAS in addition, for six weeks. They were evaluated with Brunnstrom Grades, Manunl Muscle Test (MMT), Fugl-Meyer Assessment (FMA) of fingers, Motor Status Scale (MSS), modified Ashworth Scale (MAS), National Institutes of Health Stroke Scale (NIHSS), Motor Hand Functional Status Score and Barthel Index (BI). Results The scores of FMA of fingers, MMT of wrist flexion, MSS, MAS and BI were more in group B than in group A (t>2.2527, P<0.05), and the score of NIHSS was less in group B (t=3.556, P<0.001). There was no significant difference between two groups in the score of Motor Hand Functional Status Score and MMT of wrist extension (t<0.310, P>0.05). Conclusion TEAS can promote the recovery of hand function and the activities of daily living in patients after stroke.
[1] 左婷飞,杨白燕. 针刺治疗脑卒中偏瘫后手功能障碍85例[J]. 长春中医药大学学报, 2012, 28(8): 677-678.
[2] Musicco M, Emberti L, Nappi G, et al. Early and long-term outcome of rehabilitation in stroke patients: the role of patient characteristics, time of initiation, and duration of interventions [J]. Arch Phys Med Rehabil, 2003, 84(4): 551-558.
[3] Bernhardt J, Dewey H, Thrift A, et al. A very early rehabilitation trial for stroke (AVERT): phase II safety and feasibility [J]. Stroke, 2008, 39(2): 390-396.
[4] 宋佳牡,陈璇. 电按摩联合被动运动对脑卒中患者手功能恢复的效果[J]. 上海护理, 2014, 14(2): 14-16.
[5] 高燕玲,陈立典,陶静. 电针肌肉运动点对脑卒中患者手功能障碍的影响[J]. 中国康复医学杂志, 2011, 26(12): 1167-1168.
[6] 彭源,张瑾,苏常春,等. 经皮穴位电刺激对脑卒中患者上肢功能及运动诱发电位的影响[J]. 中国康复医学杂志, 2015, 30(6): 547-550.
[7] 王丽菊,陈立早,欧艺,等. 镜像视觉反馈和肌电生物反馈对脑卒中偏瘫患者上肢功能的影响[J]. 中国康复理论与实践, 2015, 21(2): 202-206.
[8] 苟成钢. 针刀治疗脑卒中上肢及手功能障碍临床观察[J]. 中国中医急症, 2015, 24(7): 1272-1274.
[9] 朱琳,宋为群,张肉,等. 优化运动技巧的康复训练对卒中后上肢功能恢复的作用[J]. 中国脑血管病杂志, 2013, 10(1): 23.
[10] Li Q, Xu F, Liang FX, et al. Effects of electroacupuncture with manifestation-root acupoint combination on ultra-structure and biosynthesis in mitochondrial of quadriceps femoris in rats with insulin resistance [J]. Zhongguo Zhen Jiu, 2014, 34(6): 578-582.
[11] 王英姿,谢辉,李国民,等. 神经干刺激结合电针拮抗肌穴位治疗脑卒中上肢痉挛临床观察[J]. 上海针灸, 2015, 34(6): 518-520.
[12] 郑薏,柳维林,上官豪,等. 针灸治疗脑卒中患者肢体运动功能障碍疗效的Meta分析[J]. 中国康复医学杂志, 2016, 31(2): 217-221.
[13] 陈付艳,李桂平. 针刺配合神经肌肉电刺激治疗缺血性卒中后运动性失语临床观察[J]. 上海针灸, 2015, 34(10): 944-946.
[14] 赵健乐,韩春,李景琦. 脑卒中康复治疗新策略[J]. 中国康复理论与实践, 2014, 20(10): 928-931.
[15] 彭源,张瑾,张廷碧,等. 经皮穴位电刺激对脑卒中患者偏瘫下肢运动功能的影响[J]. 广州医药, 2015, 46(1): 19-22.
[16] 唐朝正,贾杰. 经皮电神经刺激在脑卒中后上肢功能障碍中的应用[J]. 中国康复理论与实践, 2014, 20(4): 306-310.
[17] Au-Yeung SS, Hui-Chan CW. Electrical acupoint stimulation of the affected arm in acute stroke: a placebo-controlled randomized clinical trial [J]. Clin Rehabil, 2014, 28(2): 149-158.
[18] Kim TH, In TS, Cho HY. Task-related training combined with transcutaneous electrical nerve stimulation promotes upper limb functions in patients with chronic stroke [J]. Tohoku J Exp Med, 2013, 231(2): 93-100.
[19] 黄烈弥,喻佳丽,杨秋萍. 经皮穴位电刺激对脑梗死后偏瘫患者肢体功能障碍康复的影响[J]. 中华物理医学与康复杂志, 2016, 38(1): 49-51.
[20] Massie CL, Malcolm MP, Greene DP, et al. Biomechanical contributions of the trunk and upper extremity in discrete versus cyclic reaching in survivors of stroke [J]. Top Stroke Rehabil, 2013, 22: 1-10.
[21] Cordo P, Wolf S, Lous JS, et al. Treatment of severe hand impairment following stroke by combining assisted movement, muscle vibration, and biofeedback [J]. J Neurol Phys Ther, 2013, 37(4): 194-203.
[22] 唐朝正,李春燕,张晓莉,等. 低频经皮穴位电刺激对软瘫期脑卒中患者手和上肢功能的影响[J]. 中国康复理论与实践, 2015, 21(3): 252-255.
[23] 刘靖芷,郑宝森,杨艳梅,等. 等离子射频髓核成形术复合臭氧髓核消融术治疗间盘源性疼痛[J]. 天津医药, 2012, 40(7): 742-743.
[24] 董悦,董玉茹,姜胤. 手针、电针及经皮穴位电刺激调节人脑功能的功能性磁共振观察[J]. 中国疼痛医学杂志, 2013, 19(2): 75-79.
[25] 陈瑶,田婧,谢蓓,等. 经皮穴位电刺激在脑卒中后手功能障碍康复中的应用[J]. 中国康复医学杂志, 2015, 30(5): 454-457.