徐桂珍 张捷 陈永茂

[摘要] 目的 探討中医推拿联合化痰通络解痉汤治疗脑卒中后痉挛性瘫痪的临床效果。 方法 选取2018年9月—2019年6月四川省简阳市人民医院收治的脑卒中后痉挛性瘫痪患者106例，按照随机数字表法将其分为对照组（n = 53）和观察组（n = 53）。两组均给予常规治疗，对照组使用康复及中医推拿治疗，观察组使用康复、中医推拿以及化痰通络解痉汤治疗。比较两组的临床疗效、血清谷氨酸（Glu）、γ-氨基丁酸（GABA）、改良Ashworth量表（MAS）、Fugl-Meyer运动功能量表（FMA）、Barthel指数（BI）评分及患者满意度。 结果 观察组总有效率高于对照组，差异有统计学意义（P < 0.05）。两组治疗后Glu水平较治疗前降低，GABA水平较治疗前升高，且观察组Glu水平低于对照组，GABA水平高于对照组（P < 0.05）。两组治疗后MAS、FMA及BI评分均较治疗前升高，且观察组高于对照组（P < 0.05）。观察组总满意度高于对照组，差异有统计学意义（P < 0.05）。两组治疗期间均无不良反应发生。 结论 中医推拿联合化痰通络解痉汤治疗脑卒中后痉挛性瘫痪患者效果显著，可有效改善患者血清氨基酸类神经递质水平。

[关键词] 中医推拿;化痰通络解痉汤;脑卒中;痉挛;瘫痪

[中图分类号] R246.6          [文献标识码] A          [文章编号] 1673-7210（2020）07（c）-0165-04

Clinical study of traditional Chinese medicine massage combined with Huatan Tongluo Jiejing Decoction in the treatment of spastic paralysis after stroke

XU Guizhen   ZHANG Jie   CHEN Yongmao

Department of Rehabilitation， People′s Hospital of Jianyang City， Sichuan Province， Jianyang   641500， China

[Abstract] Objective To explore clinical effect of traditional Chinese medicine massage combined with Huatan Tongluo Jiejing Decoction in the treatment of spastic paralysis after stroke. Methods One hundred and six patients with spastic paralysis after stroke treated in People′s Hospital of Jianyang City from September 2018 to June 2019 were divided into control group （n = 53） and observation group （n = 53） by random number table method. Two groups were given routine treatment. Control group was treated with rehabilitation and massage therapy of traditional Chinese medicine. Observation group was treated with rehabilitation and massage therapy of traditional Chinese medicine and Huatan Tongluo Jiejing Decoction. Clinical efficacy， serum glutamate （Glu）， gamma aminobutyric acid （GABA）， modified Ashworth scale （MAS）， fugl meyer motor function scale （FMA）， Barthel index （BI） and patient satisfaction were compared between two groups. Results Total effective rate in observation group was higher than that in control group， the difference was statistically significant （P < 0.05）. After treatment， Glu level in two groups was lower than that before treatment， and GABA level in two groups was higher than that before treatment， Glu level in observation group was lower than that in control group， and GABA level in observation group was higher than that in control group （P < 0.05）. After treatment， the scores of MAS， FMA and BI in two groups were higher than those before treatment， and the scores in observation group were higher than those in control group （P < 0.05）. Total satisfaction of observation group was higher than that of control group （P < 0.05）. No adverse reactions occurred in two groups during the treatment. Conclusion Traditional Chinese medicine massage combined with Huatan Tongluo Jiejing Decoction has a significant effect in the treatment of spastic paralysis after stroke， which can effectively improve the level of serum amino acid neurotransmitters.

观察组总满意度高于对照组，差异有统计学意义（P < 0.05）。见表4。

2.5 两组患者不良反应情况

两组治疗期间均未产生与药物相关的不良反应。

3 讨论

脑卒中是导致我国成年人残疾的首要因素，研究显示，90%以上脑卒中患者在患病3周后出现偏瘫痉挛，部分未得到及时治疗，机体痉挛时间过长导致运动困难。脑卒中可损伤上肢运动神经元，释放中枢反射，引起强直和运动障碍，而患者肢体长期处于痉挛状态，如未能及时治疗，则会出现肢体疼痛，甚至造成患者运动障碍。

临床常使用康复联合中医推拿对脑卒中后痉挛性瘫痪患者进行治疗。康复医学认为，肢体的运动失去了高级中枢的调控才导致脑卒中患者出现痉挛性瘫痪[12]。康复治疗通过各种感觉刺激促使患侧肢体肌肉收缩，使肢体产生动作，出现共同运动[13]。……