廖婵 张聪 李婷

【关键词】 针刺运动 强制性运动疗法 脑卒中 手功能障碍

[Abstract] Objective： To investigate the clinical effect of acupuncture exercise combined with compulsory exercise therapy in the treatment of hand dysfunction after stroke. Method： A total of 60 patients with hand dysfunction after stroke admitted to our hospital from January 2019 to October 2020 were selected， and they were divided into control group and study group according to random number table method， 30 cases in each group. The control group was treated with routine acupuncture and occupational intervention， the study group was treated with acupuncture exercise combined with compulsory exercise therapy intervention. The clinical efficacy was compared between two groups， the hand function scores， ADL scores， QOL scores， neurological impairment degree and motor function scores before and after intervention were compared between two groups. Result： Before intervention， there were no significant differences in hand function scores， ADL scores and QOL scores in all dimensions between two groups （P>0.05）; after intervention， hand function scores， ADL scores， QOL scores in all dimensions in both groups were higher than those before intervention， and those in the study group were higher than those in the control group， the differences were statistically significant （P<0.05）. The total effective rate in the study group was higher than that in the control group， the difference was statistically significant （P<0.05）. Before intervention， there were no significant differences in NIHSS and FMA scores between two groups （P>0.05）; after intervention， NIHSS scores in both groups were lower than those before intervention， and FMA scores in both groups were higher than those before intervention， and the NIHSS score in the study group was lower than that in the control group， and FMA score in the study group was higher than that in the control group， the differences were statistically significant （P<0.05）. Conclusion： Acupuncture exercise combined with compulsory exercise therapy intervention is conducive to the improvement of clinical efficacy， can improve the hand function of stroke patients， improve daily living ability， quality of life and motor function， but also can effectively improve the neurological function deficit， the effect is ideal， and it is worth learning.

[Key words] Acupuncture exercise Compulsory exercise therapy Stroke Hand dysfunction

First-author’s address： Pingxiang People’s Hospital， Pingxiang 337000， China

doi：10.3969/j.issn.1674-4985.2021.26.019

脑卒中属于缺血性脑血管疾病，临床发病率较高，致残、致死率也不断升高，脑卒中会损害丘脑，引起神经功能损伤，威胁患者生命安全[1]。随着临床诊疗技术进步，脑卒中的救治率也得到了提升，但致残率仍达80%左右，超过2/3患者有上肢功能障碍，其中以手指功能恢复难度最大，对患者日常生活能力的恢复造成严重影响[2]。在日常活动中，患者易用健侧代替患侧活动，导致患侧手失用，严重影响生活能力的恢复。中医学认为，针刺可舒缓血液流动，促进脑供血改善，而强制性运动属于新兴运动疗法，利于患侧肢体功能的恢复[3]。本研究对脑卒中患者进行针刺运动联合强制性运动疗法，探其对手功能障碍的临床效果，现报道如下。

1 资料与方法

1.1 一般资料 选取2019年1月-2020年10月本院接收的60例脑卒中后手功能障碍患者。纳入标准：（1）完善MR或头颅CT检查，结合临床症状，参照《中医病证诊断疗效标准》及高等医学院教材《神经病学》诊断相关标准，确诊为脑卒中，且处于康复期[4];（2）合并手部功能障碍，精神功能无异常，具备一定的认知功能，能交流沟通，治疗依从性良好;（3）首次发病，病程在6个月以内，存在单侧肢体偏瘫;（4）无心、肝、肺、肾等脏器功能障碍或血液循环功能障碍;（5）患者无支撑端坐可坚持30 min以上。排除标准：（1）合并影响运动功能、神经功能的疾病;（2）合并恶性肿瘤;（3）合并失语或视觉障碍;（4）生命体征不稳定。根据随机数字表法将患者分为研究组和对照组，每组30例。……