針刺結合康復治療腦出血偏癱患者102例療效觀察
【關鍵詞】 腦出血/偏癱下肢;針刺/神經干刺激療法;康復訓練
1、臨床資料
2006.12/2007.12收治腦出血偏癱患者102(男62,女40)例,年齡40~71(60±3)歲.其中基底節出血40例,額葉出血24例,顳葉出血20例,枕葉出血16例.臨床診斷均符合1995年全國第四屆腦血管病會議制定的標準①,且均接受頭顱(lu)CT或MRI檢(jian)查,發病(bing)24h后(hou)仍留(liu)有(you)下(xia)(xia)肢運(yun)(yun)動(dong)(dong)(dong)(dong)障(zhang)(zhang)礙(ai).有(you)嚴重(zhong)心(xin)肺(fei)疾病(bing)、關(guan)(guan)節疾病(bing)、意識障(zhang)(zhang)礙(ai)、語(yu)言(yan)理解障(zhang)(zhang)礙(ai)者除(chu)外.所有(you)患(huan)者均給(gei)予常(chang)規治(zhi)(zhi)療(liao)(liao)(liao)(liao),待生命體征(zheng)穩定、神(shen)志清、顱(lu)內壓正常(chang)后(hou)開始針(zhen)刺(ci)(ci)康(kang)復治(zhi)(zhi)療(liao)(liao)(liao)(liao).①針(zhen)刺(ci)(ci)刺(ci)(ci)激(ji)(ji)(ji)(ji)(ji)點選擇:臀下(xia)(xia)神(shen)經(jing)(jing)刺(ci)(ci)激(ji)(ji)(ji)(ji)(ji)點(相當于(yu)會(hui)陽穴)、坐骨神(shen)經(jing)(jing)刺(ci)(ci)激(ji)(ji)(ji)(ji)(ji)點(為(wei)環(huan)跳穴和(he)(he)殷門穴)、股(gu)神(shen)經(jing)(jing)刺(ci)(ci)激(ji)(ji)(ji)(ji)(ji)點(位(wei)(wei)于(yu)腹(fu)股(gu)溝韌帶(dai)下(xia)(xia)1寸,股(gu)動(dong)(dong)(dong)(dong)脈外側緣(yuan))、脛神(shen)經(jing)(jing)刺(ci)(ci)激(ji)(ji)(ji)(ji)(ji)點(相當于(yu)合陽穴)、腓總神(shen)經(jing)(jing)刺(ci)(ci)激(ji)(ji)(ji)(ji)(ji)點(位(wei)(wei)于(yu)腓骨小頭后(hou)下(xia)(xia)方(fang)0.5cm處),用(yong)(yong)(yong)毫針(zhen)刺(ci)(ci)法(fa)(fa),要求強(qiang)刺(ci)(ci)激(ji)(ji)(ji)(ji)(ji)、針(zhen)感(gan)強(qiang),留(liu)針(zhen)30min,其間行(xing)(xing)針(zhen)3次(ci)(ci),每(mei)日(ri)針(zhen)刺(ci)(ci)1次(ci)(ci),10次(ci)(ci)為(wei)一療(liao)(liao)(liao)(liao)程,每(mei)療(liao)(liao)(liao)(liao)程間休息(xi)2d.②康(kang)復訓練(lian):患(huan)者下(xia)(xia)肢功(gong)能(neng)Brunnstrom1~2期時保持良肢位(wei)(wei),進行(xing)(xing)肢體按(an)摩,被動(dong)(dong)(dong)(dong)活動(dong)(dong)(dong)(dong)肢體,運(yun)(yun)用(yong)(yong)(yong)興(xing)奮性易化技(ji)術(shu)提(ti)高(gao)肌張力;Brunnstrom達(da)3~4期時,行(xing)(xing)主、被動(dong)(dong)(dong)(dong)運(yun)(yun)動(dong)(dong)(dong)(dong)關(guan)(guan)節和(he)(he)坐位(wei)(wei)平(ping)(ping)衡訓練(lian);Brunnstrom達(da)4~5期時,糾(jiu)正和(he)(he)抑制異(yi)常(chang)運(yun)(yun)動(dong)(dong)(dong)(dong)模(mo)式,提(ti)高(gao)正常(chang)運(yun)(yun)動(dong)(dong)(dong)(dong)模(mo)式和(he)(he)協調能(neng)力,運(yun)(yun)用(yong)(yong)(yong)手法(fa)(fa)降(jiang)低肌張力,訓練(lian)立位(wei)(wei)平(ping)(ping)衡,下(xia)(xia)肢負(fu)重(zhong),平(ping)(ping)衡杠(gang)內行(xing)(xing)走,糾(jiu)正步態(tai).每(mei)日(ri)2次(ci)(ci),每(mei)次(ci)(ci)訓練(lian)45min.療(liao)(liao)(liao)(liao)效評(ping)價(jia)采用(yong)(yong)(yong)FuglMeyer評(ping)價(jia)法(fa)(fa),分(fen)(fen)別(bie)對患(huan)者治(zhi)(zhi)療(liao)(liao)(liao)(liao)前(qian)和(he)(he)治(zhi)(zhi)療(liao)(liao)(liao)(liao)2mo后(hou)偏癱下(xia)(xia)肢運(yun)(yun)動(dong)(dong)(dong)(dong)功(gong)能(neng)進行(xing)(xing)評(ping)分(fen)(fen)后(hou)分(fen)(fen)級(ji)(ji),總分(fen)(fen)34分(fen)(fen).嚴重(zhong)運(yun)(yun)動(dong)(dong)(dong)(dong)障(zhang)(zhang)礙(ai)(0~16分(fen)(fen))為(wei)Ⅰ級(ji)(ji),明(ming)顯運(yun)(yun)動(dong)(dong)(dong)(dong)障(zhang)(zhang)礙(ai)(17~28分(fen)(fen))為(wei)Ⅱ級(ji)(ji),中度運(yun)(yun)動(dong)(dong)(dong)(dong)障(zhang)(zhang)礙(ai)(29~30分(fen)(fen))為(wei)Ⅲ級(ji)(ji),輕度運(yun)(yun)動(dong)(dong)(dong)(dong)障(zhang)(zhang)礙(ai)(31~33分(fen)(fen))為(wei)Ⅳ級(ji)(ji),正常(chang)運(yun)(yun)動(dong)(dong)(dong)(dong)功(gong)能(neng)(34分(fen)(fen))為(wei)Ⅴ級(ji)(ji).治(zhi)(zhi)療(liao)(liao)(liao)(liao)前(qian)Ⅰ級(ji)(ji)64例,Ⅱ級(ji)(ji)26例,Ⅲ級(ji)(ji)12例;治(zhi)(zhi)療(liao)(liao)(liao)(liao)后(hou)Ⅱ級(ji)(ji)10例,Ⅲ級(ji)(ji)49例,Ⅳ級(ji)(ji)31例,Ⅴ級(ji)(ji)12例.
2、討論
腦出血患者神經功能損傷后,中樞神經系統的可塑性和功能上的重組,使腦細胞可以通過軸突再生、樹突發芽及改變突觸閾值等途徑恢復正常功能.神經康復技術通過反射和隨意運動的結合促進正確的運動反應形成,降低神經傳導中突觸阻力,產生由意志控制的隨意運動,從而在中樞神經系統中建立一條新的神經傳導通路,恢復正常的運動功能②.毫針對外周神經干刺激后,通過脊髓反射通路,不斷向脊中樞輸入運動、感覺刺激信息,從而使軟、硬偏癱均得到一定恢復③.我(wo)們使用神(shen)經(jing)干刺激療法結合現代康(kang)復技術對(dui)102例腦(nao)出(chu)(chu)血患者偏(pian)癱(tan)下(xia)(xia)肢進行(xing)了系統的(de)(de)(de)治(zhi)療,顯著提高了患者偏(pian)癱(tan)下(xia)(xia)肢的(de)(de)(de)運動功能,并有效(xiao)防止了如壓瘡、肌(ji)肉萎縮、關節攣縮的(de)(de)(de)并發(fa)(fa)癥的(de)(de)(de)發(fa)(fa)生和(he)異常模式的(de)(de)(de)出(chu)(chu)現,起到了良性的(de)(de)(de)治(zhi)療和(he)促進作用.
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