1.福建中医药大学护理学院,福建省福州市闽侯上街邱阳路1号,350122
2.福建省福州市第二总医院
3.福建省龙岩市中医院
973883018@qq.com
收稿:2024-02-22,
修回:2024-09-30,
纸质出版:2025-01-17
移动端阅览
李壮苗,李施恩,李霞等.四子散定向透药对脑卒中偏瘫患者上肢运动功能影响的随机对照研究[J].中医杂志,2025,66(02):157-164.
LI Zhuangmiao,LI Shien,LI Xia,et al.Effect of Sizi Powder (四子散) Orientation Osmotherapy on Upper Limb Motor Function in Stroke Patients with Hemiplegia:A Randomized Controlled Study[J].Journal of Traditional Chinese Medicine,2025,66(02):157-164.
李壮苗,李施恩,李霞等.四子散定向透药对脑卒中偏瘫患者上肢运动功能影响的随机对照研究[J].中医杂志,2025,66(02):157-164. DOI: 10.13288/j.11-2166/r.2025.02.010.
LI Zhuangmiao,LI Shien,LI Xia,et al.Effect of Sizi Powder (四子散) Orientation Osmotherapy on Upper Limb Motor Function in Stroke Patients with Hemiplegia:A Randomized Controlled Study[J].Journal of Traditional Chinese Medicine,2025,66(02):157-164. DOI: 10.13288/j.11-2166/r.2025.02.010.
目的
2
观察四子散定向透药治疗脑卒中偏瘫患者的临床疗效和安全性。
方法
2
将脑卒中偏瘫患者94例随机分为对照组和治疗组各47例。对照组进行常规治疗、护理及康复训练,治疗组在对照组的基础上进行四子散定向透药治疗,每次20 min,每日1次,每周5次,2周为1个疗程,共治疗2个疗程。于治疗前、治疗2周后、治疗4周后采用Fugl-Meyer肢体运动功能评定量表的上肢部分(U-FMA)总分评价上肢运动功能,采用改良Ashworth痉挛量表(MAS)评定患者上肢痉挛程度,检测肩关节前屈、后伸、外展、内旋、外旋,肘关节屈曲,腕关节掌屈、背伸、尺屈、桡屈的关节活动度;治疗2周、4周后评价痉挛临床疗效;研究过程中观察患者实施部位皮肤情况如有无烫伤、过敏、水疱等不良反应。
结果
2
最终治疗组44例、对照组45例完成试验。治疗2周、4周后两组患者U-FMA总分均较本组治疗前升高,且治疗组总分均高于对照组(
P
<0.05)。两组患者治疗4周后MAS等级分布较治疗前改善(
P
<0.05),但两组治疗2周、4周后MAS等级分布比较差异均无统计学意义(
P
>0.05)。治疗组治疗2周、4周后痉挛临床疗效总有效率分别为15.91%(7/44
)、40.91%(18/44),对照组分别为11.11%(5/45)、22.22%(10/45),两组治疗2周后总有效率比较差异无统计学意义(
P
>0.05),治疗4周后治疗组总有效率高于对照组(
P
<0.05)。两组患者治疗2周、4周后上肢各关节活动度均大于本组治疗前(
P
<0.05);治疗2周后治疗组肩前屈、肩后伸、肩外展的活动度均大于对照组,治疗4周后治疗组肩前屈、肩后伸、肩外展、肩内旋、肩外旋、肘屈活动度均大于对照组(
P
<0.05)。治疗过程中,治疗组1例患者出现轻度皮肤过敏,其余患者均未发生剧烈疼痛、瘙痒、严重水疱、感染等不良反应。
结论
2
四子散定向透药能够有效改善脑卒中偏瘫患者上肢运动功能和关节活动度,治疗4周可改善上肢痉挛程度、提高临床疗效,且安全性较好。
Objective
2
To observe the clinical efficacy and safety of
Sizi Powder
(四子散, SP) orientation osmotherapy in the treatment of stroke patients with hemiplegia.
Methods
2
In this study, 94 patients with post-stroke hemiplegia were randomly divided into a control group and a treatment group with 47 patients in each group. The control group received conventional treatment, nursing and rehabilitation training, while the treatment group was treated with SP orientation osmotherapy in addition to the treatments in the control group. The treatment consisted of 20 minutes per session, once daily, 5 times a week, 2 weeks per course, with a total of 2 courses. Before the intervention, after 2 weeks intervention and after 4 weeks intervention, the upper limb motor function was evaluated by using the Fugl-Meyer Assessment (U-FMA). The modified Ashworth Scale (MAS) was used to assess upper limb spasticity, and joint range of motion was measured for shoulder flexion, extension, abduction, internal rotation, external rotation, elbow flexion, wrist palmar flexion, dorsiflexion, ulnar deviation, and radial deviation. Clinical efficacy for spasticity was evaluated after 2 and 4 weeks of treatment. Skin conditions, including burns, allergic reactions, and blisters, were monitored during the treatment process.
Results
2
A total of 44 patients in the treatment group and 45 patients in the control group completed the study. The results showe
d that after 2 and 4 weeks of intervention, the U-FMA scores of both groups increased, with the treatment group showing higher scores than the control group (
P
<0.05). After 4 weeks of treatment, the MAS score distribution improved significantly in both groups (
P
<0.05), although no significant difference was found between the groups after 2 and 4 weeks treatment(
P
>0.05). The total effective rate of spasticity clinical efficacy in the treatment group after 2 and 4 weeks was 15.91% (7/44) and 40.91% (18/44), respectively, while in the control group, it was 11.11% (5/45) and 22.22% (10/45). There was no significant difference after 2 weeks treatment (
P
>0.05), but the treatment group showed a significantly higher total effective rate after 4 weeks treatment (
P
<0.05). After 2 and 4 weeks of treatment, the joint range of motion in the upper limbs was greater in both groups (
P
<0.05). After 2 weeks of intervention, the treatment group showed greater range of motion in shoulder flexion, extension, and abduction than the control group, and after 4 weeks of intervention, the treatment group demonstrated greater range of motion in shoulder flexion, extension, abduction, internal rotation, external rotation, and elbow flexion compared to the control group (
P
<0.05). During the treatment, one patient in the treatment group experienced mild skin allergy, while no other severe adverse reactions, such as intense pain, itching, blisters, or infection, were observed in any patients.
Conclusion
2
SP orientation osmotherapy can effectively improve upper limb motor function and joint range of motion in stroke patients with hemiplegia. After 4 weeks of treatment, it can reduce upper limb spasticity and improve clinical efficacy, with good safety.
CHINNAVAN E , PRIYA Y , RAGUPATHY R , et al . Effectiveness of mirror therapy on upper limb motor functions among hemiplegic patients [J]. Bangladesh J Med Sci , 2020 , 19 ( 2 ): 208 - 213 .
彭闪闪 . 不同频率的中频脉冲电疗法对急性脑梗死偏瘫患者肢体功能康复的疗效研究 [D]. 新乡 : 新乡医学院 , 2021 .
张蕊 , 李壮苗 , 庄玲玲 , 等 . 脑卒中后情感障碍患者叙事护理研究进展 [J]. 护理学杂志 , 2023 , 38 ( 4 ): 120 - 124 .
赵若男 , 宋瑞 , 何丽云 , 等 . 中医综合康复方案治疗中风后关节活动障碍前瞻性队列研究 [J]. 中医杂志 , 2022 , 63 ( 21 ): 2060 - 2065 .
王君鳌 , 邓晋丰 . 邓晋丰教授治疗膝骨性关节炎用药经验总结 [J]. 新中医 , 2016 , 48 ( 6 ): 214 - 217 .
李壮苗 , 陈岚榕 , 李荣清 , 等 . 四子散加粗盐循经热熨对脑卒中痉挛性偏瘫患者的影响 [J]. 中华护理杂志 , 2019 , 54 ( 5 ): 690 - 695 .
覃桂水 . 中医定向透药疗法治疗60例脑卒中肢体半身不遂的临床观察 [J]. 中国医药指南 , 2019 , 17 ( 23 ): 168 - 169 .
张婷 . 中医定向透药疗法治疗偏瘫肩痛患者疗效的临床观察 [D]. 蚌埠 : 蚌埠医学院 , 2017 .
中华医学会神经病学分会 , 中华医学会神经病学分会脑血管病学组 . 中国急性缺血性脑卒中诊治指南2018 [J]. 中华神经科杂志 , 2018 , 51 ( 9 ): 666 - 682 .
中华医学会神经病学分会 , 中华医学会神经病学分会脑血管病学组 . 中国脑出血诊治指南(2019) [J]. 中华神经科杂志 , 2019 , 52 ( 12 ): 994 - 1005 .
BOHANNON RW , SMITH MB . Interrater reliability of a modified Ashworth scale of muscle spasticity [J]. Phys Ther , 1987 , 67 ( 2 ): 206 - 207 .
BRUNNSTROM S , SAWNER KA , LAVIGNE JM . Brunnstrom's movement therapy in hemiplegia : a neurophysiological approach [M]. 2nd ed . Philadelphia : J.B.Lippincott Company , 1992 : 57 - 60 .
FUGL-MEYER AR , JAÄSKÖ L , LEYMAN I , et al . The post-stroke hemiplegic patient.1.a method for evaluation of physical performance [J]. Scand J Rehabil Med , 1975 , 7 ( 1 ): 13 - 31 .
薛丽杰 . 中医定向透药疗法联合康复训练对于脑卒中患者肢体功能恢复的效果观察研究 [J]. 反射疗法与康复医学 , 2020 , 29 ( 7 ): 16 - 17,20 .
史周华 , 何雁 . 中医药统计学与软件应用 [M]. 2版 . 北京 : 中国中医药出版社 , 2017 : 268 - 269 .
中华医学会神经病学分会 , 中华医学会神经病学分会神经康复学组 , 中华医学会神经病学分会脑血管病学组 . 中国脑卒中早期康复治疗指南 [J]. 中华神经科杂志 , 2017 , 50 ( 6 ): 405 - 412 .
国家市场监督管理总局 , 国家标准化管理委员会 . 经穴名称与定位 [EB/OL].( 2021-11-26 )[ 2023-03-14 ]. https://www.nssi.org.cn/nssi/front/115424470.html https://www.nssi.org.cn/nssi/front/115424470.html .
寇程 , 刘小燮 , 毕胜 . 四种上肢功能评定量表用于脑卒中患者的信度研究 [J]. 中华物理医学与康复杂志 , 2013 , 35 ( 4 ): 269 - 272 .
郭铁成 , 卫小梅 , 陈小红 . 改良Ashworth量表用于痉挛评定的信度研究 [J]. 中国康复医学杂志 , 2008 , 23 ( 10 ): 906 - 909 .
韦珊瑶 . 温阳益气通络法联合替扎尼定治疗中风后痉挛性偏瘫的临床研究 [D]. 南宁 : 广西中医药大学 , 2020 .
王艳 . 康复评定学 [M]. 2版 . 北京 : 人民卫生出版社 , 2018 : 46 - 58 .
杨玺 . 用于脑卒中上肢功能评定三种量表的效果评价 [D]. 南京 : 东南大学 , 2017 .
夏小敏 , 阮丽玲 . 中医定向透药治疗仪联合早期康复护理对脑卒中患者功能康复的影响 [J]. 黑龙江医学 , 2020 , 44 ( 11 ): 1626 - 1628 .
许秀峰 . 头针联合肌电生物反馈治疗脑卒中后上肢功能障碍临床研究 [D]. 长沙 : 湖南中医药大学 , 2020 .
贺敬波 . 《辨证奇闻》中白芥子的运用规律探讨 [J]. 环球中医药 , 2020 , 13 ( 8 ): 1377 - 1378 .
蒋蔓菁 . 超声电导定向透药技术对重症患者幽门后置管成功率影响的临床研究 [D]. 杭州 : 浙江中医药大学 , 2022 .
陈施一骏 . 复方癌痛方采用中医定向透药法治疗瘀毒内结型中重度癌性疼痛的临床研究 [D]. 长沙 : 湖南中医药大学 , 2019 .
韩玉 . 针刺健侧运动区改善中风后遗症期上肢运动功能的临床疗效观察 [D]. 哈尔滨 : 黑龙江中医药大学 , 2019 .
邰先桃 , 黄学平 , 陈奇刚 , 等 . 电针对脑卒中后偏瘫患者上肢运动功能影响的研究 [J]. 时珍国医国药 , 2018 , 29 ( 12 ): 2948 - 2950 .
DAS J , RAJANIKANT GK . Post stroke depression: the sequelae of cerebral stroke [J]. Neurosci Biobehav Rev , 2018 , 90 ( 7 ): 104 - 114 .
0
浏览量
0
下载量
0
CSCD
关联资源
相关文章
相关作者
相关机构
京公网安备11010102007558号