中醫推拿聯合化痰通絡解痙湯治療腦卒中后痙攣性癱瘓的臨床研究

徐桂珍 張捷 陳永茂

[摘要] 目的 探討中醫推拿聯合化痰通絡解痙湯治療腦卒中后痙攣性癱瘓的臨床效果。 方法 選取2018年9月—2019年6月四川省簡陽市人民醫院收治的腦卒中后痙攣性癱瘓患者106例，按照隨機數字表法將其分為對照組（n = 53）和觀察組（n = 53）。兩組均給予常規治療，對照組使用康復及中醫推拿治療，觀察組使用康復、中醫推拿以及化痰通絡解痙湯治療。比較兩組的臨床療效、血清谷氨酸（Glu）、γ-氨基丁酸（GABA）、改良Ashworth量表（MAS）、Fugl-Meyer運動功能量表（FMA）、Barthel指數（BI）評分及患者滿意度。 結果 觀察組總有效率高于對照組，差異有統計學意義（P < 0.05）。兩組治療后Glu水平較治療前降低，GABA水平較治療前升高，且觀察組Glu水平低于對照組，GABA水平高于對照組（P < 0.05）。兩組治療后MAS、FMA及BI評分均較治療前升高，且觀察組高于對照組（P < 0.05）。觀察組總滿意度高于對照組，差異有統計學意義（P < 0.05）。兩組治療期間均無不良反應發生。 結論 中醫推拿聯合化痰通絡解痙湯治療腦卒中后痙攣性癱瘓患者效果顯著，可有效改善患者血清氨基酸類神經遞質水平。

[關鍵詞] 中醫推拿;化痰通絡解痙湯;腦卒中;痙攣;癱瘓

[中圖分類號] R246.6? ? ? ? ? [文獻標識碼] A? ? ? ? ? [文章編號] 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.

觀察組總滿意度高于對照組，差異有統計學意義（P < 0.05）。見表4。

2.5 兩組患者不良反應情況

兩組治療期間均未產生與藥物相關的不良反應。

3 討論

腦卒中是導致我國成年人殘疾的首要因素，研究顯示，90%以上腦卒中患者在患病3周后出現偏癱痙攣，部分未得到及時治療，機體痙攣時間過長導致運動困難。腦卒中可損傷上肢運動神經元，釋放中樞反射，引起強直和運動障礙，而患者肢體長期處于痙攣狀態，如未能及時治療，則會出現肢體疼痛，甚至造成患者運動障礙。

臨床常使用康復聯合中醫推拿對腦卒中后痙攣性癱瘓患者進行治療。康復醫學認為，肢體的運動失去了高級中樞的調控才導致腦卒中患者出現痙攣性癱瘓[12]。康復治療通過各種感覺刺激促使患側肢體肌肉收縮，使肢體產生動作，出現共同運動[13]。……