Effect of transcutaneous electrical nerve stimulation in selected acupoints combined with rehabilitation training in treatment of spastic hemiplegia after craniotomy
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摘要:目的 探讨取穴经皮神经电刺激(TENS)联合康复训练治疗脑出血开颅术后痉挛性偏瘫的临床疗效。方法 将110例痉挛性偏瘫患者随机分为治疗组57例和对照组53例, 对照组进行为期6周的康复训练，治疗组在对照组基础上加用取穴TENS治疗，取患侧上下肢阳明经各4穴, TENS治疗每次60 min, 每周5~6次，连续6周。记录患者干预后患侧上下肢肌痉挛改善情况与肌电运动单位动作电位(MUAP)数目、Fugl-Meyer评分、Barthel指数变化情况。结果 干预6周后，治疗组上肢和下肢肌痉挛的治疗总有效率均显著高于对照组(P < 0.05)。干预后, 2组肱二头肌和小腿三头肌MUAP数目均较干预前显著下降(P < 0.05), 且治疗组较对照组下降更显著(P < 0.05)。干预6周后, 2组患肢Fugl-Meyer评分和Barthel指数均较干预前显著提高，且治疗组较对照组提高更显著(P < 0.05)。结论 采用康复训练联合取穴TENS治疗脑出血术后痉挛性偏瘫，能进一步减轻患者肌痉挛，有助于改善分离运动，提高运动功能。Abstract:Objective To observe the clinical efficacy of transcutaneous electrical nerve stimulation(TENS) of selected acupoints combined with rehabilitation training in treatment of spastic hemiplegia after craniotomy.Methods A total of 110 spastic hemiplegia patients were randomly divided into treatment group (n=57) and control group (n=53). The control group implemented a 6-week course of rehabilitation training, while the treatment group was additional given TENS of selected acupoints, four acupoints in Yangming meridian were selected in the upper and lower limbs of the affected side, and the duration of TENS was 60 min, 5 to 6 times a week, lasting for 6 weeks. The improvement of spasticity in the upper and lower limbs of the affected side, and the variations on the numbers of motor unit action potentials (MUAP), Fugl-Meyer score and Barthel index scores of the two group were compared.Results After 6 weeks of treatment, the total effective rate of upper and lower limbs with spasm in the treatment group was higher than that in the control group(P < 0.05). After treatment, the number of MUAP of the biceps brachii and the triceps triceps in both groups were decreased, and the treatment group decreased more significantly than that of the control group(P < 0.05). After 6 weeks of intervention, the scores of Fugl-Meyer score and Barthel index in two groups were greatly improved, and the treatment group increased more significantly than the control group(P < 0.05).Conclusion Rehabilitation training combined with TENS in acupoints in the treatment of spastic hemiplegia after cerebral hemorrhage can relieve muscle spasm, improve movement of separation and motor function.
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表 1 2组患者干预前基线资料比较(x±s)[n(%)]
组别 n 性别 年龄/岁 手术距入组时间/d 偏瘫部位 上肢Ashworth肌张力分级 BMI/(kg/m2) 男 女 左侧 右侧 1+级 2级 3级 4级 治疗组 57 31(54.4) 26(45.6) 57.1±6.5 71.3±18.2 32(56.1) 25(43.9) 4(7.0) 20(35.1) 24(42.1) 9(15.8) 24.5±3.0 对照组 53 34(64.2) 19(35.8) 55.4±6.1 65.5±15.8 33(62.3) 20(37.7) 7(13.2) 21(39.6) 19(35.8) 6(11.3) 23.8±2.5 BMI: 体质量指数。 
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表 2 2组患者干预后上下肢肌痉挛改善情况比较[n(%)]
组别 肢体部位 显效 有效 无效 总有效 对照组(n=53) 上肢 14(26.4) 30(56.6) 9(17.0) 44(83.0) 下肢 15(28.3) 26(49.1) 12(22.6) 41(77.4) 治疗组(n=57) 上肢 25(43.9) 27(47.4) 5(8.8) 52(91.2)* 下肢 21(36.8) 28(49.1) 8(14.0) 49(86.0)* 与对照组比较, *P < 0.05。
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表 3 2组患者干预前后患侧MUAP数目比较(x±s)
组别 n 肱二头肌 小腿三头肌 干预前 干预后 干预前 干预后 对照组 53 19.1±2.3 13.4±2.7* 21.5±2.7 15.2±2.9* 治疗组 57 18.8±2.8 9.7±1.9*# 20.3±2.3 11.5±2.6*# 与干预前比较, *P < 0.05; 与对照组比较, #P < 0.05。
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表 4 2组患者干预前后Fugl-Meyer评分与Barthel指数比较(x±s)
分 组别 n Fugl Meyer评分 Bathel指数 干预前 干预后 干预前 干预后 对照组 53 47.8±8.8 73.2±9.7* 38.7±8.2 55.3±8.5* 治疗组 57 45.2±9.1 75.3±12.5*# 37.6±7.8 57.3±9.2*# 与干预前比较, *P < 0.05; 与对照组比较, #P < 0.05。
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