摘要
目的观察芍药甘草汤化裁（芍甘汤）联合运动训练治疗脑卒中后偏瘫肘关节屈曲痉挛（其痉挛等级包括I、I^＋、Ⅱ级）的临床疗效。方法将197例脑卒中后肘关节屈曲痉挛患者按痉挛等级不同进行分层，采用随机数字表法将各层面患者分为治疗组（给予芍甘汤及运动训练）、对照1组（给予运动训练）及对照2组（给予巴氯芬及运动训练），疗程均为3周。于治疗前、治疗3周后分别采用改良Ashworth量表（MAS）、Barthel指数量表（BI）、简化Fugl-Meyer评分（FMA）上肢部分及Berg平衡量表（BBS）对各组患者进行疗效评定。结果在人选时肌张力为I级层面，发现治疗组、对照2组痉挛改善等级均显著优于对照1组（P〈0．05），治疗组BI、FMA及BBS评分改善情况均显著优于对照1组及对照2组（P〈0．05）；在入选时肌张力为I^＋级层面，发现治疗组、对照2组痉挛改善等级均显著优于对照1组（P〈0．05）；治疗组、对照2组BI、FMA评分改善情况均显著优于对照1组（P〈0．05）；治疗组BBS评分改善情况均显著优于对照1组、对照2组（P〈0．05）；在人选时肌张力为Ⅱ级层面，发现对照2组痉挛改善等级显著优于对照1组（P〈0．05），治疗组痉挛改善等级与对照1组间差异无统计学意义（P〉0．05）；对照2组BI、FMA评分改善情况显著优于治疗组及对照1组（P〈0．05）；对照2组BBS评分改善情况显著优于对照1组（P〈0．05），治疗组BBS评分改善情况与对照1组间差异无统计学意义（P〉0．05）。结论芍药甘草汤化裁联合运动训练适用于脑卒中后偏瘫肘关节屈曲痉挛为I级和I^＋级患者，在显著缓解肢体痉挛同时，还能进一步改善患者上肢运动功能、日常生活活动能力及平衡能力；巴氯芬联合运动训练则更适用于痉挛程度为I^＋级和Ⅱ级的脑卒中后偏瘫患者，尤其对痉挛程度为Ⅱ级的脑卒中患者具有显著疗效。
Objective To observe any clinical effect of peony and licorice decoction combined with kinesio- therapy in treating hemiplegia and elbow joint spasticity after stroke. Methods A total of 197 patients suffering from hemiplegia complicated with elbow joint flexion spasticity after stroke were classified into different levels accord- ing to the severity of the spasticity. Patients of different levels were divided into a treatment group （receiving peony and licorice decoction combined with kinesiotherapy） , a control group 1 （receiving kinesiotherapy solely） and a con- trol group 2 （accepting baclofen and kinesiotherapy）. Before and after 3 weeks of treatment, the 3 groups were evalu- ated by using the modified Ashworth scale （MAS） , the modified Barthel index （BI） , the Fugl-Meyer assessment （FMA） and the Berg Balance Scale （BBS）. Results The spasticity of patients with spasticity at level I in the treatment group and control group 2 demonstrated significantly greater relief compared with those in control group 1. The BI, FMA and BBS scores of the treatment group were significantly better than those of both control groups. A- mong the patients with level I^＋ spasticity, the spasticity, BI and FMA scores of the treatment group and the control group 2 were all significantly better on average than those in control group 1. The BBS score of the treatment group was significantly higher than that of either control group. For patients with level Ⅱ spasticity the average BBS score of control group 2 was significantly better than that of control group 1, but no significant difference was observed between the treatment group and control group 1. The BI and FMA scores of control group 2 were, however, significantly more improved than those of the treatment group and control group 1. Conclnsion Peony and licorice decoction com- bined with kinesiotherapy is applicable to patients with mild spastieity complicating hemiplegia after stroke. It not on- ly can relieve spasticity, but also improves upper limb motor function, ability in the activities of daily living and bal- ance. Baclofen combining with kinesiotherapy is more suitable for patients with mild to moderate spasticity, especially those with level Ⅱ spasticity.
出处
《中华物理医学与康复杂志》
CAS
CSCD
北大核心
2015年第2期107-111,共5页
Chinese Journal of Physical Medicine and Rehabilitation
基金
上海市卫生局中医药科研基金课题资助项目（2010L098A）,上海市医学重点专科建设（脑卒中重点专科）配套子课题（ZK2012A40）
关键词
脑卒中
偏瘫
痉挛
芍药甘草汤
运动疗法
Stroke
Hemiplegia
Spasticity
Peony decoction
Licorice decoction
Kinesiotherapy
