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題名 | 穴位電針刺激降低腦中風患者下肢痙攣性之研究=Effect of Electro-Acupuncture on Decreasing Spasticity of Lower Limbs in Stroke Patients |
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作者 | 魏大森; 劉森永; 蔣博文; Wei, Ta-sen; Liu, Sen-yung; Chiant, Po-wen; |
期刊 | 中華針灸醫學會雜誌 |
出版日期 | 20041200 |
卷期 | 2004.12[民93.12] |
頁次 | 頁33-42 |
分類號 | 413.91 |
語文 | chi |
關鍵詞 | 腦中風; 痙攣性; 電針; H反射恢復曲線; Stroke; Spasticity; Electro-acupuncture; H-reflex recovery curve; |
中文摘要 | 背景:痙孿性下肢是腦中風患者步態障礙常見之原因,對病人安全及日常活動功能影響甚鉅。腦中風後三個月內是患者功能恢復之黃金時期,亦是肢體痙性出現之顯著期,故本研究採用穴位電針刺激於此類患者,探討它對患者下肢痙性(spasticity)之影響。方法:本研究選取18位患者,其中男性10人,患者年齡55~75(64.7(6.8)歲,Brunnstrom分級Ⅱ-Ⅳ,患者平均住院日16~75(31(17)天。電針刺激位置為陽陵泉(GB34), 記錄電極為腓骨肌肌腹中點,使用2Hz及50Hz之混合波,刺激強度以50Hz時可見踝外翻肌之最小強直收縮。評估在電針刺激之前一次、之後30分鐘一次,以Modified Ashworth scale (MAS)測小腿後肌痙孿度,Verimed Myoexerciser Ⅲ肌電迴饋儀測小腿前、後肌肉之活動電位;另以Medelec肌電圖儀測H反射與M波最大振幅之比值(H/M ratio)及H反射恢復時間來定量下肢痙孿性。結果:病人之H反射恢復時間在電針灸之前,患側為60.1(22.5毫秒,健側為76.3(26.7毫秒,兩者有顯著差異(p<0.001);電針灸之後患側為74.9(24.0毫秒,健側則為77.7(25.8毫秒,兩者之恢復時間已無顯著差異(p=0.212);此外分析患側、健側針灸前後之恢復時間變化,患側有顯著差異(p=0.011),健側則否(p=0.929)。MAS與H反射恢復時間有類似情形,但電針灸後患側、健側之MAS仍有顯著差異(P<0.01)。患側、健側之H/M ratio與小腿肌肉活動電位在電針灸前、後均無顯著差異。結論:穴位電針刺激對腦中風三個月內患者之下肢痙孿性有顯著之降低作用,連續性的電針介入對患者功能性活動及步態相關變數之影響須進一步研究。 |
英文摘要 | Background: Spasticity of affected lower limbs, a major cause of gait disturbance in stroke patients, impairs patient safety and interferes with the activities of daily living. The golden period of functional recovery is within the first three months post-stroke and spasticity obviously appears during this period. We try to use electro-acupuncture to decrease the spasticity in these patients. Methods: Eighteen stroke patients with spastic hemiparesis were enrolled in this study: 10 were male, from 55-75(64(6.7) years old. Brunnstrom's stage was Ⅱ to Ⅲ and range of hospitalization was 16 to 75(31(17) days. The frequency of the electro-acupuncture was alternated between 2Hz and 50Hz, and the intensity was set when the minimal tetanic contraction of ankle evertor was reached. The stimulating electrode was inserted into Yang Ling Chuan (GB34) and the recording electrode was inserted into the muscle belly of peroneal muscle. Evaluation of spasticity was taken before and thirty minutes after intervention: Modified Ashworth scale (MAS) was used to measure the spasticity of calf muscle. Verimed myoexerciser Ⅲ was used to detect the surface electric muscle action potential of anterior and posterior leg muscles, and the ratio of maximum amplitude of H wave to M wave and H-reflex recovery time were detected as quantitative evaluations of spinal motor neuron excitability. Results: The mean H-reflex recovery time of paretic limbs before electro-acupuncture was 60.1(22.5 ms and that of the sound-side limbs was 76.3(26.7 ms, and the difference was significant statistically (p<0.001). However, the mean H-reflex recovery time of the paretic limbs prolonged to 74.9(24.0 ms after electro-acupuncture, and that of the sound-side limbs was 77.7 (25.8 ms, and the difference became non-significant statistically (p=0.2l2). The comparison of the H-reflex recovery time before and after electro-acupuncture was significantly different in paretic limbs (p=0.0ll) but non-significant in sound-side limbs (p=0.929). Just like H-reflex recovery time, there was a significant difference of MAS before and after electro-acupuncture between paretic and sound-side limbs. There was no significant difference of HIM ratio and muscle action potential of legs before and after electro-acupuncture in paretic or sound-side limbs. Conclusion: Electro-acupuncture had a significant effect on decreasing the spasticity of lower limbs when applied within the first three months from lesion. The effect of serial electro-acupuncture to improve functional activities and gait patterns of stroke patients needs further investigation. |
本系統之摘要資訊系依該期刊論文摘要之資訊為主。