四子散蜡疗手三阴经筋对脑卒中偏瘫患者上肢运动功能的效果研究

doi:10.3761/j.issn.0254-1769.2022.19.011

摘要/Abstract

摘要：

目的观察四子散蜡疗手三阴经筋对脑卒中偏瘫患者上肢运动功能、痉挛状态及生存质量的影响。方法便利选取2020年5月—2021年1月入住福建省某三级甲等康复医院恢复期的脑卒中上肢偏瘫患者作为研究对象,将141例患者随机分为四子散蜡疗组、蜡疗组、对照组,每组各47例。3组均进行常规治疗、护理和康复训练;四子散蜡疗组在此基础上于手三阴经筋循行部位进行四子散蜡疗;蜡疗组在此基础上于手三阴经筋循行部位进行蜡疗;四子散蜡疗组和蜡疗组干预时间均为1次/d,20 min/次,5次/周,连续干预4周。于干预前、干预2周后及干预4周后评估患者上肢运动功能及痉挛程度,干预前后评估患者生存质量。结果共130例完成试验,四子散蜡疗组剔除1例、脱落3例、中止1例;蜡疗组剔除1例、脱落2例、中止1例;对照组剔除1例、脱落1例。干预4周后,四子散蜡疗组上肢运动功能评分、上肢痉挛改善程度高于对照组（P<0.05）;四子散蜡疗组及蜡疗组脑卒中生存质量量表评分高于对照组（P<0.05）。广义估计方程结果显示,3组上肢运动功能评分的时间效应与交互效应差异具有统计学意义（P<0.05）,上肢痉挛改善程度的时间效应差异具有统计学意义（P<0.05）。结论四子散蜡疗手三阴经筋可提升卒中偏瘫患者上肢运动功能,改善上肢痉挛程度及生存质量。

关键词: 卒中, 上肢运动功能, 四子散, 蜡疗法, 经筋, 中医护理学, 康复护理

Abstract:

Objective To observe the effects of Sizi powder wax therapy on the area of Three Yin Muscle Meridians of arm for upper limb motor function,spasticity and quality of life for upper limb motor dysfunction in stroke patients with hemiplegia. Methods The stroke patients with upper limb hemiplegia who were admitted to the Affiliated Rehabilitation Hospital of Fujian University of Traditional Chinese Medicine from May 2020 to January 2021 were selected. 141 patients were randomly divided into a Sizi powder wax therapy group,a wax therapy group and a control group with 47 cases in each group. All patients in the 3 groups received the routine treatment,nursing and rehabilitation training protocol. On this basis,the Sizi powder wax therapy group received Sizi powder wax therapy on the Three Yin Muscle Meridian of arm;the wax therapy group received wax therapy on the Three Yin Muscle Meridian of arm,once a day,20 minutes each time,5 times per week for 4 weeks. The upper limb motor function and degree of spasticity were evaluated before the intervention,2 weeks after the intervention and 4 weeks after the intervention,and the quality of life was evaluated before the intervention and after the intervention. Results A total of 130 cases completed the trial. In the Sizi powder wax therapy group,1 case was excluded,3 cases fell off and 1 case was discontinued. In the wax therapy group,1 case was excluded,2 cases fell off and 1 case was discontinued. In the control group,1 case was excluded and 1 case fell off. After 4 weeks of intervention,the improvement of Upper Limb Fugl-Meyer Assessment Scale（U-FMA） and Modified Ashworth Scale（MAS） in Sizi powder wax therapy group was higher than that in control group（P<0.05）;the Stroke Specific Quality of Life（SS-QOL） scores of Sizi powder wax therapy group and wax therapy group were better than those of the control group（P<0.05）. The results of Generalized Estimation Equation showed that the time effect and interaction effect of U-FMA score were statistically significant（P<0.05）,and the time effect of clinical efficiency of spasticity was statistically significant（P<0.05）. Conclusion Sizi powder wax therapy on the Three Yin Muscle Meridian of arm can improve upper limb motor function,spasticity and quality of life of patients with upper limb motor dysfunction after stroke.

Key words: Stroke, Upper Limb Motor Function, Sizi Powder, Wax Therapy, Muscle Meridian, Traditional Chinese Medicine Nursing, Rehabilitation Nursing

李壮苗, 张佳宇, 刘芳, 李霞, 李秀霞, 李施恩. 四子散蜡疗手三阴经筋对脑卒中偏瘫患者上肢运动功能的效果研究[J]. 中华护理杂志, 2022, 57(19): 2378-2384.

LI Zhuangmiao, ZHANG Jiayu, LIU Fang, LI Xia, LI Xiuxia, LI Shien. Effect of Sizi powder wax therapy on Three Yin Muscle Meridians of arm for upper limb motor dysfunction in stroke patients with hemiplegia[J]. Chinese Journal of Nursing, 2022, 57(19): 2378-2384.

图/表 4

表1 研究对象一般资料的比较[例（百分比,%）]

Table 1 Comparison of general data of patients before intervention [cases,（percentage,%）]

表2 3组干预前后Fugl-Meyer上肢运动功能评定量表评分的比较

Table 2 Comparison of U-FMA scores in the 3 groups before and after intervention

表3 3组干预前后改良Ashworth量表等级及临床有效率的比较

Table 3 Comparison of MAS grade and clinical effective rate among 3 groups of patients before and after intervention

表4 3组干预前后脑卒中专门化生存质量量表评分比较（分,$\bar{x}±s$）

Table 4 Comparison of SS-QOL scores of 3 groups of patients before and after intervention（score,$\bar{x}±s$）

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