开窍定志方与头针联合视觉观察训练对脑卒中后单侧空间忽略的康复效果研究

赵文化; 卢俊英; 赵怀消; 刘银芳; 张晓曼

doi:10.16766/j.cnki.issn.1674-4152.002698

开窍定志方与头针联合视觉观察训练对脑卒中后单侧空间忽略的康复效果研究

doi: 10.16766/j.cnki.issn.1674-4152.002698

1.
河南五建建设集团职工医院内科，河南郑州 450000
2.
郑州市第一人民医院神经内科，河南郑州 450000

基金项目:

河南省医学科技攻关项目 2018020725

详细信息

通讯作者:
赵文化, E-mail: zwhh515@163.com

中图分类号: R743.3R493
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- 文章访问数: 202
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- PDF下载量: 2
- 被引次数: 0
出版历程
- 收稿日期: 2022-03-21
- 网络出版日期: 2022-11-30

Study on the rehabilitation effect of Kaiqiao Dingzhi Prescription and head acupuncture combined with visual observation training on unilateral spatial neglect after stroke

1.
Internal Medicine Department, Staff Hospital of Henan Wujian Construction Group, Zhengzhou, Henan 450000, China

摘要

摘要: 目的观察开窍定志方、头针联合视觉观察训练对脑卒中后单侧空间忽略患者的康复干预效果。方法将河南五建建设集团职工医院2019年1月—2020年6月收治的94例脑卒中单侧空间忽略患者按照随机数字表法分为治疗组(47例)和对照组(47例)。对照组在常规康复训练的基础上给予视觉观察训练，观察组在对照组基础上给予开窍定志方、头针。对比2组各项指标。结果与对照组相比，观察组患者治疗后的直线二等分试验、画钟试验、临摹画图试验、数字删除试验评分均有所降低(均P＜0.05)；运动功能评分量表(FMA)、日常生活能力(ADL)量表、脑卒中专用生活质量量表(SS-QOL)评分均显著升高(均P＜0.05)；治疗2周、4周后，观察组的凯瑟琳-伯哥量表(CBS)评分均显著低于对照组[(16.17±2.32)分vs. (18.24±3.27)分、(12.58±1.83)分vs. (16.06±2.10)分，均P＜0.05]，简易智能状态量表(MMSE)评分均显著高于对照组[(24.16±3.25)分vs. (22.30±3.20)分、(26.51±2.78)分vs. (25.10±1.69)分，均P＜0.05]；观察组治疗后血清中颅脑损伤相关因子S100β蛋白(S100β)、巨噬细胞炎性蛋白1α(MIP-1α)、神经元特异性烯醇化酶(NSE)水平及血小板聚集率、纤维蛋白原、全血高切黏度、全血低切黏度均低于对照组(均P＜0.05)。结论开窍定志方、头针联合视觉观察训练利于控制脑卒中后单侧空间忽略患者的病情，可能与抑制S100β、MIP-1α、NSE等表达、改善血液流变以促进脑功能恢复、提高脑局部血液灌注有关。
- 开窍定志方 /
- 头针 /
- 视觉观察训练 /
- 脑卒中后单侧空间忽略 /
- 临床研究
Abstract: Objective To observe the effect of rehabilitation intervention using Kaiqiao Dingzhi Prescription and head acupuncture combined with visual observation training on patients with unilateral spatial neglect after stroke. Methods A total of 94 patients suffering from stroke and unilateral spatial neglect and admitted to the Staff Hospital of Henan Wujian Construction Group from January 2019 to June 2020 were divided into treatment group (47 cases) and control group (47 cases) by the random-number table method. The patients in the control group underwent visual observation training on the basis of routine rehabilitation training, whereas the patients in the observation group received a combination of Kaiqiao Dingzhi Prescription and head acupuncture. The indicators of the two groups were compared. Results Compared with the control group, the scores of linear bisection test, bell drawing test, copy drawing test and number deletion test in the observation group all decreased after treatment (all P < 0.05). The Fugl-Meyer motor function assessment (FMA), activities of daily living (ADL) and stroke specific quality of life scale (SS-QOL) scores of the observation group significantly increased (all P < 0.05). After 2 and 4 weeks of treatment, the Catherine Bergego scale (CBS) score of the observation group was significantly lower than that of the control group [(16.17±2.32) points vs. (18.24±3.27) points, (12.58±1.83) points vs. (16.06±2.10) points, all P < 0.05]. The mini-mental state examination (MMSE) score of cognitive function was significantly higher than that of the control group [(24.16±3.25) points vs. (22.30±3.20) points, (26.51±2.78) points vs. (25.10±1.69) points, all P < 0.05]. After treatment, the serum S100β, macrophage inflammatory protein-1α (MIP-1α), neuron-specific enolase (NSE) levels, platelet aggregation rate, fibrinogen, whole blood high shear viscosity and whole blood low shear viscosity of the observation group were significantly lower than that of the control group (all P < 0.05). Conclusion Kaiqiao Dingzhi Prescription and head acupuncture combined with visual observation training are beneficial to control unilateral spatial neglect of patients after stroke, which may be related to the inhibited expression of S100β, MIP-1α and NSE, improving hemorheology to promote brain function recovery and improve cerebral blood perfusion.
- Kaiqiao Dingzhi Prescription /
- Head needle /
- Visual observation training /
- Unilateral spatial neglect after stroke /
- Clinical research

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图 1 2组脑卒中单侧空间忽略患者MMSE评分比较

Figure 1. Comparison of MMSE score between two groups of patients with unilateral spatial neglect of stroke

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表 1 2组脑卒中单侧空间忽略患者基线资料比较

Table 1. Comparison of baseline data between two groups of patients with unilateral spatial neglect of stroke

组别	例数	性别(例)		年龄(x ±s，岁)	脑卒中类型(例)		病程(x ±s，d)	文化程度(例)
组别	例数	男性	女性	年龄(x ±s，岁)	脑出血	脑梗死	病程(x ±s，d)	高中以下	高中及以上
观察组	47	27	20	57.42±3.17	17	30	23.15±2.04	21	26
对照组	47	25	22	56.84±4.20	18	29	23.12±2.11	23	24
统计量		0.172^a		0.756^b	0.046^a		0.070^b	0.171^a
P值		0.678		0.452	0.830		0.944	0.679
注：^a为χ²值，^b为t值。

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表 2 2组脑卒中单侧空间忽略患者单侧空间忽略程度评分比较(x ±s，分)

Table 2. Changes in unilateral spatial neglect degree score of patients between two groups of patients with unilateral spatial neglect of stroke (x ±s, score)

组别	例数	直线二等分试验		画钟试验		临摹画图试验		数字删除试验
组别	例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
对照组	47	2.57±0.34	1.24±0.13^a	3.11±0.19	1.03±0.20^a	2.29±0.56	1.72±0.35^a	2.62±0.14	1.75±0.06^a
观察组	47	2.60±0.27	0.76±0.08^ab	3.10±0.22	0.54±0.12^ab	2.32±0.61	0.84±0.14^ab	2.65±0.10	1.10±0.12^ab
t值		0.474	21.558	0.236	14.403	0.248	16.004	1.195	33.214
P值		0.637	＜0.001	0.814	＜0.001	0.804	＜0.001	0.643	0.643
注：与同组治疗前比较，^aP＜0.05；与对照组比较，^bP＜0.05。

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表 3 2组脑卒中单侧空间忽略患者FMA、ADL、SS-QOL评分比较(x ±s，分)

Table 3. Comparison of FMA, ADL and SS-QOL score between two groups of patients with unilateral spatial neglect of stroke (x ±s, score)

组别	例数	FMA		ADL		SS-QOL
组别	例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
对照组	47	53.17±5.35	67.52±6.45^a	36.75±6.22	42.21±5.29^a	60.54±11.12	71.02±12.34^a
观察组	47	52.20±4.78	79.24±8.15^ab	37.04±5.78	47.56±7.70^ab	61.40±10.89	82.58±15.26^ab
t值		0.927	7.731	0.234	3.926	0.379	4.038
P值		0.356	＜0.001	0.851	＜0.001	0.706	＜0.001
注：与同组治疗前比较，^aP＜0.05；与对照组比较，^bP＜0.05。

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表 4 2组脑卒中单侧空间忽略患者治疗前后CBS总分比较(x ±s，分)

Table 4. Comparison of the CBS total score between two groups of patients with unilateral spatial neglect of stroke before and after treatment (x ±s, score)

组别	例数	治疗前	治疗2周	治疗4周	F值	P值
对照组	47	20.34±4.58	18.24±3.27^a	16.06±2.10^ab	19.475	＜0.001
观察组	47	20.30±4.76	16.17±2.32^a	12.58±1.83^ab	13.296	＜0.001
t值		0.042	3.539	8.568
P值		0.967	0.001	＜0.001
注：与同组治疗前比较，^aP＜0.05；与同组治疗2周比较，^bP＜0.05。

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表 5 2组脑卒中单侧空间忽略患者血清中脑损伤相关因子水平比较(x ±s)

Table 5. Comparison of serum levels of brain-injury-related factors between two groups of patients with unilateral spatial neglect after stroke (x ±s)

组别	例数	S100β(μg/L)		MIP-1α(pg/mL)		NSE(ng/L)
组别	例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
对照组	47	0.411±0.102	0.268±0.057^a	90.72±8.36	82.45±4.78^a	21.45±2.35	18.15±2.23^a
观察组	47	0.407±0.100	0.109±0.032^ab	90.66±7.98	74.27±1.96^ab	21.39±2.42	13.20±1.70^ab
t值		0.192	16.676	0.036	10.855	0.122	12.102
P值		0.848	＜0.001	0.972	＜0.001	0.903	＜0.001
注：与同组治疗前比较，^aP＜0.05；与对照组比较，^bP＜0.05。

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表 6 2组脑卒中单侧空间忽略患者血液流变学指标比较(x ±s)

Table 6. Comparison of hemorheological indexes between two groups of patients with unilateral spatial neglect after stroke (x ±s)

组别	例数	血小板聚集率(%)		纤维蛋白原(g/L)		全血高切黏度(mPa/s)		全血低切黏度(mPa/s)
组别	例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
对照组	47	73.11±6.72	62.53±5.28^a	9.26±1.34	6.88±0.53^a	6.79±1.22	5.11±0.67^a	13.11±3.24	10.24±1.85^a
观察组	47	73.47±6.58	51.03±3.25^ab	9.19±1.26	4.08±0.19^ab	6.68±1.31	4.05±0.12^ab	13.07±3.16	7.56±0.34^ab
t值		0.262	12.716	0.261	34.094	0.421	10.676	0.061	9.678
P值		0.794	＜0.001	0.795	＜0.001	0.675	＜0.001	0.952	＜0.001
注：与同组治疗前比较，^aP＜0.05；与对照组比较，^bP＜0.05。

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