針刺治療腦中風後痙攣性癱瘓之臨床研究分析

目的：藉由實證醫學方法分析近四年腦中風後痙攣性癱瘓的針灸治療特點。方法：檢索中國期刊全文數據庫、Pubmed自2016年1月至2019年7月間以針刺為治療方法的臨床隨機對照研究，歸納其治療細節如針灸方法、選穴特點、手法、療程及療效等，並分析針灸治療腦中風後痙攣性癱瘓的特點。結果：共納入文獻12篇，合計患者923例；其中有4篇為電針治療，其餘均為單純針刺。治療組最常被選用的經絡前四名分別是手少陽三焦經、手陽明大腸經、足太陽膀胱經、足少陽膽經；上下肢選穴頻次最高的分別為外關和陽陵泉。針刺研究中有4篇使用平補平瀉手法，其餘8篇使用提插撚轉補瀉手法；電針則使用低頻斷續波、疏波或50 Hz頻波。所有研究留針時間皆在20～40分鐘；10篇研究的治療頻次在1週5～6次；10篇研究療程在4～8週。經針灸治療後，治療組的痙攣均較對照組有顯著改善（P＜0.05）。結論：針刺治療腦中風後痙攣性癱瘓具有一定療效，而選穴和手法不僅依據中醫學理論，解剖構造及現代復健醫學觀點亦成為考量的因素，在治療時強調肢體肌肉運動的協調，選穴以分布在痙攣肌和拮抗肌之經絡穴位為主，補瀉手法參考在痙攣肌側用瀉法、拮抗肌側用補法的原則，進行早期針灸介入預防痙攣。

關鍵字

腦中風；痙攣；針灸

並列摘要

Objective: The purpose of this study is to utilize the method of evidence-based medicine to analyze the characteristics of acupuncture treatments on patients with post-stroke spastic paralysis in recent four years. Method: We reviewed literature published on PubMed and Chinese National Knowledge Infrastructure (CNKI) between January 2016 and July 2019. Randomized controlled trials (RCTs) analyzing the effects of acupuncture treatment were included. The details, such as acupuncture methods, acupoints, supplementation and drainage, needle retention time, and outcomes assessing spasticity severity, were summarized and analyzed to determine the characteristics of acupuncture treatment for post-stroke spasticity. Results: Twelve RCTs including 923 cases were enrolled in this analysis. Four trials received electroacupuncture while others received single acupuncture treatment. The top four meridians used in experimental groups were TE, LI, BL, and GB. TE5 and GB34 were the most commonly used acupoints on upper and lower limbs, respectively. Four trials used even supplementation and drainage while other eight trials used twirling supplementation and drainage. The electroacupuncture stimulation were low frequency intermittent wave, sparse wave or 50 Hz wave. Needle retention time was 20~40 minutes in all trials. Participants received 5~6 treatment sessions per week in ten trials. Treatment course was 4~8 consecutive weeks in ten trials. After treatment, the improvement in spasticity in acupuncture group was significantly greater than that in control group. Conclusion: Our results revealed that acupuncture is effective in treating post-stroke extremities spasticity. The selection of acupoints, supplementation and drainage methods is not only based on the theory of traditional Chinese medicine, but based on anatomy and modern rehabilitation concepts. Acupoints on spastic muscles or antagonistic muscles are the main choices. Besides, early intervention of acupuncture treatment using drainage on spastic muscles and supplementation on antagonistic muscles is recommended for preventing post-stroke spasticity.

並列關鍵字

stroke ； spasticity ； acupuncture

參考文獻

Jan Mehrholz 著、張恆誌等譯，中風病人的物理治療：早期復健介入，合記出版社，2015：1,7

Google Scholar

Chih-Lin Kuo, Gwo-Chi Hu: Post-stroke Spasticity: A Review of Epidemiology, Pathophysiology, and Treatments, International Journal of Gerontology, 2018, 12(4):280-284