运动训练结合腕踝针疗法对脑卒中后偏瘫患者下肢运动功能及平衡功能的影响

杨洁; 朱咏梅; 牛阳; 张田宁; 汪龙

doi:10.16766/j.cnki.issn.1674-4152.004113

运动训练结合腕踝针疗法对脑卒中后偏瘫患者下肢运动功能及平衡功能的影响

doi: 10.16766/j.cnki.issn.1674-4152.004113

安徽省第二人民医院康复医学科，安徽合肥 230041

基金项目:

安徽省卫生健康委科研项目 AHWJ2021b053

详细信息

通讯作者:
朱咏梅，E-mail：2399418005@qq.com

中图分类号: R743 R747.9
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- 文章访问数: 12
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出版历程
- 收稿日期: 2025-01-22
- 网络出版日期: 2025-10-31

Effect of exercise training combined with wrist and ankle acupuncture on lower limb motor function and balance in patients with hemiplegia after stroke

Department of Rehabilitation Medicine, the Second People ' s Hospital of Anhui Province, Hefei, Anhui 230041, China

摘要

摘要: 目的对比常规运动训练与联合疗法治疗脑卒中后偏瘫患者的效果，为临床治疗提供更优方案，助力患者提升下肢运动能力、改善平衡功能。方法选取2020年1月—2023年1月在安徽省第二人民医院进行脑卒中后偏瘫治疗的80例患者，采用随机数字表法分为对照组38例和联合组42例。对照组给予腕踝针疗法；联合组给予运动训练结合腕踝针疗法。检测2组患者血浆黏度(PV)、全血黏度(BV)、纤维蛋白原(FIB)、血管生成素-1(Ang-1)、血管内皮生长因子(VEGF)、屈髋峰值、屈膝峰值、步频水平，采用Berg平衡量表(BBS)、Fugl-Meyer量表(FMA)、脑卒中康复运动功能评定量表(STREAM)对患者的平衡功能及下肢功能情况进行评估，对比临床治疗效果。结果治疗后，联合组PV、BV、FIB水平均低于对照组(P＜0.05)；联合组Ang-1、VEGF、屈髋峰值、屈膝峰值、步频水平、BBS、FMA、STREAM评分均高于对照组(P＜0.05)；联合组总有效率[92.86%(39/42)]高于对照组[71.05%(27/38)，χ²=6.570，P=0.010]。结论运动训练、腕踝针疗法结合治疗脑卒中后偏瘫患者，可以改善患者血液流变学、运动学参数及血管活性情况，提升下肢运动功能及平衡功能，临床治疗效果显著。
- 脑卒中后偏瘫 /
- 运动训练 /
- 腕踝针疗法 /
- 下肢运动功能 /
- 平衡功能
Abstract: Objective To explore the effect of exercise training combined with wrist and ankle acupuncture on lower limb motor function and balance in patients with hemiplegia after stroke. Methods From January 2020 to January 2023, 80 patients were divided into two groups by the random number table method: 38 patients in the reference group and 42 patients in the combination group. The reference group received wrist and ankle needle therapy alone, while the combination group received exercise training combined with wrist and ankle needle therapy. Plasma viscosity (PV), whole blood viscosity (BV), fibrinogen (FIB), angiopoietin-1 (Ang-1), vascular endothelial growth factor (VEGF), peak hip flexion, knee flexion, and stride frequency were measured. Berg balance scale (BBS), Fugl-Meyer scale (FMA), and stroke rehabilitation assessment of monvement (STREAM) were used to compare the clinical treatment effect. Results After treatment, the levels of PV, BV, and FIB in the combination group were lower than those in the reference group (P < 0.05). The levels of Ang-1, VEGF, peak hip flexion, peak knee flexion, step frequency, BBS, FMA and STREAM in the combined group were all higher than those in the reference group (P < 0.05). The total effective rate of the combination group [92.86%(39/42)] was higher than that of the reference group [71.05% (27/38), χ²=6.570, P=0.010]. Conclusion Exercise training combined with wrist and ankle acupuncture therapy significantly improves hemorheology parameters, kinematic parameters, and vascular activity in the treatment of patients with hemiplegia after stroke, resulting in enhanced lower limb motor function and balance. The therapeutic efficacy of the combined intervention is notably superior to acupuncture alone.
- Hemiplegia after stroke /
- Exercise training /
- Wrist and ankle acupuncture /
- Lower limb motor function /
- Balance function

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表 1 2组脑卒中后偏瘫治疗患者一般资料比较

Table 1. Comparison of general data between two groups of patients with hemiplegia after stroke

组别	例数	性别(男性/女性，例)	年龄(x ±s, 岁)	病程(x ±s，月)	BMI(x ±s)	卒中类型(例)		偏瘫侧(例)
组别	例数	性别(男性/女性，例)	年龄(x ±s, 岁)	病程(x ±s，月)	BMI(x ±s)	脑梗死	脑出血	左	右
对照组	38	23/15	65.73±4.42	4.05±0.59	24.34±2.01	27	11	22	16
联合组	42	23/19	65.64±5.47	4.13±1.02	24.41±1.83	31	11	22	20
统计量		0.272^a	0.080^b	0.424^b	0.163^b	0.076^a		0.245^a
P值		0.603	0.936	0.673	0.871	0.783		0.621
注：^a为χ²值，^b为t值。

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表 2 2组脑卒中后偏瘫患者治疗前后血液流变学指标比较(x ±s)

Table 2. Comparison of hemorheological indicators before and after treatment in two groups of hemiplegic patients after stroke(x ±s)

组别	例数	PV(mPa/s)		t值	P值	BV(mPa/s)		t值	P值	FIB(g/L)		t值	P值
组别	例数	治疗前	治疗后	t值	P值	治疗前	治疗后	t值	P值	治疗前	治疗后	t值	P值
对照组	38	2.91±0.32	2.05±0.29	12.276	0.001	8.56±0.64	6.47±0.62	14.459	0.001	4.35±0.28	3.44±0.26	14.681	0.001
联合组	42	2.86±0.27	1.26±0.18	31.954	0.001	8.43±0.50	4.20±0.39	43.231	0.001	4.43±0.33	2.21±0.27	33.743	0.001
统计量		0.758^a	14.794^b			1.017^a	19.841^b			1.163^a	20.711^b
P值		0.451	0.001			0.312	0.001			0.248	0.001
注：^a为t值，^b为F值。

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表 3 2组脑卒中后偏瘫患者治疗前后血管活性物质水平比较(x ±s)

Table 3. Comparison of vasoactive substance levels before and after treatment in two groups of hemiplegic patients after stroke(x ±s)

组别	例数	Ang-1(ng/mL)		t值	P值	VEGF(pg/mL)		t值	P值
组别	例数	治疗前	治疗后	t值	P值	治疗前	治疗后	t值	P值
对照组	38	23.94±3.37	36.80±4.53	14.041	0.001	150.08±15.68	205.39±20.75	13.110	0.001
联合组	42	23.60±3.38	47.42±5.17	24.992	0.001	151.81±15.61	235.79±23.86	19.088	0.001
统计量		0.450^a	9.726^b			0.494^a	6.051^b
P值		0.654	0.001			0.623	0.001
注：^a为t值，^b为F值。

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表 4 2组脑卒中后偏瘫患者治疗前后运动学参数水平比较(x ±s)

Table 4. Comparison of kinematic parameter levels before and after treatment in two groups of hemiplegic patients after stroke(x ±s)

组别	例数	屈髋峰值(°)		t值	P值	屈膝峰值(°)		t值	P值	步频(步/min)		t值	P值
组别	例数	治疗前	治疗后	t值	P值	治疗前	治疗后	t值	P值	治疗前	治疗后	t值	P值
对照组	38	32.52±3.53	35.27±4.45	2.985	0.004	32.13±7.65	35.89±7.90	2.108	0.038	70.45±18.24	79.65±18.59	2.178	0.033
联合组	42	33.30±3.49	38.72±5.53	5.372	0.001	33.89±8.32	41.44±8.34	4.154	0.001	71.55±16.16	87.67±11.40	5.283	0.001
统计量		0.281^a	3.054^b			0.145^a	3.048^b			0.286^a	2.351^b
P值		0.780	0.003			0.885	0.003			0.776	0.021
注：^a为t值，^b为F值。

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表 5 2组脑卒中后偏瘫患者治疗前后平衡功能、下肢运动功能情况比较(x ±s，分)

Table 5. Comparison of balance function and lower extremity motor function before and after treatment in two groups of hemiplegic patients after stroke(x ±s, points)

组别	例数	BBS		t值	P值	FMA		t值	P值	STREAM		t值	P值
组别	例数	治疗前	治疗后	t值	P值	治疗前	治疗后	t值	P值	治疗前	治疗后	t值	P值
对照组	38	18.67±4.09	30.33±3.39	13.530	0.001	14.12±3.73	23.67±4.81	9.672	0.001	9.15±3.84	11.71±4.25	2.755	0.007
联合组	42	19.34±4.03	36.76±5.66	16.248	0.001	14.19±2.86	28.77±5.68	14.858	0.001	9.09±3.77	15.26±4.84	6.518	0.001
统计量		0.737^a	6.083^b			0.095^a	4.311^b			0.070^a	3.471^b
P值		0.463	0.001			0.925	0.001			0.944	0.001
注：^a为t值，^b为F值。

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表 6 2组脑卒中后偏瘫治疗患者临床总有效率比较[例(%)]

Table 6. Comparison of the total clinical effective rates of hemiplegia treatment in two groups of patients after stroke[cases (%)]

组别	例数	显效	有效	无效	总有效
对照组	38	12(31.58)	15(39.47)	11(28.95)	27(71.05)
联合组	42	22(52.38)	17(40.48)	3(7.14)	39(92.86)
注：2组总有效率比较，χ²=6.570，P=0.010。

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参考文献(24)

[1]	STINEAR C M, LANG C E, ZEILER S, et al. Advances and challenges in stroke rehabilitation[J]. Lancet Neurol, 2020, 19(4): 348-360. doi: 10.1016/S1474-4422(19)30415-6
[2]	陆军伟, 王云, 周淼, 等. 醒脑开窍针刺法联合加味芍药汤治疗中风后肢体痉挛的临床疗效[J]. 南京中医药大学学报, 2023, 39(11): 1129-1133. LU J W, WANG Y, ZHOU M, et al. Clinical efficacy of Xingnao Kaiqiao acupuncture combined with Jiawei Shaoyao Tang in the treatment of post-stroke limb spasticity[J]. Journal of Nanjing University of Traditional Chinese Medicine, 2023, 39(11): 1129-1133.
[3]	YANG Y W, PAN W X, XIE Q. Combined effect of repetitive transcranial magnetic stimulation and physical exercise on cortical plasticity[J]. Neural Regen Res, 2020, 15(11): 1986-1994. doi: 10.4103/1673-5374.282239
[4]	韩珊, 周静, 马武开, 等. 腕踝针疗法联合苗药五藤散冷湿敷治疗湿热蕴结型急性痛风性关节炎效果观察[J]. 山东医药, 2023, 63(2): 50-53. HAN S, ZHOU J, MA W K, et al. Observation on the effect of wrist ankle acupuncture combined with Miao medicine Wuteng San cold and wet compress in the treatment of acute gouty arthritis with damp heat accumulation type[J]. Shandong Medical Journal, 2023, 63(2): 50-53.
[5]	马秋云, 史镇平, 何晓华, 等. 悬吊运动训练改善脊髓损伤患者下肢运动功能的机制研究[J]. 河北医药, 2023, 45(1): 82-84, 88. MA Q Y, SHI Z P, HE X H, et al. Mechanism study on the improvement of lower limb motor function in patients with spinal cord injury by suspension exercise training[J]. Hebei Medical Journal, 2023, 45(1): 82-84, 88.
[6]	中华医学会神经病学分会, 中华医学会神经病学分会脑血管病学组. 中国急性缺血性脑卒中诊治指南2018[J]. 中华神经科杂志, 2018, 51(9): 666-682. Chinese Medical Association Neurology Branch, Cerebrovascular Disease Group of Chinese Medical Association Neurology Branch Chinese Guidelines for Diagnosis and Treatment of Acute Ischemic Stroke 2018[J]. Chinese Journal of Neurology, 2018, 51(9): 666-682.
[7]	张心曙, 凌长全, 周庆辉. 实用腕踝针疗法[M]. 北京: 人民卫生出版社, 2009: 13-18. ZHANG X S, LING C Q, ZHOU Q H. Practical wrist ankle acupuncture therapy[M]. Beijing: People ' s Health Press, 2009: 13-18.
[8]	黄春莉, 韩冰, 孙文, 等. 针刺联合重复经颅磁刺激疗法治疗脑卒中后偏瘫足下垂41例临床研究[J]. 江苏中医药, 2023, 55(1): 36-40. HUANG C L, HAN B, SUN W, et al. Clinical study on acupuncture combined with repetitive transcranial magnetic stimulation therapy for the treatment of 41 cases of post-stroke hemiplegic foot drop[J]. Jiangsu Traditional Chinese Medicine, 2023, 55(1): 36-40.
[9]	齐琳, 甄巧霞, 刘翠, 等. 半导体激光穴位照射联合智能康复机器人治疗脑卒中偏瘫及对BBS、FMA评分的影响[J]. 临床和实验医学杂志, 2022, 21(5): 539-542. QI L, ZHEN Q X, LIU C, et al. Semiconductor laser acupoint irradiation combined with intelligent rehabilitation robot for the treatment of stroke hemiplegia and its impact on BBS and FMA scores[J]. Journal of Clinical and Experimental Medicine, 2022, 21(5): 539-542.
[10]	荆睿, 贾博, 郝永连. 高压氧联用文拉法辛治疗脑卒中后抑郁症的效果及对日常生活能力和运动功能的影响[J]. 中华航海医学与高气压医学杂志, 2023, 30(1): 24-28. JING R, JIA B, HAO Y L, et al. The effect of hyperbaric oxygen combined with venlafaxine in the treatment of post-stroke depression and its impact on daily living ability and motor function[J]. Chinese Journal of Naval Medicine and Hyperbaric Medicine, 2023, 30(1): 24-28.
[11]	廖源, 孙光华, 封蔚彬, 等. 强调呼吸训练的脑卒中偏瘫患者综合康复治疗的临床有效性[J]. 中国老年学杂志, 2020, 40(4): 698-701. LIAO Y, SUN G H, FENG W B, et al. The clinical effectiveness of comprehensive rehabilitation therapy for stroke hemiplegia patients emphasizing respiratory training[J]. Chinese Journal of Gerontology, 2020, 40(4): 698-701.
[12]	陈芷枫, 尹建军, 金义羚. 针刺阴经穴联合雷火灸对脑卒中偏瘫肢体肌张力的影响[J]. 陕西中医, 2024, 45(7): 971-974, 979. CHEN Z F, YIN J J, JIN Y L, et al. The effect of acupuncture at Yin meridian points combined with thunder fire moxibustion on muscle tone of hemiplegic limbs after stroke[J]. Shaanxi Traditional Chinese Medicine, 2024, 45(7): 971-974, 979.
[13]	WÅHLIN A, EKLUND A, MALM J. 4D flow MRI hemodynamic biomarkers for cerebrovascular diseases[J]. J Intern Med, 2022, 291(2): 115-127. doi: 10.1111/joim.13392
[14]	徐艳, 黄知期, 钟寒, 等. 针灸联合MOTOmed智能运动训练对脑卒中偏瘫患者功能康复的影响[J]. 江西医药, 2022, 57(10): 1627-1629. XU Y, HUANG Z Q, ZHONG H, et al. Effect of acupuncture and moxibustion combined with MOTOMED intelligent exercise training on functional rehabilitation of stroke patients with hemiplegia[J]. Jiangxi Medical Journal, 2022, 57(10): 1627-1629.
[15]	景福权, 周钰, 牛相来, 等. 腹针、腕踝针配合康复疗法治疗缺血性脑卒中偏瘫临床观察[J]. 上海针灸杂志, 2018, 37(2): 154-158. JING F Q, ZHOU Y, NIU X L, et al. Clinical Observation on Abdominal Acupuncture, Wrist Ankle Acupuncture Combined with Rehabilitation Therapy for Ischemic Stroke Hemiplegia[J]. Shanghai acupuncture and moxibustion Journal, 2018, 37(2): 154-158.
[16]	TAKEKAWA H, TSUKUI D, KOBAYASI S, et al. Ultrasound diagnosis of carotid artery stenosis and occlusion[J]. J Med Ultrason(2001), 2022, 49(4): 675-687. doi: 10.1007/s10396-022-01259-7
[17]	左鹏, 王政, 田学峰. 不同身体质量指数急性心肌梗死患者发病时间分布及影响因素分析[J]. 中国基层医药, 2024, 31(2): 161-164. ZUO P, WANG Z, TIAN X F, et al. Analysis of the distribution of onset time and influencing factors in patients with acute myocardial infarction with different body mass indices[J]. Chinese Journal of Primary Medicine, 2024, 31(2): 161-164.
[18]	马秋云, 王正田, 孟海超, 等. 悬吊运动训练联合中药熏蒸对老年缺血性脑卒中偏瘫患者血管活性物质及预后的影响[J]. 中医药导报, 2021, 27(8): 90-95. MA Q Y, WANG Z T, MENG H C, et al. The effect of suspension exercise training combined with traditional Chinese medicine fumigation on vascular active substances and prognosis in elderly patients with ischemic stroke hemiplegia[J]. Chinese Medicine Review, 2021, 27(8): 90-95.
[19]	GARRO F, CHIAPPALONE M, BUCCELLI S, et al. Neuromechanical biomarkers for robotic neurorehabilitation[J]. Front Neurorobot, 2021, 15(1): 742163. DOI: 10.3389/fnbot.2021.742163.
[20]	王盛, 郭川, 龚晨, 等. 自制偏瘫步行矫正带对慢性期脑卒中患者伸肌协同偏瘫步态的运动学及时空参数影响[J]. 中华物理医学与康复杂志, 2018, 40(10): 740-744. WANG S, GUO C, GONG C, et al. The effect of self-made hemiplegic walking correction belt on the kinematic and spatiotemporal parameters of extensor coordinated hemiplegic gait in patients with chronic stroke[J]. Chinese Journal of Physical Medicine and Rehabilitation, 2018, 40(10): 740-744.
[21]	肖乐, 刘超, 李元, 等. 体外冲击波治疗联合全身振动对脑卒中偏瘫患者下肢痉挛及平衡步态的影响[J]. 中南大学学报(医学版), 2022, 47(6): 755-761. XIAO L, LIU C, LI Y, et al. The effect of extracorporeal shock wave therapy combined with whole-body vibration on lower limb spasticity and balanced gait in stroke hemiplegia patients[J]. Journal of Central South University (Medical Edition), 2022, 47(6): 755-761.
[22]	DEKOSKY S T, KOCHANEK P M, VALADKA A B, et al. Blood biomarkers for detection of brain injury in COVID-19 patients[J]. J Neurotrauma, 2021, 38(1): 1-43. doi: 10.1089/neu.2020.7332
[23]	吴近仪, 吴敏杰, 魏鹏, 等. 早期综合康复治疗对改善中老年脑卒中偏瘫患者运动功能及日常生活能力的临床疗效观察[J]. 中华全科医学, 2022, 20(12): 2123-2126. doi: 10.16766/j.cnki.issn.1674-4152.002784 WU J Y, WU M J, WEI P, et al. Observation of the clinical efficacy of early comprehensive rehabilitation therapy in improving motor function and daily living ability in middle-aged and elderly stroke patients with hemiplegia[J]. Chinese Journal of General Practice, 2022, 20(12): 2123-2126. doi: 10.16766/j.cnki.issn.1674-4152.002784
[24]	ALONSO-ALONSO M L, SAMPEDRO-VIANA A, FERNÁNDEZ-RODICIO S, et al. Need for a paradigm shift in the treatment of ischemic stroke: the blood-brain barrier[J]. Int J Mol Sci, 2022, 23(16): 9486. DOI: 10.3390/ijms23169486.