基于正交设计的不同针刺方法对中风后踝背屈障碍患者步行能力的影响

摘要

Objective:To compare the effects of different acupoints,acupuncture ways and pulse wave on the walking ability of patients with ankle dorsiflexion after stroke,and to optimize the acupuncture program.Methods:40 cases of stroke patients were selected according to the inclusion criteria,and were divided into 4 groups by three factors and two levels of orthogonal design test,namely,different acupuncture points (Factor A:A1:Zusanli,Tiaokou;A2:Zusanli,Xuanzhong),different acupuncture ways (Factor B:B1:routine needling method;B2:Hegu needling method),different pulse wave (Factor C:C1:sparse wave;C2:intermittent wave).The optimal scheme was screened on the basis of gait analysis parameters (step length,stance phase),the maximum ankle active dorsiflexion angle and the IEMG o[f tibialis anterior muscle at MIVC before and after treatment.Results:After treatment,the step length,stance phase,the maximum active dorsiflexion angle of the ankle joint and the IEMG of the tibialis anterior muscle in the MIVC condition were improved in different degrees(P＜0.05).The observation indexes of the different levels of different factors were κ2＞ κ1,i.e.A2＞A1,B2＞B1,C2＞C1.In the observation of the primary and secondary effects of each factor,RA＞Rc＞RB.Conclusions:Different acupoints of electroacupuncture can improve the walking ability of ankle dorsiflexion after stroke.The primary and secondary relationship among the three factors for the impacts on the therapeutic effects were:acupoints＞pulse wave＞acupuncture ways.The best optimal schene was needling Zusanli and Xuanzhong with intermittent wave and Hegu needling.%目的 观察不同针刺穴位、针刺方式、脉冲波型对中风后踝背屈障碍患者步行能力的影响,优化针刺方案.方法 选择符合纳入标准的脑卒中患者40例,采用三因素两水平的正交设计试验分为4组,即不同针刺穴位(因素A为A1足三里、条口;A2足三里、悬钟)、不同针刺方式(因素B为B常规刺法;B2合谷刺法)、脉冲波型(因素C为C1疏波;C2断续波),应用步态分析参数(步长、支撑相)、踝关节最大主动背屈角度、踝关节最大屈伸等长收缩状态下(MIVC)胫前肌的积分肌电值(IEMG)客观评价治疗前后的差异,以筛选出最佳治疗方案.结果 治疗后各组患者步长、支撑相、踝关节最大主动背屈角度、MIVC状态下胫前肌IEMG均有不同程度的改善(P＜0.05);各因素不同水平对观察指标的影响均表现为κ2＞κ1,即A2＞A1,B2＞B1,C2＞C1;在对各因素主次影响的观察中,RA＞Rc＞RB.结论不同穴位电针方式均能改善中风后踝背屈障碍的步行能力;三因素对疗效的主次关系为:针刺穴位＞脉冲波型＞针刺方式;最佳治疗方案为针刺足三里、悬钟穴,选用电针断续波和合谷刺法.