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研究生:林士鼎
研究生(外文):Shin-Din Lin
論文名稱:電針治療慢性中風上肢痙攣患者之功能療效評估
論文名稱(外文):The functional effect of electro-acupuncture on the upper-extremity spasticity in chronic stroke patients
指導教授:林昭庚林昭庚引用關係
學位類別:碩士
校院名稱:中國醫藥大學
系所名稱:針灸研究所碩士班
學門:生命科學學門
學類:生物科技學類
論文種類:學術論文
論文出版年:2009
畢業學年度:97
語文別:中文
論文頁數:58
中文關鍵詞:針灸電針中風上肢痙攣
外文關鍵詞:AcupunctureElectro-AcupunctureStrokeSpasticity
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電針治療慢性中風上肢痙攣患者之功能療效評估
中文摘要
在全球的開發中國家腦中風疾病(Cerebral Vascular Accident)是造成死亡或殘障的主要原因1-3。在台灣將近18.9%到26.4%的中風存活者伴隨著中等到重度之運動功能殘障4。同時根據資料顯示有23%的中風病人感受到患側關節因肌肉攣縮而緊脹、疼痛5。
痙攣(Spasticity) 可以說是中風病人在復建過程中阻礙上肢隨意運動控制及功能獨立使用能力的潛在因數6。痙攣可視為一種上運動神經元損傷現象,典型之表現是隨著關節曲伸活動速度的增加所誘發的僵直性屈肌反射,導因於過大的肌腱抽搐及伸張反射超敏感所造成7,大部分病人會出現上肢屈肌及下肢伸肌的共同運動(co-contraction)。
針灸從遠古的中國被利用來治病已經超過3000年的歷史,研究中8-10證實針灸能幫助中風病人後遺症之改善。在東方醫學中已經利用針灸11, 12或電針((electroacupuncture,EA)13來治療痙攣,且通過臨床試驗證實的確有其療效。但對於治療之週期以及療效是否能持續鞏固仍存在著爭議。最近的一個研究顯示14,電針能幫助首次阻塞性中風病人上肢運動功能改善,但卻不能因此導致上肢功能獨立使用能力的恢復。基於上述之理由,我們提出二點實驗假說:(1)電針能有效抑制中風所誘發之上肢痙攣(2)電針配合常規之中風復健療程能改善慢性中風患者之日常生活功能獨立使用之能力。因此我們設計一個隨機、單盲之臨床試驗針對慢性中風上肢痙攣及功能獨立使用能力的恢復,進行一系列之研究及療效評估。
結果發現實驗組肘關節被動式關節活動角度檢測組內治療前後差異檢定於第三週(P=0.0013)與第六週(P=0.0149)均達到明顯之差異,兩組間之比較也在第六週(P=0.0014)出現明顯之差異;但對於腕關節及日常生活功能獨立使用之能力均沒有明顯之效益出現。
結論是經過六週的常規中風復健療程與電針治療能有效改善慢 性中風患者上肢肘關節痙攣的程度並增加關節活動角度,這兩種效應均通過被動式關節活動角度檢測(PROM)獲得驗證。
目 錄
第一章 前言 1
第二章 文獻探討 3
第一節 腦血管疾病 3
第二節 痙攣的認識 7
第三節 中醫之病因病機及治療 11
第四節 針灸治療慢性中風上肢痙攣之科學期刊文獻回顧 14
第五節 穴位探討 19
第三章 材料與方法 23
第四章 結果 27
第五章 討論 39
第六章 結論 44
參考文獻 45
附錄一:研究流程表(Flow Chart): 51
附錄二:人體試驗委員會人體試驗計畫同意書 52
附錄三:健康調查表 53
附錄五:巴氏量表(Barthel Index) 56
英文摘要 57
謝辭 58


圖 目 錄
圖1.1痙攣之致病機轉流程圖 8
圖4.1 受試者接受電針完成實景 31
圖4.2 受試者接受肘關節被動式關節活動角度檢測(PROM)實景 31
圖4.3 受試者接受腕關節被動式關節活動角度檢測(PROM)實景 32
圖4.4 實驗組肘關節被動式關節活動角度檢測(PROM)組內差異檢定統計圖 33
圖4.5 實驗組腕關節被動式關節活動角度檢測(PROM)組內差異檢定統計圖 33
圖4.6 偽針控制組肘關節被動式關節活動角度檢測(PROM)組內差異檢定統計圖 34
圖4.7 偽針控制組肘關節被動式關節活動角度檢測(PROM)組內差異檢定統計圖 34
圖4.8 肘關節被動式關節活動角度檢測(PROM)組間差異檢定統計圖 35
圖4.9 腕關節被動式關節活動角度檢測(PROM)組間差異檢定統計圖 36


表 目 錄
表2.1 台灣歷年主要死亡原因表 6
表4.1 受試者基本資料 27
表4.2 實驗組(n=9)肘關節被動式關節活動角度檢測(PROM)組內差異檢定 28
表4.3 實驗組(n=9)腕關節被動式關節活動角度檢測(PROM)組內差異檢定 28
表4.4 偽針控制組(n=6) 肘關節被動式關節活動角度檢測(PROM)組內差異檢定 29
表4.5 偽針控制組(n=6) 腕關節被動式關節活動角度檢測(PROM)組內差異檢定 29
表4.6 肘關節被動式關節活動角度檢測(PROM)組間差異檢定 30
表4.7 腕關節被動式關節活動角度檢測(PROM)組間差異檢定 30
表4.8 生活獨立量表(單位:分) 37
表4.9 巴氏量表(單位:分) 38
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