针刺不同穴位对痉挛性偏瘫患者诱发肌电图的影响

目的:比较与分析不同取穴方法对脑卒中后痉挛性偏瘫患者的诱发肌电图的影响。方法:选择脑中风后遗症并伴有单侧上肢痉挛性偏瘫患者11人为实验对象,分别采用对偏瘫肢体的痉挛侧和非痉挛侧进行电针治疗方法,以诱发肌电图中的H波和M波的变化,作为反映脊髓运动神经元兴奋性变化的客观指标。结果:(1)患侧肢体Hmax振幅(7.61±1.23)和H/Mmax比值(0.86±0.19),明显高于健侧Hmax振幅(4.66±1.23)和H/Mmax比值(0.55±0.11)(P<0.01),Mmax振幅无明显差异。(2)针刺刺激非痉挛侧经穴后,Hmax振幅随即由5.32mv降低至1.68mv,刺激停止后并立即未恢复到针刺前水平。(3)针刺后的痉挛侧和非痉挛侧的H/Mmax比值都明显下降,与针刺前比较呈现非常显著性差异(P<0.01),而且非痉挛侧的H/Mmax比值低于痉挛侧。结论:针刺非痉挛侧肢体的穴位,对脑卒中后遗症患者脊髓运动神经元异常活动的抑制效果,明显好于痉挛侧肢体的穴位,其机制可能是通过交互抑制的反射活动,对异常活动的脊髓α运动神经元产生了调整作用。

Effect of Puncturing Different Points on Evoked EMG of Spastic Hemiplegia Patients

Objective：compare the effects of different methods to Evoked EMG of spastic hemiplegia patients after suffering stroke. Methods ： Choose the patient who suffers spastic hemiplegia in the one-sided upper limb, accompanied with sequel of stroke as the object,and adopt the electrical acupuncture on both the spasticity side and non spasticity side to the emipegic limb,so as to evoke the change of H wave and M wave in the electromyogram,which will serve as the objective index of judging the change of excitability of spinal motor neurons. Results ： （ 1 ） Hmax amplitude （7.61± 1.23） and H/Mmax（0. 86 ±0. 19） in the suffering side of the limb are obviously higher than that in the healthy side （P 〈0. 01） ,while Mmax amplitude experiences no obvious change. （2） After electrical acupuncture to the acupoints of the channels in the non spasticity side, Hmax amplitude is immediately reduced from 5.32my to 1.68my. When acupuncture is stopped,Hmax is not instantly returned to the original level before electrical acupuncture. （3） The H/Mmax ratio on both the spasticity side and non spasticlty side are reduced obviously after acupuncture; and there exists an extremely obvious difference compared with that before the acupuncture （ P 〈0. 01 ） ,besides,the H/Mmax ratio on the non spasticity side is less than that on the spasticity side. Conclusion：the inhibiting effect on abnormal movement of spinal motor neurons of the patient suffering sequel of stokes by means of acupuncture to the acupoints on the non spaaticity side of the limb is better than by means of acupuncture to the acupoints on the spasticity side of the limb. The mechanism maybe has produced adjustment to the the abnormally active spinal amotor neurons through the reflex activities of reciprocal inhibition.