Journal of research in viet mmt traditional medicine and pharmacy No 34 - 2012
BU'dC DAU DANH GIA TAC D^NG PHUC H 6 I VAN D Q N G Of BENH NHAN N H 6 I MAU NAO BANG DAU CHAM Preliminary evaluation on Ihe effects of movemcnl recovery by using scalp
acupunlurc in IrcalmenI of post-stroke palienis
* DuoTig Irgng NghTa ', ** Nguyen Nhugc Kim ^ ' Binh viin Y hgc cd Iruyin Trung uang. ^ Tru&ng Dai hgc Y Ha Ngi T6m tdt:
Ddu ehdm id mdt phuang phdp dang du&c irng dgng a mdt sd nu&c trin the gidi di diiu Iri ph\ic hdi di chung TBMMN
M^c tieu: Ddnh gid tdc dung phgc hdi vgn dgng & b^nh nhdn TBMMN bang ddu chdm vd miic dg an lodn ciia pliuong phdp ndy
Phirffng phdp nghii-n cuu: ihu nghiem Idm .sdng. tiin ciru. so sdnh trudc vd sau diiu trj 60 binh nhdn chdn dodn di chiing TBMMN dmic chia ldm 2 nhdm mdi nhdm 30 b^nh nhdn Nhdm chung du^c diiu tri bdng phuong phdp thi chdm. udng thudc YHCT; nhdm nghien eini tren ca s& trin diing ihem ddu chdm. Ddnh gid kel qud llieo do Hit Rankin, diem Banhel vd vgn dpng iheo Orgogozo
Ket qua; Binh nhdn cd 2 nhdm diu phuc hdi vgn dgng tdt iheo dg li^l Rankin, diim Barlhel vd vgn dgng theo Orgogozo vdi p <0.01, Irong do nhdm nghien cuu cd kit qud tot han nhdm chung v&i p < 0, OS.
Kit lugn: Ddu chdm Id mgt phuang phdp an todn vd hiiu qud trong dieu triphgc hdi di chirng TBMMN Tir khoa: Benh nhan nhoi mdu nao; dau cham phuc hoi van d9ng
I. DAT VAN DE
Tai bien mgch mau nao (TBMN4N) thudng dfi lgi di chirng liet vdn ddng va suy giam tri tue, dnh hudng den boat dgng chung ciia ca thfi. Trong nhirng nam gdn ddy, d nude ta TBMMN dang cd chifiu hudng gia tang, cudp di sinh mang ciia nhifiu ngudi hoac dfi lgi di chung, gdy thiet hgi to Idn cho gia dinh vd xa bgi. Difiu tn di chdng TBMMN Id rdt cdn thifit cdn su phdi hgp ciia nhifiu chuyfin nganh dfi giam bdt tan phfi.
Trong YHCT, TBMMN vdi cdc di chirng ciia nd dd dugc md ta trong cac chimg "tning phong", "bdn than bat togi".
"thien khd".... YHCT cd nhifiu phuang phap difiu trj: diing thudc, cham cim, dign cham d tay chan, nhT chdm, dau chdm. Phuang phdp ddu cham dugc su dyng tu Idu d ngoai nude [1,2] song chua cd mgt cdng trinh nao nghifin ciru ve tdc dung phyc hdi van dgng ciia nd tgi Viet nam. Vi vdy chimg tdi lien hdnh nghien cihi vdi muc tifiu:
1. Ddnh gid tdc dung phuc hoi van dpng & binh nhdn TBMMN bdng ddu clidm.
2. Theo ddi tdc dung khdng mong mudn (niu cd) cua dhu chdm trin ldm sdng.
Phan bien khoa hgc: PGS T S . Trdn Qudc Binh * TS.BSCKll; • * PGS.TS
50
Nghien cim YDHCT Viet Nam Sd'34 - 2012
II. D6I TUQNC; VA PHUONG PHAP NGHIIN c u u
2.1. Doi tugng nghifin cuu:
Coin 60 bgnh nhan difiu trj n^i Irii tgi khoa chain cdu dudng sinh - B^nh vign YHC r TW, thdi gian: 4/2010 d^n 10/2010.
2.1.1. Tiiu chudn chgn bpnh nhdn theo YHHD:
- Bfinh nhdn dugc chan dodn Id nh6i mdu ndo qua giai dogn cfip (sau khi xudt hi?n bgnh 14 ngdy).
- Tudi Id 40 ludl trd Ifin
- I ict nua ngudi: Gidm hay mdt vgn dgng ty chii nua ngudi d cdc mdc dg khdc nhau.
- Cdc chi sd sinh ton: Mach, nhifit dg, nhjp Ihddn dinh.
- Huyfit dp tam thu dudi hodc bdng 160 mm Hg, huyfit dp tdm truang dudi hodc bang lOOmmHg.
- Da thodt khdi hdn me, tifip xiic dugc 2.I.2.Tiiu chudn logi trir:
- Lifit nua ngudi do cdc nguyen nhdn khdc.
- Khdng giao tiep, hgp tdc vdi ngudi difiu trj.
- Khdng ludn thii diing qui trinh difiu trj.
2.2. Phuang phdp nghien ciiru:
Thifit ke nghien cdu: theo phuang phdp thu nghiem ldm sang ngau nhifin cd doi chimg, tifin cuu, so sanh trudc va sau difiu trj.
Tdi cd cdc bgnh nhan thugc dign nghien ciiu vdo Khoa dfiu dugc khdm vfi ngi khoa.
ldm bgnh dn theo mau bgnh dn nghifin cdu, dugc chan dodn theo y hgc cd truyen vd y hgc hi$n dgi,
2.2.1. Quy trinh nghiin ciru Sau khi hdi bgnh, thdm khdm Idm sdng vd c$n Idm sdng theo mgt mau bgnh an th6ng nhdt, ti^n hdnh chia ngau nhifin bfinh nhdn vdo 2 nhdm:
- Nhdm nghien cdu: gdm 30 b?nh nhan dugc difiu trj bdng phuang phdp ddu chdm kfit hgp the cham, uong thudc YHCT (86 ducmg hodn ngu thang)
- Nhdm chung: gom 30 bgnh nhan dugc difiu trj bdng phuang phdp thfi chdm, uong thudc YHCT (Bd duong hodn ngu thang)
Ligu trinh dieu trj cho cd 2 nhdm Id 30 ngay.
2.2.2. Theo ddi Idm sdng
* Dg lici Rankin
* Difim Orgogozo, difim Barthel
* Dfim mgch vd do huyet dp
* Theo ddi tac dyng khdng mong mudn: vyng chdm, chay mau
2.2.3. Ddnh gid kit qua
DO ligt Rankin: Tdt: BN djch chuyfin td 2 dg ligt trd len, Khd. dich chuyfin 1 dO, Kfim: khdng chuyfin
Difim Orogogozo Difim Barthel
2.2.4. Xur ly va phdn tich so U$u.
Cdc sd lieu dugc xu ly theo phuang phdp thong kfi y sinh hgc, sis dyng chucmg trinh SPSS 11.0.
Journal of research in viet nam traditiimal medicine and pharmacy
III. KET QUA
3.1. So sanh su djch chuyen Ihco Rankin sau 30 ngdy dieu tri
Bieu do 1. Kcl qua ticn trien theo Rankin sau 30 ngdy dieu Iri Nhdn xfit:
Ty Ig bgnh nhan dgt kfit qua lot d nhdm nghifin ciiu Id 43,3%, d nhdm chimg la 33,3%. Sy khdc bifit cd y nghTa thdng kfi vdi p < 0,05.
Ty lfi bfinh nhan dgt kfil qua khd d nhdm nghifin cdu Id 53,4% va nhdm chung Id 60. Su khac bifit khdng cd y nghTa thdng kfi p > 0,05.
Bieu do 2. K^t quS tiln trien theo thang diem Barthel sau 30 ngay dieu tri
Nhdn xet:
- Difim trung binh Barlhel cua Nhdm nghifin cuu vd nhdm chdng dfiu cdi thi^n rd ret, chfinh Igch cd y nghTa thdng kfi vdi p<0,01.
- Sd difim cua nhdm nghifin cuu lang cao ban so vdi nhdm chiing cd y nghTa thdng kfi vdi p < 0,05.
Nghien cira YDIICT Viet Nam S6 34 • 2012
Phyc hoi tay chiin Iheo Ihang difim Orgogozo
Bang I. Phyc hoi lay chiln Ihco thang diem Orgogozo ciia 2 nhdm sau 30 ngdy
l>icm
Nang tay
Van dgng Mn
tay
Nang chan GSp ban
chSn 16111
10 diem P 15 diem 10 diem P 15 diem 10 diem P 10 diem
P N 4
0 6
Nfjliivn CITU
v„
T L % 13,3
N N 28
<0,01 0 20
8 18
JO
T L %
26,7 60
<0,01 2
6 6,7 20
12 18
40 60
<0,01 4 13,3 1 20 60
<0,01
Chirng
^
n 4
0
T L % 13,3
N n 22
<0,01 0
5 0 16,7
5 18
30
T L % 73,3
16,7 60
<0,01 2
8 6,7 26,7
7 20
23,3 60
<0,01 4 13,3 1 15 50
<0,01
P
<0,01
<0,05
<0,05 Nhdn xfit:
- Nhdm nghifin ciru:
Ndng tay mdc 10 diem tdng tu 13,3%
Ifin 93,3%.
Vdn dgng bdn tay mdc 1 0 - 1 5 difim tdng Id 20% Ifin 86,7%.
Nang chan muc 15 difim tang Id 6,7%
Ifin 40%
Nang chan muc 10 difim tdng tu 20%
len 60%
c a p bdn chdn mire 10 diem tSng tu 13,3% Ifin 60%.
- Nhdm chdng:
Nang tay mdc 10 difim tdng td 13,3 % Ifin 73,3%.
Van dgng bdng tay 10 - 15 difim tdng td 16,7% len 76,7%.
Vgn dgng ndng chan muc 15 difim tdng td 6,7% Ifin 23,3%.
Ndng chan mdc 10 diem tflng td 26,7%
Ifin 60%
Gdp bdn chdn mdc 10 diem tdng tii 13.3% Ifin 50%.
Trong timg nhdm ket qua trudc vd sau difiu trj khdc bigt c6 y nghTa thdng kfi vdi p
<0,0I.
So sdnh kfit qud tiiiig loat vgn dgng tdi thdy: Diem Nang tay nhdm nghifin ciru tdng hem nhdm chdng vdi p <0,01. Difim van dgng ban tay, nang chdn, gdp ban chdn ciia nhdm nghien ciiu tdng cao ban nhdm chung vdi sy khdc bigt cd y nghTa thdng ke vdi p < 0,05.
53
Journal of research in viet nam traditional medicine and pha No 34 - 2012
3.2. Quan sdt Idc dung khdng mong mnon ciia "dau cham" tren lam sdng:
- Vgng chdm. mfit mdi, chdng m^t - Chay mdu: khi tuan thii diing ligu trinh difin cham d ddu, kiem tra can thgn cho chdm sau khi riit kim, neu thdy cha;
mdu diing bdng khd lau lgi, cho chdm se hfit chay mdu. Trong qud trinh thyc hifin dfi tdi chua cd trudng hgp ndo bj chay mdu nhifiu.
IV. BAN LUAN
4.1. Danh gid theo tien trien do liet Rankin, Ihang diem Barthel va Orgogozo Bifiu dd 1 cho thdy: Ty lg bfinh nhan dat kfit qua tdt d nhdm nghifin cdu Id 43,3%, d nhdm chdng Id 33,3%. Su khac biel cd y nghTa thdng kfi vdi p < 0,05. Ty lfi b^nh nhan dgt kfil qud khd d nhdm nghien cuu Id 53,4% vd nhdm chimg Id 60. Su khac bifit khdng cd y nghTa thdng kfi p > 0,05. Difiu dd chihig td rang cd hai phuang phdp dfiu cd tac dung tdt trong phyc hdi liet van dgng sau nhdi mdu nao vd phuang phdp thfi cham + thudc thang + ddu chdm tdt ban phuang phdp thfi chdm + thudc thang.
Bifiu dd 2 cho thdy kfit qud phyc hdi sau difiii tri difim Barlhel ciia timg nhdm
tang Ifin rd rfii, khde bifit cd y nghTa Ihong kc vdi p < 0,01. Sau dieu trj Barlhel trung binh cua nhdm nghien cdu tdng 29 difim, eiia nhdm chung tdng 17 difim chdng Id rang ca 2 phuong phap dfiu cd tac dyng lot trong difiu trj phuc hdi liet van dgng vd d nhdm nghifin cuu tdng ban nhdm chdng khdc biet cd y nghTa Ihdng kfi vdi p < 0,05.
So sdnh vdi difim trung binh Orgogozo ciia nhdm nghifin cdu Irong nghifin cuu ciia Trdn Thj Quyfin [3] Id 86,1± 5,9. Difim Barthel trung binh d nhdm nghien cuu theo Truang Mau San [4] Id 69 ± 23,4 thi mdc difim trong nghien cdu ciia chiing tdi ciing hodn loan phii hgp.
Phuc hdi lay chan Iheo Ihang diem Orgogozo
Bdng 1 cho thdy: Kfit qud difim sd ndng cdnh tay, van dgng bdn tay, ndng chdn, gdp bdn chdn ciia hai nhdm tinh theo mdc difim 10 va 15 diem, so sdnh trudc vd sau dieu trj dfiu tdng vdi su khdc biet cd y nghTa thdng kfi vdi p < 0.01. O nhdm chirng sau dieu trj mdc difim ndng tay cd 22 bgnh nhdn chifim ty lg 73,3% so vdi nhdm nghien cdu cd 28 benh nhdn chifim ty lfi 93,3% su khac biet cd y nghTa thdng kfi vdi p< 0,01. Mdc diem
Nghien ciru YDIICT Viet Nam Sd 34 - 2012
ndng chdn, v^n dgng bdn lay, gfip bdn chdn d nhdm nghien cdu ciio han nhdm cluing sy khdc hifit ed y nghTa Ihong kfi vdi p< 0,05.
Difiu dd cho ihay: cii hai phuang phdp deu cd Iiic dyng Ini trong phyc hoi vgn dgng lay vd chan. Phyc hdi bdn lay khd ban phyc hoi cdnh tay: d nhdm ngiiiOn cuu diem tdi da ndng canh lay 10 difim dgt 93,3% cdn difim loi da v§n dgng bdn lay dgt 26.7%. d nhdm chimg diem nang canh tay loi da dat 73,3%, cdn diem toi da van dgng bdn tay dgt 16,7%. Chiing tdi thay rdng sy phyc hdi ciia bdn tay khd han vi van dgng ciia bdn lay Id van dgng linh te, ban lay cd nhifiu khdp nhd ban lay hay bj phii do roi logn van mgch khi bj liet, ddng thdi cdc ca co khdc ban cac ca duoi Idm bdn lay co lgi cdc khdp sdt Igi gdn nhau hon nfin de bj cumg khdp. Dfi khdc phuc vdn dfi nay edn phdi cd ke hogch phyc hdi sdm cho bfinh nhdn, d$c bigt Id sau giai dogn cdp vd ludn chii y khi Mfit vgn dgng canh lay hay bj trgt d khdp vai do ca ndng vd dgng cdnh tay dfiu bj ligt, cac ca bj ico va gidn nfin vige phyc hdi lay thucmg khd ban chan. Phyc hdi d nhdm nghifin cuu cao han nhdm chdng. Sy khdc bigt cd -y nghTa
thong kfi vdi p < 0,05. Cdc kfil qua trfin chdng minh sy phyc hdi cua tay chdn Iheo thang difim Ozgogozo ciia nhdm nghifin cthi lot han nhdm chdng. Kel qud cua chiing loi cung phii hgp vdi kfit qua nghifin ciru ciia Tran Thj Quyfin [3] cho thdy sau 30 ngay dieu trj diem so ndng lay toi da dat Id 83.3%
difim vgn d^ng bdn tay Idi da dgt 30%.
4.2. Tac dung khdng mong muon Chua cd trudng hgp ndo xdy ra vimg cham, chdy mdu nhifiu. mgch va huyfit ap ciia bgnh nhdn hodn todn dn djnh.
V. KET Ll AN
1. Qua nghifin cdu trfin Idm sang danh gia tac dyng phyc hdi chdc ndng vgn dgng d bgnh nhan nhdi mau ndo bdng dau cham ket hgp \di thfi cham. bd duang hodn ngu ihang cd ket qua rd rgt trong phyc hdi van dgng cho bfinh nhdn sau nhdi mau ndo lot hon so vdi nhdm chi dimg thfi chdm kfil hgp vdi B6 duang hodn ngu.
2. Phuang phdp su dyng dau chdm kfit hgp thfi cham va thudc YHCT Id an loan, khdng quan sat thay tdc dyng khdng mong
Journal of research in viet nam traditional medicine and pharmacy No 34 - 2012
TAI LIEU THAM KHAO
I . ^ J S Z E , ^...(2006) 3. Tran Thi Quyen (2005). "Ddnh
"5k%tt>Bir74'RRMS^ifiSlfll14ft^RllllJS gid diiu tri phuc hdi chirc ndng van
^ $ T ^ ^ dgng cho binh nhdn tai hien mach mdu
^^^W^-'l^U^^^-k^Wi^^^n , ndo bdng diin chain" vd "Bd duang (610075 ) 66-69. hodn ngu Ihang", Luan van Thgc sT y
2. Wang DH, Bao F, Zhang YX, hgc, Trudng Dgi hgc Y Ha Ngi.
Wang FQ, Sun H (2008) "Compari.son 4. T r u a n g Mau So-n (2006), "Ddnh of the therapeutic effects between body gid tdc dung phijc hdi chirc ndng vgn acupuncture and scalp acupuncture dgng do nhdi mdu ndo .lau giai dogn cdp combined with body acupuncture on bdng thuoc Ligustan kit hap v&i diin atherosclerotic cerebral infarction at chdm", Luan vSn Bac sT chuyfin khoa cap acute stage", Zbongguo Zhen Jiu, 11, Dai hgc Y khoa Ha Ngi.
28(l):10-2.
Sumary
PRELIMINARY EVALUATION ON THE EFFECTS OF MOVEMENT RECOVERY BV USING .'SCALP ACUPUNTURE IN TREATMENT OF POST-STROKE PATIENTS Scalp accupuncture is a method widely applied worldwide for the treatment of post-stroke sequelae.
Objective: To evaluate the effects of scalp accupuncture combined with body accupuncture and herbal medicine on the treatment of post-stroke patients and side effect of this method.
Metltod: Prospective clinical study, comparing the results before and after treatment. 60 post- stroke patients were divided into two groups, 30 patients each group. Patients in control group were treated by body accupuncture and herbal medicine. Patients in study group were treated on such basic combined with scalp accupuncture. Results were evaluated by Rankin paralysis scale, Barthel and Orgogozo scores.
Results: Patients in both groups had good movement recovery according to Rankin paralysis scale, Barthel and Orgogozo scores with p < 0,01; the results in study group were better than control group.
Conclusion: Scalp acupuncture is a safe and effective method in treatment of post-stroke sequelae.
Key words: Cerebral infarction, scalp acupuncture, movement recovery
