| ObjectiveTo analyze the effect of herbal fumigation on stroke spasmodic paralysis by quantitative analysis and Meta-analysis by searching the clinical literature of herbal for stroke spastic paralysis in recent 20 years;To observe the clinical efficacy and safety of herbal fumigation combined with tension-balance acupuncture in the treatment of cerebral apoplexy spastic paralysis by using the method of randomized controlled trial to study the effect of herbal fumigation on stroke spastic paralysis;To further evaluate the improvement of daily life ability and life quality of the patients during their rehabilitation period at home treated by herbal fumigation and the unique health guidance of the traditional Chinese medicine,after applying the unique continuous nursing model of traditional Chinese Medicine to the treatment of stroke spastic paralysis patients discharged from hospital,so as to provide the basis for the application of the treatment of herbal fumigation on stroke spastic paralysis patients and the extension of the unique transitional nursing model of traditional Chinese medicine.Method1.Literature reviewPutting "stroke hemiplegia","herbal fumigation","random" as the key words,setting up the inclusion and exclusion criteria,searching the database of CBM and Wan Fang Database by computer and hand examination,collecting the clinical experimental literature on the treatment of stroke spastic hemiplegia by herbal fumigation with traditional Chinese medicine,to analyze the literature and its contents by the method of literature measurement;Collecting the RCTs related to the treatment of stroke hemiplegia by herbal fumigation of traditional Chinese medicine,and then screening and collecting the retrieved results according to certain procedures,to evaluate the clinical effect of herbal fumigation on hemiplegic spasm after stroke,by Meta-analysis method.2.Clinical study on the treatment of herbal fumigation combined with tension-balance acupuncture on hemiplegic spasm after stroke138 inpatients in convalescence and sequelae of spastic paralysis of stroke were selected as study objects.They were randomly divided into two groups:control group(n = 68)and treatment group(n = 70).The patients in control group were treated with tension balance acupuncture and nursing according to nursing routine and rehabilitation training,while the treatment group had fumigation besides the treatments control group has.The period of treatment was 4 weeks.On admission,2 weeks and 4 weeks of treatment respectively,the curative effect was evaluated.The modified Ashworth Scale,the clinical Spasticity Index and surface electromyography s EMG were used to evaluate the spasm state.The simplified Fugal-Meyer was used to evaluate the limb motor function,and the Barthel index BI was applied to evaluate the activity of daily living(ADL)of the patients.3.The Construction and Application of the Continuous Nursing Model of Traditional Chinese Medicine characteristics based on the Three-Dimension Quality Evaluation in procedure of Structure-Process-ResultUnder the framework of the Donabedian ' s three-dimensional quality evaluation system,by studying on the literature,consulting the experts,and combining the physiologic and disease characteristics of the patients with spastic paralysis of stroke,the transitional nursing care model with TCM on stroke spastic paralysis patients was preliminarily constructed.The model was applied to 65 patients with spastic paralysis after stroke in the third part of the clinical study group.They were randomly divided into two groups:the intervention group(n = 33)and the control group(n = 32).The control group were discharged by following the routine guidance and revisited by telephone follow-up.The intervention group carried out transitional nursing care of TCM characteristics,including TCM health guidance,herbal fumigation technology,establishment of QQ group,We Chat group,telephone follow up after discharge and family follow-up.Data were collected at discharge and 3 months after intervention.The data collected from FMA,the Mos 36-item short form Healthsurvey SF-36,the satisfaction questionnaire,the compliance questionnaire and health service questionnaire were used to evaluate patients' limb motor function,service satisfaction,disease knowledge mastery,outpatient frequency and compliance.Results1.Literature reviewThe total number of clinical trials of herbal in the treatment of cerebral apoplexy spasm hemiplegia is increasing year by year,and the clinical trial research has been concentrated in recent 3 years.Its resource type,subject,source and theory WF support,author and agency distribution analysis,source of papers and periodicals,research teams and institutions are relatively dispersed.Spastic paralysis after stroke mainly occurs in convalescence and sequelae.There are three different common therapeutic regimen which are herbal fumigation,herbal fumigation combined with acupuncture and herbal fumigation combined with rehabilitation physiotherapy for post apoplectic spastic hemiplegia.Common principles of treatment are: spasm lysis,phlegm and collaterals,spasm lysis and pain relief.Jieshujin decoction,self-made spasm lysis and pain-relieving prescription,Huatan Tongluo Jie Jing decoction is a common prescription for herbal.The results of Meta-analysis showed that the clinical effective rate of herbal fumigation group was higher than that of routine treatment,and the difference was statistically significant.The score of VAS in the herbal fumigation group was better than that in the routine therapy(P<0.00001),and the Ashworth index score of fumigation and washing of traditional Chinese medicine was better than that of the routine therapy(P < 0.00001).2.Clinical study on the treatment of hemiplegic spasm after stroke with herbal fumigation and tension-balance acupunctureThe general information of the two groups,the diagnosis and complication of the disease,and the Brainstorm classification before treatment,there was no significant difference between the two groups(P>0.05).After 4 weeks ‘treatment,the FMA-BII-EMG scores of the two groups were improved compared with those before treatment,and there was no significant difference(P>0.05)between the two groups in the scores of motor function and motor function of limbs,the electromyography of the upper and lower extremity limbs and the activity of daily living(BI)index(BI index)of the upper and lower extremities were improved after 4 weeks of treatment,and there was no significant difference between the two groups.The clinical curative effect evaluation of the treatment group was better than that of the control group(P<0.05),including the evaluation of FMA-BII,musculus biceps brachii i EMG,i EMG of rectus femoris muscle,but it did not come out after treatment.There is an obvious adverse reaction.3.Construction and application of the transitional nursing care model with TCM based on structure process result TDT quality evaluation.There was no statistical difference(P>0.05)but comparability with the general information of the patients between intervention group and control group as well as the upper and lower extremity FMA-BII-SF-36 before intervention.And the scores of the upper and lower extremities FMA-BII-SF-36 were improved after 3months compared with those before intervention.The intervention group was superior to control group(P<0.05)in scores of discharged compliances,with significant differences(P< 0.05).There was no significant difference in re-hospitalization rate between two groups,but the outpatient visit rate in the intervention group was significantly higher than that in the control group(P<0.05)with statistical significance.The nursing satisfaction of the patients in the intervention group was higher than that in the control group(P<0.05).It was significantly higher than that of the control group(P<0.05).Conclusion1.Herbal fumigation and tension-balance acupuncture therapy combined with routine rehabilitation training have some effect on alleviating spasmodic state of stroke and improving motor function as well as ADL(activities of daily living).Herbal fumigation combined with tension-balance acupuncture therapy is obviously better than tension-balance acupuncture alone.2.The transitional nursing care model of TCM(Traditional Chinese Medicine)characteristics based on TDT(Three-Dimensional Theory)of Donabedian structure process result can standardize workflow and improve the quality of transitional nursing care.3.The transitional nursing care intervention with TCM can improve the motor function,ADL,knowledge,guidance compliance discharged,quality of life,health service utilization and satisfaction with nursing care of post apoplectic spastic hemiplegia.4.The transitional nursing care with TCM is an efficient guarantee to post apoplectic spastic hemiplegia for maintaining the rehabilitation effectiveness in hospital and promoting a longer lasting of functional recovery.5.Herbal fumigation therapy is effective,convenient,safe and feasible for a clinical and community-based & family-based generalization and application. |
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