동서양 대체의학

뇌졸중에서 침의 효과   글쓴이 : 이병철     날짜 : 02-01-16 14:26     조회 : 6357     뇌졸중에서 침의 효과  뇌졸중환자에서 침의 효과가 확실히 인정되어 있지 않으나 우리 나라에서 는 아주 당연한 치료법으로 여겨져 국민적 호응(?)하에 정말 널리 시행되 고 있는 것 같다. 침의 효과를 밝히기 위한 임상적 연구에는 여러 어려움이 따른다. 우선은 이중 맹검 대조 연구가 가능하지 않을 것이며 침의 효과를 지지하는 측과 침의 효과를 인정하지 않으려는 측의 협력적이며 편견 없는 감시통제가 필 요할 것이나 현실적으로, 적어도 우리 나라에선, 그러하지 못한 실정이다. 뇌졸중 환자에서 침구요법은 우리 나라를 포함한, 동양 권 국가 뿐 아니라 서양에서도 시행되어 왔으나 아직까지 그 효과에 대해 확실히 입증할 자료 는 없다. 지금까지 뇌졸중에서 침의 효과를 지지하는 몇몇 연구가 있었으 나 대부분의 연구가 대상수가 적고, 대조 군이 없으며, 또한 무작위화되어 있지 않아 그 결과에 대해서는 신빙성이 적다. 국내에서는 뇌졸중에서 침의 효과에 대한 한의학계 연구결과를 쉽게 검색 하기 어려워 국내연구실적을 파악하기 어렵다. 최근 스웨덴에서 시행된, 비교적 잘 설계된 2개의 “뇌졸중환자에서 침의 효과”에 대한 연구가 있었고 그 결과, 뇌졸중 후 기능적 예후나 삶의 질 향상에 있어 대조 군에 비해 이점이 없음으로 결론지었다. *아래 다음 두 편 논문의 초록이 있습니다.  Acupuncture and Transcutaneous Nerve Stimulation in Stroke Rehabilitation: A Randomized, Controlled Trial. Stroke 2001; 32:707-713. Effects of Acupuncture Treatment on Daily Life Activities and Quality of Life: A Controlled, Prospective, and Randomized Study of Acute Stroke Patients. Stroke 1998; 29:2100-2108.   ......................................... Acupuncture and Transcutaneous Nerve Stimulation in Stroke Rehabilitation, A Randomized, Controlled Trial Barbro B. Johansson, MD, PhD; Eva Haker, PhD; Magnus von Arbin, MD, PhD; Mona Britton, MD, PhD; Goran Langstrom, PhD; Andreas Terent, MD, PhD; Dag Ursing, MD; Kjell Asplund, MD, PhD; for the Swedish Collaboration on Sensory Stimulation After Stroke1 From the Department of Neurology (B.B.J.), Lund University Hospital, Lund; Department of Physiotherapy (E.H.), Karolinska Institutet; Department of Medicine at Danderyd Hospital (M. von A.), Stockholm; Swedish Council for Technology Assessment in Health Care (M.B.), Astra Hassle AB (G.L.), Molndal; Departments of Medicine at Uppsala University Hospital (A.T.), Uppsala; Angelholm Hospital (D.U.), Angelholm; and Umea University Hospital (K.A.), Umea, Sweden. Correspondence to Prof Kjell Asplund, Department of Medicine, University Hospital, SE-901 85 Umea, Sweden. E-mail kjell.asplund@medicin.umu.se (Stroke 2001: 32-707) Background and Purpose In small trials with control groups that receive no intervention, acupuncture has been reported to improve functional outcome after stroke. We studied effects of acupuncture and transcutaneous electrical nerve stimulation on functional outcome and quality of life after stroke versus a control group that received subliminal electrostimulation. Methods In a multicenter randomized controlled trial involving 7 university and district hospitals in Sweden, 150 patients with moderate or severe functional impairment were included. At days 5 to 10 after acute stroke, patients were randomized to 1 of 3 intervention groups: (a) acupuncture, including electroacupuncture; (b) sensory stimulation with high-intensity, low-frequency transcutaneous electrical nerve stimulation that induces muscle contractions; and (c) low-intensity (subliminal) high-frequency electrostimulation (control group). A total of 20 treatment sessions were performed over a 10-week period. Outcome variables included motor function, activities of daily living function, walking ability, social activities, and life satisfaction at 3-month and 1-year follow-up. Results At baseline, patients in each group were closely similar in all important prognostic variables. At 3-month and 1-year follow-ups, no clinically important or statistically significant differences were observed between groups for any of the outcome variables. The 3 treatment modalities were all conducted without major adverse effects. Conclusions When compared with a control group that received subliminal electrostimulation, treatment during the subacute phase of stroke with acupuncture or transcutaneous electrical nerve stimulation with muscle contractions had no beneficial effects on functional outcome or life satisfaction. Key Words: acupuncture  trancutaneous electric nerve stimulation  activities of daily living  quality of life  outcome .............................. Effects of Acupuncture Treatment on Daily Life Activities and Quality of Life, A Controlled, Prospective, and Randomized Study of Acute Stroke Patients   Gunilla Gosman-Hedstrom, OT, MSc; Lisbet Claesson, OT, MSc; Ulrika Klingenstierna, RPT, MSc; Jane Carlsson, RPT, PhD; Bengt Olausson, MD, PhD; Martin Frizell, MD, PhD; Bjorn Fagerberg, MD, PhD;  Christian Blomstrand, MD, PhD From the Department of Clinical Neuroscience, Section of Neurology (G.G.-H., L.C., J.C., C.B., M.F.), Sahlgrenska University Hospital; Goteborg College of Health Sciences, Department of Rehabilitation (G.G.-H., L.C., U.K., J.C.); Department of Clinical Neuroscience, Section of Psychiatry (B.O.), Molndal/Sahlgrenska University Hospital; and Department of Medicine, Section of Internal Medicine (B.F.), Sahlgrenska University Hospital, Goteborg, Sweden. Correspondence to Associate Professor Christian Blomstrand, Department of Clinical Neuroscience, Section of Neurology, Sahlgrenska University Hospital, S-413 45 Goteborg, Sweden. E-mail cbl@neuro.gu.se  (Stroke 1998, 29:2100-2108)  Background and Purpose A number of studies have indicated that acupuncture might improve the functional recovery of stroke patients. These studies vary in inclusion criteria, sample size, and evaluation methods. The present study was designed to investigate whether electroacupuncture treatment favorably affects stroke patients' ability to perform daily life activities, their health-related quality of life, and their use of health care and social services. Methods One hundred four consecutive patients >40 years of age admitted to hospital because of an acute stroke were randomized to 3 groups: deep, superficial, and no acupuncture treatment. The acupuncture treatment given by 4 physiotherapists started 4 to 10 days after randomization and was given twice a week for 10 weeks. All patients underwent conventional stroke rehabilitation as well. Two occupational therapists, blinded regarding the patients' allocation, evaluated the treatment effects. The assessments were performed 4 times during the first year after randomization by means of interviews and observations. Results There were no differences between the groups with reference to changes in the neurological score and the Barthel and Sunnaas activities of daily living index scores after 3 and 12 months. Regarding the Nottingham Health Profile, the no acupuncture group had somewhat fewer mobility problems. No differences in health care and social services were found between the groups. Conclusions The present study does not give support to the previous studies, which indicates that acupuncture treatment may have a beneficial effect on acute stroke patients' ability to perform daily life activities, their health-related quality of life, and their use of health care and social services. Key Words: activities of daily living  acupuncture  cerebrovascular disorders  quality of life  stroke outcome ----------------------