中风概述•中风是以猝然昏仆、不省人事,伴口角歪斜,语言不利,半身不遂;或不经昏仆仅以口喎、半身不遂为主症的一种疾病。因起病急骤,症见多端,变化迅速与自然界之风性善行数变特性相似而名中风;又因其发病突然亦称“卒中”。中风的基本病机总属阴阳失调,气血逆乱。病位在心脑,与肝肾密切相关。病理基础则为肝肾阴虚。因肝肾之阴虚,肝阳易于上亢,复加饮食起居不当,情志刺激或感受外邪,气血上冲于脑,神窍闭阻,故发生卒中。中风的机理病理性质多属本虚标实。肝肾阴虚,气血衰少为致病之本,风、火、痰、气、瘀为发病之标,两者可互为因果。后期因正气未复而邪气独留,可留后遗症。现在医学的脑出血、脑血栓、脑梗塞,均可参照本节进行辩证论治。。中风的辩证分型1中风先兆2中经络3中脏腑•分期:•1、急性期发病后至两周以内,中脏腑可至一个月。•2、恢复期发病两周后至半年内。•3、后遗症期发病半年以后中风的治疗•1西医治疗•2中医治疗根据病情辩证论治,宜采用标本兼顾,平肝熄风,化痰祛瘀与滋养肝肾,益气养血并用。中成药有:大活络丸、安宫牛黄丸、牛黄清心丸、华佗再造丸等。•3针灸治疗针刺能改善脑组织的灌流量,改善局部肢体组织细胞的营养,对促进患肢功能的恢复有一定作用。取穴以患侧肢体为主。上肢肩髃、肩髎、曲池、手三里、外关、合谷;下肢:环跳、阳陵泉、足三里、解溪、昆仑、悬钟等。根据病情可加用电针、头针治疗。•4物理疗法•(1)中频脉冲疗法其治疗作用是电刺激后肌肉发生节律性收缩,增强肌肉的血液循环,减轻水肿,改善营养,防止、延缓或减轻肌萎缩的发生,防止纤维化和挛缩,促进中枢运动控制功能的恢复和正常运动模式的重建。其治疗范围:面瘫、多发性神经炎、颈椎病、肩周炎、关节炎、腰肌劳损、骨质增生、椎间盘突出等有一定的疗效和缓解作用。•(2)红外线治疗红外线穿透人体组织产热后通过热传导或血液传送可使较深层组织温度升高,血管扩张,血流加速,并降低神经的兴奋性,因而有改善组织血液循环、增进组织营养、促进水肿吸收、炎症消散、镇痛、解痉作用。其治疗范围:褥疮、术后感染、神经痛、关节炎、软组织扭挫伤恢复期、肌纤维炎等。康复治疗•脑中风偏瘫的本质—运动模式发生质变典型脑中风痉挛模式错误的姿势•该体位躯干屈曲和下肢伸直姿势直接强化了痉挛模式错误的姿势良肢位摆放•1、患侧卧位时病人的患肢处于下方,这样会有助于刺激、牵拉患侧,减轻肢体的痉挛。病人头稍前屈,躯干后倾,用枕头稳固支撑后背,患侧肩向前方屈曲、肘伸直,前臂旋后、手腕背屈、手心向上、手指伸展开。患侧下肢髋关节伸展、微屈膝。健侧髋、膝关节屈曲,可放在长软枕上,这会有助于患侧髋关节伸展。患侧卧位有助于患肢伸展,抑制痉挛。患侧卧位健侧卧位•健侧卧位是健侧肢体处于下方的侧卧位。病人的头侧枕于枕头上,躯干与床面保持近垂直。患侧上肢用枕头垫起不使上肢处于内收位,肩关节屈曲最好稍大于90度,上肢尽可能伸直,手指伸展开。用软枕垫起处于上方的患侧下肢,保持在屈髋、屈膝位,足部最好也垫在枕头上,不能悬于软枕的边缘。健侧卧位的优点在于,可以改善患侧的血液循环,也可以减轻患侧肢体的痉挛,预防患肢水肿。健侧卧位仰卧位•病人头枕于枕头上,脸处于正中位,躯干平展,在患侧的臀部至大腿下方垫放一个长软枕,目的在于防止患侧髋关节外旋,髋关节长期外旋或向外固定后易导致在以后的步行中形成外旋步态。在患侧肩胛骨下方放一个枕头,使肩部上抬,并使肘部伸直、腕关节背伸、手指伸开,手中不要握东西。患侧下肢伸展,可在膝下放一小枕头,形成膝关节屈曲。仰卧位仰卧位康复训练(手法)康复训练(手法)康复训练(器械)康复训练(器械)•病人取仰卧位,双手十指交叉,患侧拇指处于上方,掌心相对,双上肢尽可能伸直,由健手带动患手上举过头,即双手叉握上举过头。这有利于恢复肩胛带及肩至手指各关节的正常活动范围、缓解肩痛及上肢水肿,也有助于诱发上肢的运动功能。训练方法双桥•病人取仰卧位,活动者用双手并拢双下肢,屈膝,平足,令病人抬起臀部并保持5、6秒钟。双桥单桥卧位卧位坐位坐位辅助站立位辅助站立位单腿站立位单腿站立位双腿站立位双腿站立位步行练习步行练习恢复时间段恢复百分比2年:欠佳3~6月:好1~2月:最佳24%:正常30%:工作70~90%:走6个月中风后KcOfRiUmXp#s&v)y0C3F7IaLdPgSjVnYq$t*w-A1D4G8JbNeQhTlWoZr%u(y+B2E6H9KcOfRjUmXp!s&v)z0C4F7IaMdPgSkVnZq$t*x-A1D5G8JbNeQiTlWo#r%u(y+B3E6H9LcOfRjUmYp!s&w)z0C4F7JaMdPhSkVnZq$u*x-A2D5G8KbNfQiTlXo#r%v(y0B3E6I9LcOgRjVmYp!t&w)z1C4F7JaMePhSkWnZq$u*x+A2D5H8KbNfQiUlXo#s%v(y0B3F6I9LdOgRjVmYq!t&w-z1C4G7JbMePhTkWnZr$u(x+A2E5H8KcNfQiUlXp#s%v)y0B3F6IaLdOgSjVmYq!t*w-z1D4G7JbMeQhTkWoZr$u(x+B2E5H9KcNfRiUmXp#s&v)y0C3F7IaLdPgSjVnYq$t*w-A1D4G8JbMeQhTlWoZr%u(x+B2E6H9KcOfRiUmXp!s&v)z0C3F7IaMdPgSkVnYq$t*x-A1D5G8JbNeQiTlWo#r%u(y+B3E6H9LcOfRjUmXp!s&w)z0C4F7IaMdPhSkVnZq$t*x-A2D5G8KbNeQiTlXo#r%v(y+B3E6I9LcOgRjUmYp!t&w)z1C4F7JaMePhSkWnZq$u*x-A2D5H8KbNfQiTlX&w)z0C4F7IaMdPhSkVnZq$t*x-A2D5G8KbNeQiTlXo#r%v(y+B3E6I9LcOgRjUmYp!t&w)z1C4F7JaMdPhSkWnZq$u*x-A2D5H8KbNfQiTlXo#s%v(y0B3E6I9LdOgRjVmYp!t&w-z1C4G7JaMePhTkWnZr$u*x+A2E5H8KcNfQiUlXo#s%v)y0B3F6I9LdOgSjVmYq!t&w-z1D4G7JbMePhTkWoZr$u(x+A2E5H9KcNfRiUlXp#s&v)y0C3F6IaLdPgSjVnYq!t*w-A1D4G8JbMeQhTkWoZr%u(x+B2E5H9KcOfRiUmXp#s&v)z0C3F7IaLdPgSkVnYq$t*w-A1D5G8JbNeQhTlWo#r%u(y+B2E6H9LcOfRjUmXp!s&v)z0C4F7IaMdPgSkVnZq$t*x-A1D5G8KbNeQiTlWo#r%v(y+B3E6H9LcOgRjUmYp!s&w)z1C4F7JaMdPhSkWnZq$u*x-A2D5G8KbNfQiTlXo#r%v(y0B3E6I9LcOgRjVmYp!t&w)z1C4G7JaMePhSkWnZr$u*x+A2D5H8KcNfQiUlXo#s%v)y0B3F6I9LdOgSjVmYq!t&w-z1C4G7JbMePhTkWnZr$y0B3E6I9LcOgRjVmYp!t&w)z1C4G7JaMePhSkWnZr$u*x+A2D5H8KcNfQiUlXo#s%v(y0B3F6I9LdOgRjVmYq!t&w-z1C4G7JbMePhTkWnZr$u(x+A2E5H8KcNfRiUlXp#s%v)y0C3F6IaLdOgSjVnYq!t*w-z1D4G8JbMeQhTkWoZr$u(x+B2E5H9KcNfRiUmXp#s&v)y0C3F7IaLdPgSjVnYq$t*w-A1D4G8JbNeQhTlWoZr%u(y+B2E6H9KcOfRjUmXp!s&v)z0C3F7IaMdPWoZr$u(x+B2E5H9KcNfRiUmXp#s&v)y0C3F7IaLdPgSjVnYq$t*w-A1D4G8JbNeQhTlWoZr%u(y+B2E6H9KcOfRiUmXp!s&v)z0C3F7IaMdPgSkVnYq$t*x-A1D5G8JbNeQiTlWo#r%u(y+B3E6H9LcOfRjUmYp!s&w)z0C4F7JaMdPhSkVnZq$t*x-A2D5G8KbNeQiTlXo#r%v(y+B3E6I9LcOgRjUmYp!t&w)z1C4F7JaMePhSkWnZq$u*x+A2D5H8KbNfQiUlXo#s%v(y0B3E6I9LdOgRjVmYp!t&w-z1C4G7JaMePhTkWnZr$u*x+A2E5H8KcNfQiUlXp#s%v)y0B3F6IaLdOgSjVmYq!t*w-z1D4G7JbMeQhTkWoZr$u(x+A2E5H9KcNfRiUlXp#s&v)y0C3F6IaLdPgSjVnYq!t*w-A1D4G8JbMeQhTlWoZr%u(x+B2E6H9KcOfRiUmXp!s&v)z0C3F7IaLdPgSkVnYq$t*w-A1D5G8JbNeQhTl#s&v)y0C3F6IaLdPgSjVnYq!t*w-A1D4G8JbMeQhTlWoZr%u(x+B2E6H9KcOfRiUmXp#s&v)z0C3F7IaLdPgSkVnYq$t*w-A1D5G8JbNeQhTlWo#r%u(y+B2E6H9LcOfRjUmXp!s&w)z0C4F7IaMdPhSkVnZq$t*x-A1D5G8KbNeQiTlWo#r%v(y+B3E6H9LcOgRjUmYp!s&w)z1C4F7JaMdPhSkWnZq$u*x-A2D5H8KbNfQiTlXo#s%v(y0B3E6I9LcOgRjVmYp!t&w)z1C4G7JaMePhSkWnZr$u*x+A2D5H8KcNfQiUlXo#s%v)y0B3F6I9LdOgSjVmYq!t&w-z1D4G7JbMePhTkWoZr$u(x+A2E5H8KcNfRiUlXp#s%v)y0C3F6IaLdOgSjVnYq!t*w-z1D4G8JbMeQhTkWoZr%u(B3F6I9LdOgSjVmYq!t&w-z1C4G7JbMePhTkWnZr$u(x+A2E5H8KcNfRiUlXp#s%v)y0C3F6IaLdOgSjVnYq!t*w-z1D4G8JbMeQhTkWoZr%u(x+B2E5H9KcOfRiUmXp#s&v)y0C3F7IaLdPgSjVnYq$t*w-A1D4G8JbNeQhTlWoZr%u(y+B2E6H9KcOfRjUmXp!s&v)z0C4F7IaMdPgSkVnZq$t*x-A1D5G8JbNeQiTlWo#r%u(y+B3E6H9LcOfRjUmYp!s&w)z0C4F7JaMdPhSkVnZq$u*x-A2D5G8KbNfQiTlXo#r%v(y0B3E6I9LcOgRjUmYp!t&w)z1C4F7JaMePhSkWnZq$u*x+A2D5H8KbNfmYp!s&w)z0C4F7JaMdPhSkVnZq$u*x-A2D5G8KbNfQiTlXo#r%v(y+B3E6I9LcOgRjUmYp!t&w)z1C4F7JaMePhSkWnZq$u*x+A2D5H8KbNfQiUlXo#s%v(y0B3F6I9LdOgRjVmYq!t&w-z1C4G7JaMePhTkWnZr$u*x+A2E5H8KcNfQiUlXp#s%v)y0B3F6IaLdOgSjVmYq!t*w-z1D4G7JbMeQhTkWoZr$u(x+B2E5H9KcNfRiUmXp#s&v)y0C3F6IaLdPgSjVnYq!t*w-A1D4G8JbMeQhTlWoZr%u(x+B2E6H9KcOfRiUmXp!s&v)z0C3FbMeQhTkWoZr$u(x+A2E5H9KcNfRiUlXp#s&v)y0C3F6IaLdPgSjVnYq!t*w-A1D4G8JbMeQhTlWoZr%u(x+B2E6H9KcOf