益气活血中药膏摩治疗脑卒中后气虚血瘀型Ⅰ期SHS的临床效果

Rehabilitation effects of qi-invigorating and blood-activating TCM ointment rubbing on stage Ⅰ post-stroke SHS with qi deficiency and blood stasis syndrome

目的 观察益气活血中药膏摩治疗脑卒中后气虚血瘀型Ⅰ期肩手综合征(SHS)的临床效果及安全性。方法 本研究选取2023年3月-2024年1月在安徽中医药大学第二附属医院接受治疗的74例脑卒中后气虚血瘀型Ⅰ期SHS患者为研究对象。采用随机数字表法,将患者分为观察组与对照组,每组37例。观察组患者采用中药膏剂(由院内制剂十一味活血酊制作而成)进行膏摩疗法干预;对照组患者选用50 mL生理盐水+100 g黄凡士林搅拌均匀进行膏摩疗法干预。比较2组患者治疗前,治疗2周、4周时中医证候积分、疼痛视觉模拟量表(VAS)评分、手部肿胀程度、肩手综合征评估量表(SHSS)评分、肩关节活动度(ROM)、上肢Fugl-Meye运动功能评定量表(FMA)评分。结果 治疗前,2组患者中医证候积分及VAS评分比较,差异均无统计学意义(P>0.05)。治疗2周、4周时,2组患者中医证候积分及VAS评分均低于治疗前,且观察组低于对照组,差异均有统计学意义(P<0.05)。治疗前,2组患者手部排水体积差比较,差异无统计学意义(P>0.05)。治疗2周、4周时,2组患者手部排水体积差均小于治疗前,且观察组小于对照组,差异均有统计学意义(P<0.05)。治疗前,2组患者SHSS评分比较,差异无统计学意义(P>0.05)。治疗2周、4周时,2组患者SHSS评分均低于治疗前,且观察组低于对照组,差异均有统计学意义(P<0.05)。治疗前,2组患者屈曲、外展、内旋、外旋ROM比较,差异无统计学意义(P>0.05)。治疗2周、4周时,2组患者屈曲、外展、内旋、外旋ROM均大于治疗前,且观察组大于对照组,差异均有统计学意义(P<0.05)。治疗前,2组患者上肢FMA评分比较,差异无统计学意义(P>0.05)。治疗2周、4周时,2组患者上肢FMA评分均大于治疗前,且观察组大于对照组,差异均有统计学意义(P<0.05)。在膏摩过程中,2组患者均未发生不良反应。结论 益气活血中药膏摩对脑卒中后气虚血瘀型Ⅰ期SHS患者具有良好的治疗作用,可明显改善患者的临床症状,促进肩关节功能恢复及提高患者上肢运动功能,值得临床推广应用。

Objective To observe the clinical effects and safety of qi-invigorating and blood-activating traditional Chinese medicine(TCM)ointment rubbing on stage Ⅰ post-stroke shoulder-hand syndrome(SHS)with qi deficiency and blood stasis syndrome.Methods Seventy-four patients with stage Ⅰ post-stroke SHS with qi deficiency and blood stasis syndrome,treated at the Second Affiliated Hospital of Anhui University of Chinese Medicine from March 2023 to January 2024,were selected.Patients were randomly allocated to an observation group and a control group,with 37 cases in each group.The observation group received TCM ointment rubbing therapy with an in-house preparation of eleven-ingredient blood-activating tincture,while the control group received ointment rubbing therapy with 50 mL physiological saline mixed with 100 g yellow vaseline.TCM syndrome scores,pain visual analog scale(VAS)scores,hand swelling,Shoulder-Hand Syndrome Score(SHSS),shoulder joint range of motion(ROM),and upper limb Fugl-Meyer assessment(FMA)scores were compared before treatment,and at 2 and 4 weeks after treatment.Results Before treatment,there were no significant differences in TCM syndrome scores and VAS scores between the two groups(P>0.05).At 2 and 4 weeks after treatment,both scores were significantly decreased in both groups,with the observation group showing lower scores than the control group(P<0.05).Hand drainage volume differences before and after treatment were not significant between the two groups(P>0.05).After 2 and 4 weeks,hand drainage volume differences were significantly smaller in both groups,with the observation group showing smaller differences than the control group(P<0.05).SHSS scores,ROM measurements,and FMA scores increased more significantly in the observation group than those in the control group(P<0.05).No adverse reactions occurred in either group during treatment.Conclusion Qi-invigorating and blood-activating TCM ointment rubbing shows significant therapeutic effects on post-stroke SHS with qi deficiency and blood stasis syndrome,effectively alleviating clinical symptoms,promoting shoulder joint function recovery,and strengthening upper limb motor function,justifying a wider clinical application.