泼尼松在脑卒中后肩手综合征患者中的应用

The application of prednisone in patients with shoulder-hand syndrome after stroke

目的探讨泼尼松治疗脑卒中后肩手综合征患者的效果。方法将新乡医学院第一附属医院收治的62例脑卒中后并发肩手综合征患者随机分为泼尼松治疗组(观察组,32例)和对照组30例,两组均行常规康复训练,观察组同时口服泼尼松,从每日30 mg起,每3~5 d减量5 mg,治疗4周后进行偏瘫侧手关节疼痛、水肿、关节活动度评分及手功能评定。全部数据采用SPSS 17.0软件进行统计学处理。两组患者疼痛、水肿及关节活动度评分计量数据均以平均值±标准差表示,两组间比较采用t检验,两组患者手功能评定及疗效评定计数资料的比较用秩和检验。结果治疗后对照组偏瘫侧手关节疼痛、水肿、关节活动度评分分别为(4.41±1.92)分、(2.85±1.48)分、(6.32±2.06)分,观察组偏瘫侧手关节疼痛、水肿、关节活动度评分分别为(2.59±1.46)分、(1.31±0.87)分、(4.53±1.78)分,两组比较差异有统计学意义(t=4.218、4.150、3.668,P<0.05);治疗后对照组废用手9例,辅助手18例,实用手3例,观察组废用手2例,辅助手25例,实用手5例,两组比较差异有统计学意义(u=2.108,P<0.05);观察组偏瘫侧手关节疼痛、水肿、关节活动度及手功能评定等方面均优于对照组。结论泼尼松能明显提高脑卒中后肩手综合征的治疗效果,有助于手功能的恢复。

Objective To explore therapeutic effect of prednisone on shoulder-hand syndrome after stroke. Methods Sixty two cases of poststroke shoulder-hand syndrome who were hospitalized in the first ＇affiliated hospital of xinxiang medical university were randomly divided into prednisone group （observation group） and control group. Both groups received regular rehabilitation training, the observation group was given oral prednisone at the same time, patients were given 30 mga day at the beginning, the dose was reduced 5 mg every 3 to 5 days. After four weeks, therapeutic eft^cts of the two groups were compared by evaluating the scores of pain, swelling, active range of motion （ AROM ） and the function of hemiplegia opposite hand joint. All data were analyzed by SPSS 17. 0 statistically. Tbe scores of pain, swelling, AROM and the function of hemiplegia opposite hand joint in two groups were indicated by mean _＋ standard deviation, t test was applied to compare the data of two groups, rank stun test was applied to compax~ the scores of hand function assessment and effieacy evaluation. Results After treatment, the scores of pain, swelling, AROM of hemiplegia opposite hand joint of control group were 4.41 ± 1.92, 2.85 ± 1.48, 6.32 ±2.06 respectively, and those of observation group were 2.59 ± 1.46, 1.31 ± 0.87,4.53 ±1.78 respectively, Results of the two groups showed statistical significance （ t = 4. 218, 4. 150, 3. 668, P 〈 0.05 ）. There were nonfunmctional hand 9 cases, partial functional hand 18 cases, functional hand 3 cases in control group, and nontlanctional hand 2 cases, partial functional hand 25 cases, functional hand 5 cases in observation group. There were statistically significant differences between two groups（ u = 2. 108, P 〈 0.05 ）. The therapeutic effect of observation group was better than that of control group at joint pain, swelling, active range of motion and hand function evaluation of hcmiplegia opposite band. Conclusions Prednisone can significantly improve the therapeutic effect of shoulder- hand syndrome after stroke, help to make hand function recovery.