针刺结合康复治疗中风后肩手综合征:随机对照研究

Post-stroke shoulder-hand syndrome treated with acupuncture and rehabilitation:a randomized controlled trial

目的:评价针刺结合康复训练治疗中风后肩手综合征的临床疗效以及对患者甲襞微循环的影响。方法:将120例患者随机分为针刺康复组和单纯康复组,每组60例。单纯康复组采用以OT(综合康复疗法)为主的康复训练进行治疗,针刺康复组在此基础上配合针刺治疗,取穴太渊、足三里、悬钟、外关、手三里、曲池、肩髃,每天1次,7天为一疗程,共治疗4个疗程。评定两组患者治疗前后Fugl-Meyer评分、上肢疼痛评分、临床神经功能缺损评分、甲襞微循环等指标,并比较两组疗效。结果:(1)针刺康复组与单纯康复组的上肢疼痛程度、上肢综合运动功能、神经功能缺损、甲襞微循环及临床症状在治疗后均有改善,与治疗前比较,差异均有统计学意义(P<0.05,P<0.01);(2)治疗后针刺康复组与单纯康复组的上肢疼痛程度(0.90±0.71vs 1.80±0.66)、上肢综合运动功能(42.43±13.57vs 29.98±15.11)、神经功能缺损(8.60±1.61vs 13.0±1.74)、甲襞微循环(总积分3.18±1.32vs 4.34±1.23)相比差异均有统计学意义(P<0.05,P<0.01),针刺康复组优于单纯康复组;(3)针刺康复组显效率为50.0%(30/60)、总有效率为93.3%(56/60),优于单纯康复组的16.7%(10/60)、63.3%(38/60,均P<0.05)。结论:针刺结合康复训练与单纯康复训练对中风后肩手综合征均有效,可改善甲襞微循环情况,且前者优于后者。

Objective To assess the clinical efficacy on post-stroke shoulder-hand syndrome （SHS） treated with acupuncture and rehabilitation and the impacts on patients＇ nailfold microcirculation. Methods One hundred and twenty patients were randomized into an acupuncture rehabilitation group and a simple rehabilitation group, 60 cases in each one. In the simple rehabilitation group, OT （comprehensive rehabilitation therapy） training was adopted. In the acupuncture rehabilitation group, on the basis of the treatment as the simple rehabilitation, acu- puncture was added at Taiyuan （LU 9）, Zusanli （ST 36）, Xuanzhong （GB 39）, Waiguan （TE 5）, Shousanli （LI 10）, Quchi （LI 11） and Jianyu （LI 15）. Acupuncture was given once a day, 7 days made one session. Totally, 4 sessions of treatment were required. Fugl-Meyer score, upper limb pain score, the score of nerve function defect and the items of nailfold microcirculation of patients were assessed in the the two groups before and after treatment. The efficacy was compared between the two groups. Results （1） The upper limb pain, the systematic motor function of the upper limbs, the nerve function defect, nailfold microcirculation and clinical symptoms were all improved after treatment in either the acupuncture rehabilitation group or the simple rehabilitation group as compared with those before treatment, indicating the significant difference （P〈0. 05, P〈0.01）. （2） The improvements in the upper limb pain （0. 90±0.71 vs 1.80±0.66）, the systematic motor function of the upper limbs （42.43±13.57 vs 29.98±15.11）, the nerve function defect （8.60±1. 61 vs 13. 0±1. 74）, nailfold microcirculation （total score 3.18±1.32 vs 4.34± 1.23） and clinical symptoms in the acupuncture rehabilitation group after treatment were different significantly as compared with those in the simple rehabilitation group （P〈0.05 ,P〈0. 01）,and the results in the acupuncture rehabilitation group were superior to the simple rehabilitation group. （3） In the acupuncture rehabilitation group, the markedly effective rate was 50.0M （30/60） and the total effective rate was 93.3%（56/60）, which was better than 16.7% （10/60） and 63.3% （38/60） respectively in the simple rehabilita- tion group （all P〈0.05）. Conclusion Both the combined therapy of acupuncture and rehabilitation and the simple rehabilitation training are effective in the treatment of post-stroke SHS, and promote the status of nailfold micro- circulation, the efficacy of the combined therapy is better than that of the latter.