浮刺对脑卒中后肩手综合征镇痛作用的时效研究(英文)

Timeliness of the analgesic effect of superficial needling on shoulder-hand syndrome after stroke

目的:观察浮刺对脑卒中后肩手综合征肩痛镇痛效果与镇痛作用持续时间的相关性,筛选最佳镇痛作用时间周期。方法:收集脑卒中后肩手综合征(第Ⅰ期)患者120例,均接受浮刺治疗。寻找患者患肩明显压痛点2个,在每一个压痛点的下方80-100 mm处作为浮刺进针部位,进针后采用双手协同行针法,左手在针刺的上方捏拿压痛点周围,右手采用青龙摆尾法,每穴行针3 min,留针30 min。采用视觉模拟评分法(visual analogue scale,VAS)分别对120例患者在治疗前、治疗即刻、治疗后30 min、治疗后1 h、治疗后24 h的镇痛效果进行动态测评。采用广义估计方程统计方法对不同时间点的镇痛效应进行分析。结果:患者在治疗前、治疗即刻、治疗后30 min、治疗后1 h、治疗后24 h VAS测评均值分别为:7.483,3.950,4.767,5.917,7.217;不同时间点的镇痛效应间差异有统计学意义(P<0.01);浮刺治疗对脑卒中后肩手综合征肩痛的镇痛效应在治疗即刻、治疗后30 min差异显著(均P<0.05),治疗后1 h、治疗后24 h差异无显著性(均P>0.05)。结论:浮刺对脑卒中后肩手综合征肩痛的镇痛作用不同时间点的镇痛效应不同,随着时间的延长镇痛效应呈递减趋势;镇痛效应在浮刺后即刻达最高峰,镇痛效应最佳持续时间段是浮刺后即刻至浮刺治疗后30 min。

Objective To observe the correlation between analgesic effect and duration of analgesic effect of superficial needling for shoulder pain of shoulderhand syndrome（SHS） after stroke, so as to screen the best time period of analgesia. Methods A total of 120 patients with SHS after stroke（stage I） were recruited and superficial needling therapy was applied. Two obvious tenderness points on the affected shoulder of patients were found out. The site 80–100 mm down each tenderness point was selected for superficial needling. Bimanual needling technique was applied after inserting needles. The surrounding of tenderness points was pinched and grasped by left hand above the needling, and the technique of green dragon swaying tail was applied by right hand. The needles at each acupoint were manipulated for3 min and retained for 30 min. The analgesic effect was evaluated dynamically by visual analogue scale（VAS） in 120 patients before treatment, immediately after treatment, 30 min after treatment, 1 h after treatment and 24 h after treatment. The analgesic effects at different time were statistically analyzed by generalized estimating equation. Results The mean values of VAS were 7.483, 3.950, 4.767, 5.917 and 7.217, respectively, before treatment, immediately after treatment, 30 min after treatment, 1 h after treatment and 24 h after treatment. The difference of analgesic effect at different time was statistically significant（P〈0.01）; the difference of analgesic effect of superficial needling in treatment of SHS after stroke was significant between immediately after treatment and 30 min after treatment（both P〈0.05）, while there was no significant difference between 1 h after treatment and 24 h after treatment（both P〈0.05）. Conclusion Analgesic effect of superficial needling for shoulder pain of SHS after stroke was different at different time points and decreased over time; analgesic effect was the most significant immediately after treatment and the optimal duration of analgesic effect was from immediately to 30 min after superficial needling therapy.