针灸穴位注射与康复训练三级治疗方案对脑梗死后肩-手综合征上肢功能及日常生活活动能力的影响

Therapeutic effect of acupoint injection and rehabilitation training three-level program on upper limb function and daily life activities of patients with shoulder-hand syndrome after cerebral infarction

目的：探讨针灸穴位注射与康复疗法对脑梗死后肩-手综合征（SHS）患者上肢功能恢复及日常生活活动能力（ADL）的影响。方法采用前瞻性研究方法。选择2014年1月至2016年2月在甘肃省酒泉市中医院和酒泉市人民医院就诊的96例脑梗死后SHS患者，按随机按数字表法分为观察组（56例）和对照组（40例）。两组患者均给予相同的综合治疗和康复训练，对照组在常规治疗基础上加用中频电治疗，观察组采用针刺与穴位注射丹参川芎嗪治疗；两组均连续治疗1个月后对患者上肢运动功能、ADL、肩关节疼痛、肩关节肿胀程度、关节活动度进行评定，并观察临床疗效。结果两组治疗后改良的Fugl-Meyer运动功能评分（FMA）、改良Barthel指数（MBI）和肩关节外展、内收、前屈、后伸、内旋、外旋的自主活动范围（ROM）均较治疗前明显增加，疼痛视觉模拟评分（VAS）、水肿体积差较治疗前降低，且治疗后上述指标的变化观察组较对照组更为显著〔FMA（分）：70.10±6.38比41.76±18.69，VAS（分）：2.00±1.37比5.00±1.25，MBI（分）：75.17±3.51比51.56±2.12，水肿体积差（cm3）：2.13±2.05比5.75±1.17，前屈：（153.1±6.7）°比（56.0±10.9）°，后伸：（39.6±5.8）°比（17.2±6.7）°，外展：（168.1±9.6）°比（52.1±8.9）°，内收：（52.1±3.6）°比（21.8±4.3）°，外旋：（49.8±7.6）°比（23.2±5.2）°，内旋：（107.0±8.5）°比（51.2±6.1）°，均P＜0.05〕，观察组总有疗效率明显高于对照组〔91.1%（52/56）比70.0%（28/40），P＜0.05〕。结论针刺穴位注射与康复训练三级治疗方案能减轻脑梗死后SHS患者的疼痛，消除水肿，有效恢复上肢运动功能及ADL。

ObjectiveTo investigate the effect of acup point injection and rehabilitation techniques on recovery of upper limb function and activities of daily life （ADL） in patients with shoulder-hand syndrome （SHS） after cerebral infarction.Methods Ninety-six patients with SHS after cerebral infarction admitted to Jiuquan City Traditional Chinese Medicine Hospital and Jiuquan City People＇s Hospital from January 2014 to February 2016 were enrolled, and they were randomly assigned to observation group （56 cases） and control group （40 cases）. The patients in the two groups were given the same routine comprehensive cerebral infarction treatments and rehabilitation technological training. In the control group, additionally intermediate frequency physiotherapy was used, while in the observation group, acupuncture and acupoint injection of salvia miltiorrhiza and ligustrazine were added. The patients in two groups were treated consecutively for one month, afterwards, the upper limb motor function, ADL, shoulder joint pain, degree of swelling and range of motion were assessed, and the clinical effects were observed.Results After treatment, the modified Fugl-Meyer motor function score （FMA）, modified barthel index （MBI） and the ranges of voluntary activities of shoulder abduction, adduction, flexion, extension, internal rotation and external rotation in patients of two groups were significantly increased than those before treatment; the pain visual analog scale （VAS） and the edema volume difference in observation group were lower than those in the control group, and after treatment, the changes of above indexes were more significant in the observation group than those in the control group [FMA： 70.10±6.38 vs. 41.76±18.69, VAS： 2.00±1.37 vs. 5.00±1.25, MBI： 75.17±3.51 vs. 51.56±2.12, edema volume difference （cm3）： 2.13±2.05 vs. 5.75±1.17, flexion： （153.1±6.7）° vs. （56.0±10.9）°, extension： （39.6±5.8）° vs. （17.2±6.7）°, abduction：（168.1±9.6）° vs. （52.1±8.9）°, adduction： （52.1±3.6）° vs. （21.8±4.3）°, external rotation： （49.8±7.6）° vs. （23.2±5.2）°, internal rotation： （107.0±8.5）° vs. （51.2±6.1）°], the total effect in observation group was significantly higher than that in the control group [91.1% （52/56） vs. 70.0% （28/40）,P 〈 0.05].Conclusions Acupuncture and acupoint injection combined with three-level therapeutic regimen of rehabilitation technological training for treatment of shoulder-hand syndrome after cerebral infarction can reduce the patient＇s pain and edema, and improve upper limb motor function and activities of daily living.