不同针灸疗法治疗中风后肩手综合征的疗效观察

Therapeutic effects of different acupuncture techniques on post-stroke shoulder-hand syndrome

目的探讨温针灸、电针以及普通针刺对中风后肩手综合征(SHS)的治疗效果。方法将2014年5月至2015年5月收治的SHS患者90例,按照完全随机原则分为温针灸组、电针组以及普通针刺组,各30例。温针灸组以温针灸疗法为主,电针组以电针疗法为主,普通针刺组以普通针刺法为主。观察三组患者治疗后临床疗效及疼痛视觉模拟评分(VAS)、简式Fugl-Meyer(FMA)运动功能评分以及肿胀评分等情况。结果 1)治疗2周后,三组患者与治疗前相比,温针灸组的肿胀评分减少,差异有统计学意义(P<0.05)。治疗4周后,三组患者的肿胀评分均减少,与治疗前相比,差异有统计学意义(P<0.05);且温针灸组肿胀评分降低明显优于电针组,电针组优于普通针刺组,三组相互比较,差异有统计学意义(P<0.05)。2)三组患者治疗后FMA各项指标评分明显升高,与治疗前比较,差异有统计学意义(P<0.05);三组FMA各项指标评分组间比较,除反射亢进评分方面,其他方面评分分值电针组显著高于普通针刺组、温针灸组显著高于电针组,差异有统计学意义(P<0.05)。3)治疗后三组患者VAS评分与治疗前比较,均有改善(P<0.05),其中电针组相对于普通针刺组有着明显的改善(P<0.0l),温针灸组改善程度优于电针组(P<0.05)。4)三组患者治疗4个疗程后,温针灸组的总有效率为96.0%,电针组为86.0%,普通针刺组为60.0%,三组间相互比较,差异有统计学意义(P<0.05)。结论温针灸治疗SHS在缓解疼痛、改善患者综合功能等方面优于电针和普通针刺疗法,采用温针灸治疗SHS效果更佳,值得临床应用与推广。

Objective To explore the effects on shoulder-hand syndrome（ SHS） treated with warm needling therapy,electroacupuncture（ EA） and common acupuncture. Methods From May 2014 to May2015,90 SHS patients were collected. According to the complete randomization principle,a warm needling group,an EA group and a common acupuncture group were divided,30 cases in each one. In the warm needling group,the warm needling technique was used. In EA group,EA was adopted and in the common acupuncture group,the common acupuncture therapy was given. The clinical therapeutic effects,VAS score,FMA motor function score and swelling score were observed in the three groups after treatment. Results 1. After 2-week group,the swelling score in the warm needling group was reduced as compared with that before treatment,indicating the significant difference（ P〈0. 05）. In 4-week treatment,the swelling score in the three groups was all reduced as compared with that before treatment,indicating the significant difference（ P〈0. 05）. Compared with the EA group and the common acupuncture group,the swelling score in the warm needling group was reduced more obviously,indicating the significant differences（ P〈0. 05）. 2. After treatment,the score of every item in FMA was increased remarkably as compared with that before treatment in the three groups（ P〈0. 05）. In comparison of the item score in FMA among three groups,except the hyperreflexia score,the scores of the other items in the EA group were all higher significantly than the common acupuncture group,and the scores in the warm needling group were higher significantly than the EA group,indicating thesignificant differences（ P〈0. 05）. 3. After treatment,VAS scores in the three groups were all improved as compared with those before treatment（ P〈0. 05）. The scores in the EA group were improved obviously as compared with the common acupuncture group（ P〈0. 01）. The improvement in the warm needling group was better than the EA group（ P〈0. 05）. 4. After 4-session treatment,the total effective rate was 96. 0% in the warm needling group,was 86. 0% in the EA group and was 60. 0% in the common acupuncture. The differences were significant in comparison among the three groups（ P〈0. 05）. Conclusion The warm needling therapy is advantageous at relieving pain and improving the patients＇ comprehensive functions as compared with EA and common acupuncture therapy. The warm needling therapy achieves the best effects on SHS and deserves to be promoted in clinical practice.