中药熏蒸与手法治疗脑卒中后肩手综合征的研究

Study on the treatment with Chinese herbal fumigation and manipulation for shoulder-hand after stroke

目的探讨中药熏蒸与手法结合治疗脑卒中后肩手综合征的临床疗效及对降钙素基因相关肽(CGRP)、血浆缓激肽(BK)、内皮素-1(ET-1)、一氧化氮(NO)的影响。方法将87例脑卒中后肩手综合征患者随机分成2组,治疗组采用中药熏蒸与手法加常规康复治疗,对照组采用手法加常规康复治疗。观察2组治疗前、治疗4周后主要证候评分、肩手综合征评估量表评分(SHSS)、疼痛视觉模拟评分(VAS)、肿胀评分、患肢Fugl-Meyer(FMA)评分及血尿CGRP、BK、NO、ET-1变化情况,并进行疗效比较。结果治疗后,2组主要证候评分、SHSS评分、VAS评分、肿胀评分及血浆BK、ET-1水平均显著降低(P均<0.05),FMA评分及血浆CGRP、NO水平均显著提高(P均<0.05),治疗组治疗后各项数据与对照组相比差异均有统计学意义(P均<0.05);治疗组总有效率为95.24%,明显高于对照组的77.78%(P<0.05)。结论中药熏蒸与手法结合可有效减轻脑卒中后肩手综合征患者临床症状体征,调节CGRP、BK、NO、ET-1水平,促进神经功能恢复,改善肢体运动能力。

Objective It is to investigate the clinical efficacy of Chinese herbal fumigation combined with manipulation on shoulder hand syndrome after stroke,and its effects on calcitonin gene related peptide(CGRP),plasma bradykinin(BK),endothelin-1(ET-1)and nitric oxide(NO).Methods Eighty seven cases of patients with post stroke shoulder-hand syndrome were randomly divided into two groups.The treatment group was treated with Chinese herbal fumigation and manipulation and routine rehabilitation,while the control group was treated with manipulation and routine rehabilitation.The changes of main syndrome scores,scores of shoulder hand syndrome Assessment Scale(SHSS),scores of pain visual analogue scale(VAS),swelling scores,Fugl-Meyer(FMA)scores,and the changes of CGRP,BK,NO,ET-1 in blood and urine were observed before and 4 weeks after treatment in the two groups,and the clinical efficacy was compared.Results After treatment,the scores of main syndromes,SHSS,VAS,swelling,and the levels of plasma BK and ET-1 were significantly decreased,FMA scores and the levels of plasma of CGRP and NO were significantly increased compared with that before treatment in the two groups(P<0.05).Compared with the control group,the differences in the improvements of these indexes were statistically significant(P<0.05).The total effective rate was 95.24%in the treatment group and 77.78%in the control group,the total effective rate in the treatment group was significantly higher than that in the control group(P<0.05).Conclusion Chinese herbal fumigation combined with manipulation can effectively reduce the symptoms and signs,regulate the levels of CGRP,BK,NO,ET-1,promote the recovery of nerve function and improve the ability of limb movement in the patients with post stroke shoulder-hand syndrome.