蜂针联合康复训练治疗卒中后肩手综合征Ⅰ期临床疗效及对血浆CGRP、BK、SP水平影响

Clinical Effect of Bee Venom Acupuncture Combined with Rehabilitation Training on Post-Stroke SHS of Stage I and Its Influence to Plasma CGRP,BK and SP

目的:观察蜂针联合康复训练治疗脑卒中后肩手综合征(SHS)Ⅰ期的临床治疗效果以及对血浆CGRP、BK、SP水平的影响。方法:收集2017年1月—2018年4月在深圳市宝安区中医院(集团)针灸科住院部以及门诊部就诊的卒中后肩手综合征Ⅰ期的患者作为研究对象,总共收集病例72例,按照随机数字法将72例研究对象按照1:1的比例纳入对照组与观察组,每组36例。对照组与观察组的研究对象均给予常规的内科对症支持处理,同时对照组患者予上肢康复训练疗法,观察组在对照组基础上加用蜂针治疗,康复训练每日1次,蜂针疗法隔日1次,均连续治疗4周。评价两组治疗后的临床疗效,进行治疗前后的肩手综合征评估量表(SHSS),水肿程度、疼痛视觉模拟评分(VAS)和上肢Fugl-Meyer功能量表(FMA)评分,检测两组治疗前后血浆CGRP、BK和SP水平。结果:根据统计结果可知,观察组总有效率94.44%,明显高于对照组总有效率72.22%,统计分析结果提示差异具有统计学意义(P<0.05);与治疗前相比,治疗后观察组和对照组患者的SHSS、VAS评分都明显下降,但两组患者的FMA评分均升高,经统计学分析,结果提示两组治疗前后差异有统计学意义(P<0.05)。治疗后组间对比,观察组治疗后的SHSS评分和VAS评分均较对照组评分低,但观察组患者治疗后的FMA评分结果显著高于对照组,经统计分析,差异有统计学意义(P<0.05)。组内比较,治疗后两组患者的血浆BK、SP水平均明显低于治疗前的血浆BK、SP水平,而治疗后两组患者的CGRP含量水平则明显增加,统计分析结果提示差异均具有统计学意义(P<0.05)。治疗后两组组间相比,显示观察组患者治疗后的血浆BK、SP含量水平明显低于对照组,而观察组患者治疗后的CGRP血浆水平显著高于对照组,经统计学分析,两组具有统计学差异(P<0.05)。结论:卒中后SHSⅠ期患者使用蜂针联合康复训练治疗,可以明显缓解患者的疼痛、肿胀和上肢活动功能障碍等临床症状,临床疗效显著,蜂针联合康复训练治疗的作用可能与血浆CGRP含量水平的升高以及血浆BK和SP水平降低有关。

Objective:To observe the clinical efficacy of bee venom acupuncture combined with rehabilitation training in the treatment of post-stroke shoulder-hand syndrome(SHS)of stage I and its influence to plasma levels of CGRP,BK and SP.Methods:A total of 72 patients met the inclusion criteria were randomly divided into the study group and the observation group,with 36 cases in each group.Both groups were treated with conventional medical support.The control group was treated with rehabilitation training of upper limbs;on the basis of the control group,the observation group was also treated with bee venom acupuncture.The rehabilitation training was performed once a day,and the bee venom acupuncture was performed once every other day for 4 weeks.The clinical efficacy,the scores of the shoulder-hand syndrome evaluation scale(SHSS),the degree of edema,the score of VAS,and the score of the upper limb Fugl-Meyer function scale(FMA)were evaluated before and after the treatment in the two groups.The plasma levels of CGRP,BK and SP were also observed.Results:The total effective rate was 94.44%in the observation group,which was significantly higher than 72.22%in the control group(P<0.05).The scores of SHSS and VAS were significantly decreased,and FMA score were increased in the two groups after the treatment(P<0.05);of which the improvements in the observation group was more significant than those in the control group(P<0.05).The plasma levels of BK and SP were significantly decreased after the treatment,and CGRP levels were significantly increased after the treatment in the two groups(P<0.05);of which the changes in the observation group were more significant(P<0.05).Conclusion:Bee venom acupuncture combined with rehabilitation training can significantly alleviate pain and swelling,it can improve the function of upper limbs in patients with post-stroke SHS of stage I,which may be related to the increase of plasma CGRP and the decrease of plasma BK and SP.