针药结合治疗脑卒中伴肩手综合征的临床研究

Acupuncture combined with Chinese herbs in treating stroke with shoulder-hand syndrome: a clinical observation study

目的探讨七味通络散外敷结合针刺治疗脑卒中伴肩手综合征的临床疗效。方法选择2015年1月至2018年1月广东省梅州市中医医院针灸推拿科收治的90例脑卒中伴肩手综合征患者,按随机数字表法随机分成对照组和研究组,每组各45例,对照组予以单纯针刺治疗,研究组予以七味通络散外敷结合针刺治疗,10 d为1个疗程,治疗3个疗程后,采用两独立样本t检验比较2组治疗前后视觉模拟评分(VAS)、简化Fugl-Meyer上肢运动功能评分法(FMA-UL),采用χ^2检验对比2组的临床疗效。结果 (1)研究组治愈3例,显效25例,有效13例,无效4例,总有效率91. 11%(41/45);对照组治愈1例,显效8例,有效24例,无效13例,总有效率71. 11%(32/45),2组患者总有效率比较,差异具有统计学意义(χ^2=5. 874,P <0. 05)。(2)对照组和研究组治疗后较治疗前VAS评分均有显著性降低(t=7. 141、16. 373,P均<0. 01),表明2组治疗均有效,且与对照组比较,治疗后研究组患者的VAS评分显著降低(t=9. 953,P <0. 01)。(3)研究组和对照组治疗前后的FMA-UL评分比较差异具有统计学意义(t=50. 333、19. 546,P均<0. 01),表明2组治疗均有效,且治疗后研究组FMA-UL评分高于对照组,差异有统计学意义(t=40. 119,P <0. 01)。结论七味通络散外敷结合针刺能明显改善肩手综合征疼痛和运动功能,临床效果确切,值得推广应用。

Objective To explore the clinical therapeutic effect of acupuncture combined with topical application of Qiwei Tongluo Powder on stroke with shoulder-hand syndrome. Methods A total of 90 cases meeting the inclusion criteria of stroke with shoulder-hand syndrome were selected from January 2015 to January 2018 in the Department of Acupuncture and Manipulation, Meizhou Hospital of Chinese Medicine.According to the random number table method, these cases were divided into two groups, observation group( acupuncture combined with topical application of Qiwei Tongluo Powder) and control group( acupuncture only), with 45 cases per group and 10 days per course of treatment. After three courses of treatment, two independent samples t tests were used to compare the visual analogue score( VAS), simplified Fugl-Meyer assessment-upper limb( FMA-UL) before and after treatment, and the χ^2 test was used to compare the clinical efficacy of the two groups. Results( 1) In the observation group, 3 cases were cured, 25 cases were markedly effective, 13 cases were effective, 4 cases were ineffective, and the total effective rate was 91. 11%( 41/45);while in the control group, 1 case was cured, 8 cases were markedly effective, 24 cases were effective, 13 cases were ineffective, and the total effective rate was 71. 11%( 32/45). Compared between the two groups, the difference of total effective rate was statistically significant( χ^2= 5. 874, P < 0. 05).( 2) The VAS scores of the control group and the observation group after the treatment were significantly lower than those before the treatment( t = 7. 141, 16. 373, all P < 0. 01), which indicated that the treatments of these two groups were both effective. Besides, compared with the control group, the VAS score of patients in the observation group was significantly reduced after three courses of treatment( t = 9. 953, P < 0. 01).( 3) The difference of FMA-UL scores between two groups before and after treatment was statistically significant( t = 50. 333, 19. 546, all P < 0. 01), which indicated that the treatments of these two groups were effective. Besides, the FMA-UL score of the observation group was higher than that of the control group after three courses of treatment, and the difference was statistically significant( t = 40. 119, P < 0. 01).Conclusion Acupuncture combined with topical application of Qiwei Tongluo Powder can obviously relieve the pain and improve motor function of patients with shoulder-hand syndrome, and the clinical effect is definite, which is worthy of popularization and application.