高能量激光疗法联合上肢智能反馈训练系统治疗缺血性脑卒中后复杂性区域疼痛综合征Ⅰ型患者的疗效研究

Curative Effect of High Intensity Laser Therapy Combined with Upper Limb Intelligent Feedback Training System on Patients with Complex Regional Pain Syndrome TypeⅠin after Ischemic Stroke

背景复杂性区域疼痛综合征Ⅰ型(CRPS-Ⅰ)是阻碍脑卒中后上肢运动功能恢复的重要因素,目前尚无特效防治方法。高能量激光疗法(HILT)是一种新型的治疗方法,其治疗疼痛具有即刻效应、持久效应,对靶点组织也具有抗炎、消肿等功效,但HILT在脑卒中后CRPS-Ⅰ患者中应用的研究仍处于相对空白阶段。目的分析HILT联合上肢智能反馈训练系统治疗缺血性脑卒中后CRPS-Ⅰ患者的疗效。方法选取2018年8月—2019年10月常州市德安医院康复中心收治的缺血性脑卒中后CRPS-Ⅰ患者60例,采用随机数字表法分为研究组与对照组,每组30例。对照组患者给予上肢智能反馈训练系统治疗,研究组患者给予HILT联合上肢智能反馈训练系统治疗;两组患者均每周治疗6 d,持续治疗6周。比较两组患者治疗前、治疗1周、治疗3周、治疗6周的疼痛程度、患侧手肿胀度、患侧肩关节活动改善程度,治疗前及治疗6周的血浆降钙素基因相关肽(CGRP)、内皮素1(ET-1)、缓激肽(BK)水平。观察治疗期间两组患者不良反应发生情况。结果时间与治疗方法在疼痛评级指数(PRI)评分、患侧手肿胀度上存在交互作用(P<0.05),时间、治疗方法在PRI评分、患侧手肿胀度上主效应显著(P<0.05)。研究组患者治疗1周、3周、6周PRI评分、患侧手肿胀度低于对照组(P<0.05)。研究组患者患侧肩关节外展、内收、外旋、内旋、前屈、后伸活动改善角度大于对照组(P<0.05)。研究组患者治疗6周血浆CGRP水平高于对照组,血浆ET-1、BK水平低于对照组(P<0.05)。两组患者均未出现与治疗相关的不良反应。结论与上肢智能反馈训练系统相比,HILT联合上肢智能反馈训练系统可有效改善缺血性脑卒中后CRPS-Ⅰ患者的疼痛程度、患侧肩关节活动度,其机制可能与其可有效提高患者血浆CGRP水平,降低血浆ET-1、BK水平有关。

Background Complex regional pain syndrome typeⅠ(CRPS-Ⅰ)is an important factor that hinders the recovery of upper limb motor function after stroke,and there is no specific prevention and cure method at present.High-intensity laser therapy(HILT)is a new type of treatment with immediate and lasting effects on pain,as well as antiinflammation,swelling reduction and other effects on target tissues.However,the research of HILT in patients with CRPS-I after stroke is still in a relatively blank stage.Objective To analyze the effect of HILT combined with upper limb intelligent feedback training system on patients with CRPS-Ⅰafter ischemic stroke.Methods A total of 60 patients with CRPS-Ⅰafter ischemic stroke admitted to Department of Rehabilitation Center of Changzhou Dean Hospital from August 2018 to October 2019 were selected and divided into research group and control group by random number table method,with 30 cases in each group.Patients in the control group were treated with upper limb intelligent feedback training system,while patients in the research group received HILT combined with upper limb intelligent feedback training system.Both groups were treated 6 days a week for 6 weeks.Before treatment,1 week,3 weeks and 6 weeks after treatment,the pain of the affected limbs,swelling of hands and the improvement of shoulder joint mobility were compared between the two groups.Plasma calcitonin gene-related peptide(CGRP),endothelin-1(ET-1)and bradykinin(BK)levels in plasma were compared between the two groups before treatment and 6 weeks after treatment.The occurrence of adverse reactions in the two groups was observed during the treatment.Results There was an interaction between time and method on PRI score and swelling degree of the affected side(P<0.05),and time and method had statistically significantly main effects on PRI score and swelling of the affected side(P<0.05).The PRI score and swelling degree of the patients'affected side in research group were lower than those in control group at 1 week,3 weeks and 6 weeks after treatment(P<0.05).The improvement angles of abduction,adduction,external rotation,internal rotation,forward flexion and posterior extension of the affected side of the shoulder joint in research group were greater than those in control group(P<0.05).Plasma CGRP level of patients in research group was higher than that in control group 6 weeks after treatment,and plasma ET-1 and BK levels in research group were lower than those in control group 6 weeks after treatment(P<0.05).Conclusion Compared with upper limb intelligent feedback training system,HILT combined with upper limb intelligent feedback training system can effectively improve pain and limb swelling,shoulder joint mobility in patients with CRPS-Ⅰafter ischemic stroke.The mechanism may be related to its ability to effectively increase the level of plasma CGRP,and reduce the levels of plasma ET-1 and BK.