综合康复训练联合针刺养老穴对卒中后肩手综合征阴虚阳亢、脉络瘀阻证患者血液流变学及日常生活能力的影响

Effect of comprehensive rehabilitation training combined with acupuncture at Yanglao(SI 6)on hemorheology and activities of daily living in patients with shoulder hand syndrome after stroke of yin deficiency and yang hyperactivity and collaterals stasis syndrome

目的观察综合康复训练联合针刺养老穴对卒中后肩手综合征(SHS)阴虚阳亢、脉络瘀阻证患者血液流变学及日常生活能力的影响。方法将100例卒中后SHS阴虚阳亢、脉络瘀阻证患者按照随机数字表法分为2组。对照组50例予综合康复训练,治疗组50例在对照组治疗基础上联合针刺养老穴治疗。2组均连续治疗8周。比较2组疗效;观察2组治疗前后血液流变学指标血浆黏度、血小板聚集率、红细胞比容变化;比较2组治疗前后简化Fugl-Meyer量表上肢运动功能测试部分(U-FMA)评分、疼痛视觉模拟评分(VAS)、改良Barthel指数评定量表(MBI)评分变化;比较2组治疗前后降钙素基因相关肽(CGRP)、一氧化氮(NO)、内皮素-1(ET-1)、缓激肽(BK)、P物质(SP)水平变化。结果治疗组总有效率92.00%(46/50),对照组总有效率76.00%(38/50),治疗组疗效优于对照组(P<0.05)。2组治疗后血浆黏度、血小板聚集率、红细胞比容均较本组治疗前降低(P<0.05),且治疗组降低更明显(P<0.05)。2组治疗后U-FMA、MBI评分均较本组治疗前升高(P<0.05),疼痛VAS较本组治疗前降低(P<0.05);治疗组治疗后U-FMA、MBI评分均高于对照组(P<0.05),疼痛VAS低于对照组(P<0.05)。2组治疗后CGRP、NO水平均较本组治疗前升高(P<0.05),ET-1、BK、SP水平均较本组治疗前降低(P<0.05),且治疗组治疗后CGRP、NO水平均高于对照组(P<0.05),ET-1、BK、SP水平均低于对照组(P<0.05)。结论综合康复训练联合针刺养老穴治疗卒中后SHS阴虚阳亢、脉络瘀阻证,可缓解患者上肢疼痛,促进上肢功能恢复,改善血液流变学,提高日常生活能力,且安全性高。

Objective To observe the effect of comprehensive rehabilitation training combined with acupuncture at Yanglao(SI 6)on hemorheology and activities of daily living in patients with shoulder hand syndrome(SHS)after stroke.Methods 100 patients with SHS after stroke were randomly divided into two groups according to the random number table method.50 cases in the control group were given comprehensive rehabilitation training.50 cases in the treatment group were treated by acupuncture on the basis of the control group.Both groups were treated for 8 weeks.The curative effect of the two groups was compared.The changes of hemorheology indexes,such as plasma viscosity,platelet aggregation rate and hematocrit were observed before and after treatment between the two groups.The changes of the simplified Fugl-Meyer scale upper limb motor function test part(U-FMA)score,pain visual analog scale score(VAS),and modified Barthel index rating scale(MBI)score were compared before and after treatment in the two groups.The levels of calcitonin gene-related peptide(CGRP),nitric oxide(NO),endothelin-1(ET-1),bradykinin(BK)and substance P(SP)were compared between the two groups before and after treatment.Results The total effective rate of the treatment group was 92.00%(46/50),and that of the control group was 76.00%(38/50).The curative effect of the treatment group was better than that of the control group(P<0.05).After treatment,plasma viscosity,platelet aggregation rate and hematocrit in both groups were lower than those in the group before treatment(P<0.05),and the decrease in treatment group was more obvious(P<0.05).After treatment,U-FMA and MBI scores of the two groups were higher than those in the group before treatment(P<0.05),and VAS was lower than that in the group before treatment(P<0.05).After treatment,the U-FMA and MBI scores of the treatment group were higher than those of the control group(P<0.05),and VAS was lower than that of the control group(P<0.05).After treatment,the levels of CGRP and NO in both groups were higher than those in the group before treatment(P<0.05),and the levels of ET-1,BK and SP were lower than those in the group before treatment(P<0.05).After treatment,the levels of CGRP and NO in the treatment group were higher than those in the control group(P<0.05),and the levels of ET-1,BK and SP in the treatment group were lower than those in the control group(P<0.05).Conclusion Comprehensive training combined with acupuncture at Yanglao(SI 6)for post-stroke SHS with yin deficiency and yang hyperactivity and collaterals stasis syndrome can relieve upper limb pain,promote upper limb function recovery,improve blood rheology,improve daily life ability,and have high safety.