眼针联合运动疗法治疗脑卒中后肩手综合征Ⅰ期疼痛的疗效和耐受性观察及对相关炎症介质表达的影响

Observation of Efficacy and Tolerability of Eye Acupuncture Combined with Kinesitherapy inTreatment of Pain Due to Post-Stroke Shoulder-Hand Syndrome at Stage I and Its Influence on Expressions of Related Inflammatory Mediators

背景肩手综合征(SHS)是脑卒中最常见的并发症之一,不及时治疗,不仅阻碍康复治疗效果,而且极易造成患者上肢功能丧失,严重降低患者的日常生活活动能力及生活质量。目前治疗脑卒中后肩手综合征(SHS)Ⅰ期患者疼痛的方法有限,而且往往无效。目的对SHS的病理生理学了解甚少,现有的有效治疗方式有限。由于这些患者的痛觉过敏和异位疼痛,周围神经阻滞在SHS中的应用受到限制。虽然口服皮质类固醇已显示出一些好处,但疼痛尚未完全解决,因此需要探索安全有效的替代治疗策略-非药物治疗方式。研究评估了眼针联合运动疗法对卒中后SHS患者急性疼痛的疗效和耐受性观察及对相关炎症介质表达的影响。方法选取医院康复科2019年10月-2020年10月接收的132例脑卒中后SHSⅠ期患者为研究对象。随机分成:常规理疗组,常规理疗+运动疗法组,常规理疗+眼针组和常规理疗+运动疗法+眼针组。在SHS发生时(基线)、每次治疗前后进行疼痛评估;通过肩和手疼痛的视觉模拟量表(VAS)与基线相比的变化、不良事件的存在以及自我报告的患者满意度评分进行耐受性评估,最后检测血清中相关炎症介质表达水平变化。结果经过治疗后,与常规理疗组相比,常规理疗+运动疗法组、常规理疗+眼针组和常规理疗+运动疗法+眼针组疼痛VAS评分显著降低(P<0.05,P<0.001),并且两者联合应用对疼痛的减轻作用更明显;四组均无不良事件发生,四组患者的满意度评分显著升高(P<0.05,P<0.001),且常规理疗+运动疗法+眼针组升高程度最大(P<0.001),四组患者PGE2、SP和IL-8水平均显著降低(P<0.05),且常规理疗+运动疗法+眼针组降低程度最大(P<0.001)。结论在常规康复治疗的基础上采用眼针治疗脑卒中后肩手综合征I期患者,减轻疼痛效果最显著,疼痛VAS评分降低最明显,无不良事件发生,并且显著增加患者满意度,显著降低血清中相关炎症介质PGE2、SP、IL-8的表达水平,值得在临床上推广应用。

Introduction Shoulder-hand syndrome(SHS) is one of the most common complications of stroke. If it is not treated in time, it will not only hinder the effect of rehabilitation, but also easily cause the patient’s upper limb function loss, which will seriously reduce the patient’s ability of daily living and quality of life. At present, the treatment of pain in patients with SHS at stage I after stroke is limited and often ineffective.Objective The pathophysiology of SHS is poorly understood, and the existing effective treatments are limited. Due to the hyperalgesia and ectopic pain of these patients, the application of peripheral nerve block in SHS is limited. Although oral corticosteroids have shown some benefits, the pain has not been completely resolved, and so it is necessary to explore safe and effective alternative treatment strategies——non-drug treatment. This study evaluated the observation of the efficacy and tolerability of acupuncture wave combined with kinesitherapy on acute pain in SHS patients after stroke, and the effect on the expression of related inflammatory mediators.Methods A total of 132 post-stroke patients with SHS at stage I in the rehabilitation department of our hospital from October 2019 to October 2020 were selected as the research objects and were randomly divided intoconventional physical factor treatment group, conventional physical factor + kinesitherapy treatment group, conventional physical factor+eye acupuncture treatment group, conventional physical factor+kinesitherapy+eye acupuncture treatment group. Pain assessment was performed at the time of SHS(baseline) and before and after each treatment. The resistance was measured by changes in the visual analog scale(VAS) of shoulder and hand pain from baseline, the presence of adverse events, and the self-reported patient satisfaction score receptivity assessment, and finally changes in the expression level of related inflammatory mediators in serum were detected.Results After treatment, compared with that of the conventional physical factor treatment group, the pain VAS score of the conventional physical factor+kinesitherapy treatment group, conventional physical factor+acupuncture treatment group and conventional physical factor+kinesitherapy+eye acupuncture treatment group was significantly reduced(P<0.05, P<0.001), and the combined application of the two had a more significant effect on pain relief. No adverse events occurred in the four groups, and the satisfaction scores of the four groups were significantly increased(P<0.05, P<0.001), and the scores of the conventional physical factor+kinesitherapy+eye acupuncture treatment group were increased mostly(P<0.001). The levels of PGE2, SP and IL-8 in the four groups were significantly reduced(P<0.05), and those of the conventional physical factor+kinesitherapy+eye acupuncture treatment were reducedmostly(P<0.001).Conclusion In this study, the use of acupuncture combined with kinesitherapy to treat patients with post-stroke SHSat stage I has the most significant pain reduction effect, the most significant reduction in pain VAS score, no adverse events, and a significant increase in patient satisfaction and a significant reduction in the expression levels of related inflammatory mediators PGE2, SP and IL-8 in serum, which is worthy of clinical application.