鍉针点穴配合肩三针在中风后肩手综合征患者中的应用研究

Application Research of Spoon Needle Acupressure Combined with Shoulder Triple Needling in Treatment of Post-Stroke SHS

目的:观察鍉针点穴配合肩三针对中风后肩手综合征患者肩关节痛及上肢运动功能的影响,评价其临床疗效。方法:符合中风后肩手综合征的60例患者采用随机数字表法分成两组,分别为对照组与治疗组,各30例。对照组患者接受中风病的基础治疗,治疗组在对照组治疗方案基础上给予鍉针点穴配合肩三针治疗,每次治疗30 min,每日治疗1次,连续治疗4周。运用视觉模拟评分法(VAS)评价两组患者治疗前后肩关节疼痛症状改善情况;运用简化上肢运动功能评分Fugl-Meyer(FMA)评定上肢运动能力;比较两组治疗前后血清一氧化氮(NO)、P物质(SP)、降钙素基因相关肽(CGRP)和内皮素1(ET-1)水平,并评价两组临床疗效。结果:两组患者治疗后VAS评分较治疗前显著降低,差异具有统计学意义(P<0.05);且与对照组比较,治疗组降低更明显,差异具有统计学意义(P<0.05)。两组患者在治疗后的FMA评分与治疗前比较,均显著升高,差异有统计学意义(P<0.05);且治疗组升高更加显著,差异具有统计学意义(P<0.05)。与治疗前比较,两组患者治疗后CGRP和NO水平均显著升高;且治疗组较对照组升高更加显著,差异具有统计学意义(P<0.05)。两组患者治疗后SP和ET-1水平均低于治疗前,并且治疗组较对照组降低更加显著,差异具有统计学意义(P<0.05)。两组临床疗效比较,治疗组的总有效率为96.67%(29/30),对照组总有效率为80.00%(24/30),治疗组明显高于对照组,差异有统计学意义(P<0.05)。结论:鍉针点穴配合肩三针可显著改善患者肩关节疼痛、上肢运动功能及提高患者的日常生活活动能力,疗效优于常规治疗。

Objective:To observe the effect of spoon needle acupressure combined with shoulder triple needling on shoulder pain and upper limb motor function in the treatment of post-stroke shoulder-hand syndrome(SHS),and to evaluate the clinical effect of the therapy.Methods:60 patients with post-stroke SHS were randomly divided into the treatment group and the control group,with 30 cases in each group.Both groups were given basic treatment for stroke;on which basis,the treatment group was also treated with spoon needle acupressure,30 min each time,once a day for continuous four weeks.VAS score was used to observe the improvement of shoulder pain in the two groups.FMA score was used to evaluate upper limb motor ability.The serum levels of endothelin 1(ET-1),nitric oxide(NO),substance P(SP)and calcitonin gene-related peptide(CGRP)were compared between before and after the treatment in the two groups.The clinical efficacy of the two groups was evaluated.Results:VAS score was significantly decreased after the treatment compared to that before the treatment in the two groups(P<0.05);of which the decrease was more significant in the treatment group(P<0.05).FMA score was significantly increased after the treatment than that before the treatment in the two groups(P<0.05);of which the increase was more significant in the treatment group(P<0.05).The levels of CGRP and NO were significantly increased after the treatment compared to those before the treatment in the two groups,and the increases in the treatment group were more significant than those in the control group(P<0.05).The levels of SP and ET-1 were decreased after the treatment than those before the treatment in the two groups,and the decreases in the treatment group were more significant than those in the control group(P<0.05).The total effective rate of the treatment group was 96.67%(29/30),which was significantly higher than 80.00%(24/30)of the control group(P<0.05).Conclusion:Spoon needle acupressure combined with shoulder triple needling can significantly reduce the shoulder joint pain,improve upper limb motor function and the ability of daily living in the patients with post-stroke SHS.The efficacy of the therapy is better than that of the routine treatment.