蜡泥灸治疗脑卒中后肩-手综合征气虚血瘀证的临床研究

Clinical study on treatment of qi deficiency and blood stasis syndrome of shoulder-hand syndrome after stroke with wax-mud moxibustion

目的 观察蜡泥灸治疗脑卒中后肩-手综合征气虚血瘀证的临床疗效。方法 选取2019年1月—2020年12月就诊于河南省中医院康复科门诊及病房的脑卒中后肩-手综合征患者,共105例,随机分为对照组(n=52)和试验组(n=53)。2组患者均给予常规药物治疗配合康复训练,试验组在此基础上予蜡泥灸治疗,2组连续治疗4周。比较2组患者的临床疗效、中医证候积分、肩-手综合征量表(SHSS)评分、视觉模拟法(VAS)评分、手排水体积差、运动功能评分法(Fugl-Meyer)评分及肩关节活动度。结果 试验组脱落8例、对照组脱落7例,最终试验组45例、对照组45例完成本研究。对照组、试验组的总有效率分别为66.67%(30/45)、86.67%(39/45),试验组总有效率高于对照组(P<0.05)。与治疗前比较,试验组患者治疗后中医证候积分、SHSS评分、VAS评分、手排水体积差均降低(P<0.01),Fugl-Meyer评分、肩关节活动度评分均升高(P<0.01);对照组患者治疗后VAS评分、手排水体积差降低(P<0.05,P<0.01),Fugl-Meyer评分升高(P<0.05)。与对照组比较,治疗后试验组患者中医证候积分、SHSS评分、VAS评分、手排水体积差均下降,Fugl-Meyer评分、肩关节活动度评分均升高(P<0.01)。结论 蜡泥灸可以改善脑卒中后肩-手综合征患者的关节疼痛、肿胀、活动范围以及运动能力,达到益气活血、温经通络、除湿宣痹的作用,较常规治疗有一定的优势。

Objective We aimed to observe the clinical effects of wax-mud moxibustion on qi deficiency and blood stasis syndrome of shoulder-hand syndrome after stroke.Methods From January 2019 to December 2020, a total of 105 patients with post-stroke shoulder-hand syndrome who visited the outpatient department and ward of Henan Hospital of Traditional Chinese Medicine were selected and randomly divided into the control group(n=52) and the experimental group(n=53).Both groups were treated with conventional drug therapy and rehabilitation training, and patients in the experimental group were treated with wax-mud moxibustion therapy.The two groups were treated for 4 weeks.Clinical efficacy, the traditional Chinese medicine(TCM)syndrome score, the shoulder-hand syndrome score(SHSS), the visual analogue scale(VAS) score, the hand drainage volume difference, the Fugl-Meyer score, and the shoulder range of motion(L-ROM) were compared between the two groups.Results During the treatment, eight cases fell off in the experimental group and seven cases in the control group. Finally, 45 cases in the experimental group and 45 cases in the control group completed this study. The total effective rate was 66.67%(30/45) in the control group and 86.67%(39/45) in the experimental group, and the total effective rate of the experimental group was higher than that of the control group(P<0.05).Compared with pre-treatment data, the TCM syndrome score, SHSS, VAS score, and hand drainage volume difference were decreased(P<0.01) and the Fugl-Meyer score and L-ROM were increased(P<0.01) in the experimental group after treatment.In the control group, the VAS score and the drainage volume difference were decreased(P<0.05, P<0.01) and the Fugl-Meyer score was increased(P<0.05) after treatment.In the experimental group, the TCM syndrome score, SHSS, VAS score, and hand drainage volume difference were lower and the Fugl-Meyer score and L-ROM were higher after treatment compared with the control group(P<0.01).Conclusion Wax-mud moxibustion can relieve joint pain, swelling and improve range of motion, athletic ability of patients with shoulder-hand syndrome after stroke by replenishing qi and activating blood, warming the channels, freeing the network vessels, removing dampness, and dredging channels, which has certain advantages over conventional treatment.