冷热中药漩涡浴联合运动控制训练对脑卒中后肩手综合征的影响

Effect of Hot and Cold Chinese Medicine Whirlpool Bath Combined with Motor Control Training on Patients with Shoulder-Hand Syndrome after Stroke

目的:观察冷热中药漩涡浴联合运动控制训练治疗脑卒中后肩手综合征(SHS)的临床疗效。方法:选择2020年1—12月在徐州市康复医院和徐州市中心医院治疗的脑卒中后SHS患者40例,按随机数字表法分为对照组和观察组,每组20例。2组患者都进行物理因子治疗、作业治疗等常规康复训练;对照组在常规康复训练基础上接受运动控制训练,40 min/次,1次/d,5次/周,持续治疗4周;观察组在对照组基础上接受冷热中药漩涡浴,40 min/次,1次/d,5次/周,持续治疗4周。分别于治疗前及治疗4周后,采用视觉模拟评分法(VAS)评估患者肩部疼痛程度;采用溢水法测量手部肿胀程度;采用Fugl-Meyer运动功能量表上肢部分(FMA-UE)评估患肢运动功能;采用改良Barthel指数(MBI)评估患者日常生活活动能力;采用运动活动记录表记录患肢使用数量(MAL-AOU)和患肢活动质量(MAL-QOM)。结果:与治疗前比较,2组治疗后VAS评分及手部肿胀值均明显降低,FMA-UE、MBI、MAL-AOU和MAL-QOM评分均明显升高,差异具有统计学意义(P<0.05)。与对照组比较,观察组治疗后VAS评分及手部肿胀值明显更低,FMA-UE、MBI、MAL-AOU和MAL-QOM评分明显更高,差异具有统计学意义(P<0.05)。结论:冷热中药漩涡浴联合运动控制训练可有效改善脑卒中后SHS患者疼痛、肿胀和上肢运动功能,提高其患肢的使用和日常生活活动能力。

Objective:To observe the effect of hot and cold Chinese medicine whirlpool bath combined with motor control training on patients with shoulder-hand syndrome(SHS)after stroke.Methods:A total of 40 patients with SHS after stroke in the Xuzhou Rehabilitation Hospital and Xuzhou Central Hospital from January to December 2020 were randomly divided into control group and observation group according to random number table method,with 20 cases in each group.Both groups received routine rehabilitation training such as physical agent modalities and occupational therapy.The control group received motor control training on the basis of routine rehabilitation training,40 minutes a time,once a day,five times a week,lasting for four weeks;the observation group received hot and cold Chinese medicine whirlpool bath on the basis of control group,40 minutes a time,once a day,five times a week,lasting for four weeks.Before and after four weeks of treatment,visual analogue scale(VAS)was used to evaluate the severity of shoulder pain;overflow method was used to evaluate the degree of hand swelling;Fugl-Meyer assessment upper extremity(FMA-UE)was used to evaluate motor function of the affected limb;modified Barthel index(MBI)was used to evaluate the activities of daily living;motor activity log-amount of use(MAL-AOU)and motor activity log-quality of movement(MAL-QOM)were recorded by the motor activity record sheet.Results:Compared with those before treatment,VAS score and hand swelling value of both groups decreased significantly after treatment,while FMA-UE,MBI,MAL-AOU and MAL-QOM scores increased significantly after treatment,and the differences were statistically significant(P<0.05).Compared with the control group,VAS scores and hand swelling value in the observation group were significantly lower after treatment,while FMA-UE,MBI,MAL-AOU and MAL-QOM scores in the observation group were significantly higher,and the differences were statistically significant(P<0.05).Conclusion:Hot and cold Chinese medicine whirlpool bath combined with motor control training can effectively improve the pain,swelling and upper extremity motor function of patients with SHS after stroke,as well as improve the use of affected limb and the ability of activities of daily living.