经筋结点恢刺法配合中药熏蒸治疗脑卒中后肩手综合征患者的临床研究

Clinical study of relaxing needling at meridian-muscle nodes combined with traditional Chinese medicine fumigation in the treatment of patients with shoulder-hand syndrome after stroke

目的脑卒中后肩手综合征(SHS)可导致肢体功能障碍,常规药物治疗和功能锻炼的长期疗效欠佳,本研究使用经筋结点恢刺法联合中药熏蒸治疗SHS,探讨其临床效果。方法选取2020年5月-2021年7月在亳州市人民医院就诊的80例脑卒中后SHS患者作为研究对象,采用随机数字表法将其分为试验组40例和对照组40例。对照组予以常规治疗、肩手关节功能锻炼和中药熏蒸治疗,试验组在对照组基础上予以经筋结点恢刺法治疗。比较2组治疗前后疼痛视觉模拟(VAS)评分、Fugl-Meyer运动功能(FMA)评分、肩关节活动度、血流动力学指标、中医证候积分及治疗后总有效率。结果治疗后,试验组VAS评分为(2.87±0.65)分,明显低于对照组的(3.51±0.84)分(t=3.811,P<0.001),试验组FMA评分为(54.28±6.17)分,显著高于对照组的(49.36±7.58)分(t=3.184,P=0.002),试验组肩关节上举活动度为(40.72±3.16)°,显著大于对照组[(36.85±4.73)°,t=4.303,P<0.001],试验组肩关节外展活动度为(70.16±4.28)°,显著大于对照组[(66.59±5.34)°,t=3.299,P=0.002];试验组治疗后高切全血黏度、低切全血黏度、血浆黏度及中医证候积分均明显低于对照组(均P<0.05);试验组临床治疗总有效率为90.00%(36/40),显著高于对照组的67.50%(27/40,χ^(2)=6.050,P=0.014)。结论经筋结点恢刺法配合中药熏蒸治疗脑卒中后SHS,不仅能有效缓解其疼痛症状,还可以改善肢体与关节的活动功能以及血流动力学,疗效显著。

Objective Shoulder-hand syndrome(SHS)after stroke can lead to limb dysfunction,and the long-term efficacy of conventional drug therapy and functional training is not so ideal,this study investigates the clinical effects of relaxing needling at meridian-muscle nodes combined with traditional Chinese medicine(TCM)fumigation in the treatment of SHS.Methods A total of 80 patients with SHS after stroke who were admitted to the People's Hospital of Bozhou from May 2020 to July 2021 were selected and divided into experimental group(40 cases)and control group(40 cases)by random number table method.The control group was given conventional treatments,functional exercise of shoulder and hand joints and traditional Chinese medicine fumigation.On this basis,the experimental group was treated with relaxing needling at meridian-muscle nodes.The pain visual analogue scale(VAS)scores,Fugl-Meyer assessment(FMA)scores,shoulder joint range of motion,hemodynamic indicators,TCM syndrome scores and total response rate were compared between the two groups.Results After treatment,the VAS score of the experimental group was 2.87±0.65,which was significantly lower than 3.51±0.84 of the control group(t=3.811,P<0.001);The FMA score was 54.28±6.17,which was significantly higher than 49.36±7.58 of the control group(t=3.184,P=0.002);The lifting motion of shoulder joint in test group[(40.72±3.16)°]was significantly higher than that in control group[(36.85±4.73)°,t=4.303,P<0.001];Abductive range of motion of shoulder joint in experimental group[(70.16±4.28)°]was significantly higher than that in control group[(66.59±5.34)°,t=3.299,P=0.002].Whole blood high-shear viscosity,whole blood low-shear viscosity,plasma viscosity and TCM syndrome scores were significantly lower than those in the control group(all P<0.05).The total clinical response rate in the experimental group(90.00%,36/40)was significantly higher than that in the control group(67.50%,27/40,χ^(2)=6.050,P=0.014).Conclusion The treatment of SHS after stroke with relaxing needling at meridian-muscle nodes combined with traditional Chinese medicine fumigation can effectively relieve pain and improve limb motor function,shoulder joint range of motion and hemodynamics,with significant curative effect.