头部穴域丛刺治疗中风后肩痛的效果观察

Observation of therapeutic effect of scalp cluster acupuncture on shoulder pain after stroke

目的观察头部穴域丛刺为主结合平衡针和经络辨证取穴疗法,配合康复运动疗法治疗中风后肩痛的临床疗效,为针灸治疗中风后肩痛提供新的治疗思路和优化整合治疗方案。方法抽取2016—2020年于开封市中医院针灸科门诊就诊和住院的中风后肩痛患者90例,按随机数字表法分为观察组和对照组,每组45例。观察组采用运动针法,予头部穴域丛刺为主,结合平衡针和经络辨证取穴疗法,留针期间配合新Bobath疗法,指导患者良肢位摆放和自主功能锻炼;对照组采用运动针法,予头针和传统针刺,留针期间配合康复运动疗法,指导患者良肢位摆放和自主功能锻炼。观察并比较两组治疗前后视觉模拟评分法(VAS)评分、Fugl-Meyer运动功能评分量表(FMA)评分,评价两组的临床疗效。结果治疗后,两组VAS评分均低于治疗前(P均<0.05),FMA评分均高于治疗前(P均<0.05),且观察组FMA评分改善程度优于对照组(P<0.05)。两种治疗方法短期内FMA和VAS评分改善情况比较差异未见统计学意义(P>0.05),但治疗4周后,观察组VAS评分降低程度优于对照组,且观察组各项观察指标改善的持续性和稳定性均优于对照组(P均<0.05)。观察组总有效率(92.3%,36/39)和对照组(95.1%,39/41)比较差异未见统计学意义(P>0.05)。结论头部穴域丛刺为主联合平衡针和经络辨证取穴针刺组合疗法可明显缓解中风后肩痛患者的疼痛程度,且疗效优于传统疗法,可明显降低VAS评分并提升FMA评分,促进患者康复,提高其生活质量。

Objective To observe the clinical efficacy of scalp cluster acupuncture assisted by balance acupuncture,meridian dialectical therapy and rehabilitation exercise therapy in the treatment of shoulder pain after stroke,and to provide a new treatment idea and optimize acupuncture therapy for shoulder pain after stroke.Methods Ninety patients with shoulder pain after stroke who visited and were hospitalized in the Department of Acupuncture and Moxibustion of Kaifeng Hospital of Traditional Chinese Medicine from 2016 to 2020 were selected.According to the random number table method,the patients were divided into observation group and control group,with 45 cases in each group.Patients in the observation group were treated by motion acupuncture,and the protocol was that,scalp acupoint cluster acupuncture as priority therapy,combined with balance acupuncture and meridian dialectical therapy,during the period of acupuncture retention,the patients were treated by the new Bobath therapy,and they were given a guidance on healthy limb placement and self-functional exercise.Patients in the control group were treated by motion acupuncture,with the scalp needling and traditional needling acupuncture,during the period of acupuncture retention,the patients were treated by the rehabilitation exercise,and they were given a guidance on healthy limb placement and self-functional exercise.Visual analogue scale(VAS)score and Fugl-Meyer motor function assessment(FMA)score of the two groups were measured and compared before and after treatment.And the clinical efficacy of the two groups were evaluated.Results After treatment,the VAS scores of the two groups were lower than those before treatment(all P<0.05),and the FMA scores were higher than those before treatment(all P<0.05).The improvement of the FMA scores in the observation group was better than that in the control group(P<0.05).There was no statistically significant difference in the improvement of FMA and VAS scores between the two treatment methods in the short term(P>0.05);however,after 4 weeks of treatment,the reduction in VAS score in the observation group was better than that in the control group,and the persistence and stability of improvement in each observed indicator in the observation group were better than those in the control group(all P<0.05).There was no statistically significant difference in the total effective rate between the observation group(92.3%,36/39)and the control group(95.1%,39/41),P>0.05.Conclusions The combined acupuncture therapy(the scalp cluster acupuncture assisted by balance acupuncture,meridian dialectical therapy,and new Bobath therapy)can significantly relieve the pain degree of patients with shoulder pain after stroke,which is better than traditional acupuncture.It can significantly reduce VAS score and improve FMA score,promote patients’recovery,and improve their quality of life.