温针灸联合中药熏蒸治疗痰瘀痹阻型肩手综合征的疗效评价

Efficacy evaluation of warm acupuncture combined with Traditional Chinese Medicine fumigation in the treatment of phlegm and blood stasis type shoulder-hand syndrome

目的探究温针灸联合中药熏蒸治疗痰瘀痹阻型肩手综合征(SHS)的疗效。方法选取2018年11月至2020年12月本院神经内科病房收治的152例中风后痰瘀痹阻型SHS患者作为研究对象,按照随机数字表法分为对照组(n=51)、实验1组(n=50)与实验2组(n=51)。对照组予常规治疗,实验1组予常规治疗+中药熏蒸,实验2组予常规治疗+中药熏蒸+温针灸。比较3组治疗前后视觉模拟评分法(VAS)评分、Fugl-Meyer运动功能评定量表(FMA)评分、血清炎症因子[白细胞介素(IL)-1β、肿瘤坏死因子-α(TNF-α)]水平及血管内皮因子[内皮素(ET)-1、一氧化氮(NO)]水平。结果3组VAS组间、时间、交互比较差异有统计学意义(P<0.05)。治疗前,3组VAS评分比较差异无统计学意义;治疗2周后,实验1组与对照组、实验1组与实验2组VAS评分比较差异无统计学意义,实验2组VAS评分低于对照组,差异有统计学意义(P<0.05);治疗4周后,实验1组和实验2组VAS评分均低于对照组,实验2组低于实验1组,差异有统计学意义(P<0.05)。3组FMA评分组间、时间、交互比较差异有统计学意义(P<0.05)。治疗前,3组FMA评分比较差异无统计学意义;治疗2周后,实验1组与对照组、实验1组与实验2组FMA评分比较差异无统计学意义,实验2组FMA评分高于对照组,差异有统计学意义(P<0.05);治疗4周后,实验1组和实验2组FMA评分均高于对照组,且实验2组高于实验1组,差异有统计学意义(P<0.05)。治疗4周后,3组TNF-α、IL-1β水平均低于治疗前,且实验2组、实验1组均低于对照组,实验2组低于实验1组,差异有统计学意义(P<0.05)。治疗4周后,3组ET-1水平均低于治疗前,NO水平均高于治疗前,且实验2组、实验1组ET-1水平均低于对照组,NO水平均高于对照组,且实验2组ET-1水平低于实验1组,NO水平高于实验1组,差异有统计学意义(P<0.05)。结论温针灸联合中药熏蒸治疗痰瘀痹阻型SHS疗效确切,在减轻疼痛、提高上肢功能活动、改善血清炎症因子水平及血管内皮因子水平方面效果显著,值得临床推广应用。

Objective To observe the efficacy of warm acupuncture combined with Traditional Chinese Medicine fumigation in the treatment of phlegm and blood stasis type shoulder-hand syndrome(SHS).Methods A total of 152 patients with post-stroke phlegm and blood stasis type SHS admitted to the Neurology Ward of our hospital from November 2018 to December 2020 were selected as the research subjects,they were divided into the control group(n=51),experimental group 1(n=50)and the experimental group 2(n=51)according to the random number table method.The control group was given routine treatment,the experimental group 1 was given routine treatment+Traditional Chinese Mdicine fumigation,and the experimental group 2 was given routine treatment+Traditional Chinese Medicine fumigation+warm acupuncture.The visual analogue scale(VAS)score,Fugl-Meyer assessment(FMA)score,serum inflammatory factors(interleukin[IL]-1β,tumor necrosis factor-α[TNF-α])levels and vascular endothelial factors(endothelin[ET]-1,nitricoxide[NO])levels were compared among the three groups before and after treatment.Results There were significant differences in VAS among the three groups of group,time points and interaction(P<0.05).Before treatment,there was no significant difference in VAS scores among the three groups;after 2 weeks of treatment,there was no significant difference in VAS score among the control group,experimental group 1 and experimental group 2,while VAS score in the experimental group 2 was lower than the control group,the difference was statistically significant(P<0.05).After 4 weeks of treatment,the VAS score in the experimental group 1 and the experimental group 2 were lower than that in control group,and experimental group 2 was lower than that in the experimental group 1,and the differences were statistically significant(P<0.05).There were statistically significant differences in FMA among the three groups of groups,time points and interaction(P<0.05).Before treatment,there was no significant difference in FMA scores among three groups;after 2 weeks of treatment,there was no statistically significant difference in FMA score among the control group,experimental group 1 and experimental group 2,FMA score in the experimental group 2 was higher than that in the control group,the differences were statistically significant(P<0.05);after 4 weeks of treatment,FMA scores in experimental group 1 and experimental group 2 were higher than that in the control group,and experimental group 2 was higher than experimental group 1,the differences were statistically significant(P<0.05).After 4 weeks of treatment,the levels of TNF-αand IL-1βof the three groups were lower than those before treatment,and the experimental group 2 and the experimental group 1 were lower those the control group,and the experimental group 2 was lower than the experimental group 1,the differences were statistically significant(P<0.05).After 4 weeks of treatment,the levels of ET-1 among the three groups were lower than those before treatment,and the levels of NO were higher than those before treatment,the levels of ET-1 in the experimental group 2 and the experimental group 1 were lower than those in the control group,and the levels of NO were higher than those in the control group,and the levels of ET-1 in the experimental group 2 was lower than that in the experimental group 1,and the levels of NO was higher than that in the experimental group 1,the differences were statistically significant(P<0.05).Conclusion The curative effect of warm acupuncture combined with Traditional Chinese Medicine fumigation in the treatment of phlegm and blood stasis type SHS is obvious,it has significant effect in reducing pain,improving upper limb function,improving serum inflammatory factor level and vascular endothelial factor level,which is worthy of clinical promotion and pplication.