肌内效贴联合针刺对急性期脑卒中后肩手综合征上肢运动功能康复的临床研究

Clinical study on kinesio taping combined with acupuncture on rehabilitation of upper limb motor function in patients with acute poststroke shoulder-hand syndrome

目的观察肌内效贴联合针刺疗法对急性期脑卒中后肩手综合征(PSHS)患者上肢运动功能康复的临床疗效。方法选取自2019年1月至2022年1月在南通大学附属南通第三医院康复科接受康复治疗的急性期PSHS患者(Ⅰ期)120例,按照随机数字表法分为A组(肌内效贴联合针刺疗法)、B组(肌内效贴治疗)、C组(针刺疗法),每组40例。3组患者均给予内科药物及一般康复作为基础治疗,分别加用肌内效贴和(或)针刺治疗,连续治疗4周。分别于治疗前和治疗4周后采用视觉疼痛评分(VAS)来评价患肢疼痛改善情况,采用Fugl-Meyer运动功能评分上肢部分(FMA-UE)、WOLF运动功能测试(WMFT)评分评价上肢运动功能康复情况。同时参照《康复评定学》的疗效标准来评价肌内效贴联合针刺治疗急性期PSHS患者上肢功能康复的效果。采用多因素二元Logistic回归分析,对性别、年龄及功能评分进行校正后,评估肌内效贴联合针刺对急性期PSHS患者上肢运动功能康复的临床有效性。结果3组患者的基线资料及治疗前VAS、FMA-UE、WMFT评分比较,差异均无统计学意义(P>0.05)。治疗4周后,3组患者的VAS评分均有下降,其中A组效果优于B、C组,差异均具有统计学意义(P<0.05);而FMA-UE、WMFT评分均有升高,其中A组效果优于B、C组,差异均具有统计学意义(P<0.05)。急性期PSHS患者上肢功能康复的总有效率73.33%,其中A组高达90.00%,明显高于B组(67.50%)和C组(62.00%),差异具有统计学意义(P<0.05)。多因素二元Logistic回归分析提示,肌内效贴联合针刺对急性期PSHS患者上肢运动功能改善的临床有效性是单独治疗的6.563倍(95%CI:1.256~34.301,P<0.05)。结论肌内效贴联合针刺疗法可促进急性期PSHS患者上肢运动功能康复。

Objective To observe the feasibility and efficacy of kinesio taping combined with acupuncture on rehabilitation of upper limb motor function in patients with acute poststroke shoulder-hand syndrome(PSHS).Methods One hundred and twenty patients with acute PSHS(StageⅠ,acute phase)who received rehabilitation treatment at the Rehabilitation Department of Affiliated Nantong Hospital 3 of Nantong University from January 2019 to January 2022 were randomly divided into the A group(kinesio taping combined with acupuncture),B group(kinesio taping),and C group(acupuncture)using a random number table method,with 40 patients in each group.All patients were given internal medicine and general rehabilitation therapy,with continuous treatment for 4 weeks.Visual analogue scale(VAS),Fugl-Meyer motor function assessment of upper limb(FMA-UE)and WOLF motor function test(WMFT)scores were used to evaluate the rehabilitation of upper limb motor function before and after 4 weeks of treatment.At the same time,the efficacy of kinesio taping combined with acupuncture in the treatment of upper limb functional rehabilitation in patients with acute PSHS is evaluated based on the efficacy criteria of the"Rehabilitation Assessment".Using multivariate binary Logistic regression analysis,after adjusting for gender,age,and functional scores,evaluate the clinical effectiveness of kinesio taping combined with acupuncture in the rehabilitation of upper limb motor function in PSHS patients.Results The baseline data and VAS,FMA-UE,WMFT scores were no statistical difference between the three groups before treatment(P>0.05).After 4 weeks of treatment,the VAS scores of all three groups of patients decreased,and the efficacy of group A was better than that of groups B and C,with statistically significant differences(P<0.05);The scores of FMA-UE and WMFT both increased,and the efficacy of group A was better than that of groups B and C,with statistically significant differences(P<0.05).Upper limb functional rehabilitation were evaluated according to rehabilitation assessment,the improvement of limb spasm in the A group(90.00%)was significantly higher than that in the B and C groups(67.50%and 62.00%;P<0.05).Multivariate binary Logistic regression analysis suggests that the clinical efficacy of kinesio taping combined with acupuncture in improving upper limb motor function in acute PSHS patients is 6.563 times higher than that of single treatment(95%CI:1.256-34.301,P<0.05).Conclusion Kinesio taping combined with acupuncture can promote the rehabilitation of upper limb motor function in PSHS patients.