电针结合运动想象疗法治疗脑卒中后肩手综合征Ⅰ期的临床观察

Clinical observation on electroacupuncture combined with motor imagery training in treating stageⅠpost-stroke shoulder-hand syndrome

目的观察电针结合运动想象疗法对脑卒中后肩手综合征Ⅰ期患者的临床疗效。方法将60例符合纳入标准脑卒中后肩手综合征Ⅰ期患者随机分配为运动想象疗法组(A组)、电针治疗组(B组)和电针结合运动想象疗法组(C组),每组20例。3组都给予常规的康复治疗,A组增加运动想象治疗,B组增加电针治疗,C组增加电针联合运动想象疗法。治疗2周后,比较数字疼痛评定量表(numeric rating scale,NRS)、患手肿胀程度评定、关节被动活动度(passive range of motion,PROM)、Fugl-Meyer运动功能评定量表上肢部分(upper fugl-meyer assessment,U-FMA)、Barthel指数(Barthel index,BI)和临床疗效。结果(1)治疗后,3组患者在NRS评分、手部肿胀程度均较治疗前降低(P<0.05);C组NRS评分低于A组(P<0.05),C组较B组在NRS评分的差异无统计学意义(P>0.05);C组手部肿胀程度低于B组(P<0.05),C组较A组手部肿胀程度的差异无统计学意义(P>0.05);A、B两组间NRS评分、手部肿胀程度差异无统计学意义(P>0.05)。(2)治疗后,3组在肩关节各被动活动度较治疗前增大(P<0.01);C组在肩关节前屈、后伸、外展和内外旋的被动活动度较A、B组增大(P<0.01);A、B两组间差异无统计学意义(P>0.05)。(3)治疗后,3组的U-FMA评分和BI评分较治疗前升高(P<0.05);3组的U-FMA和BI评分结果显示,C组较A、B组更高(P<0.05),A、B两组间差异无统计学意义(P>0.05)。(4)A组总有效率是85%,B组总有效率是90%,C组总有效率是95%,C组较A、B组差异有统计学意义(P<0.05),A、B两组间差异无统计学意义(P>0.05)。结论3组患者经治疗在疼痛、手部肿胀、上肢运动功能和日常生活活动能力方面均得到明显改善;且与单独的电针和运动想象疗法相比,电针联合运动想象治疗肩手综合征有明显的疗效优势。

Objective To observe the clinical efficacy of electroacupuncture(EA)combined with motor imagery training(MIT)on patients with stageⅠpost-stroke shoulder-hand syndrome(SHS).Methods Sixty patients with stageⅠpost-stroke SHS who met the inclusion criteria were randomized into MIT(Group A),EA(Group B),and EA combined with MIT(Group C)groups,with 20 patients in each group.Besides routine rehabilitation treatment to all three groups,Group A was additionally treated with MIT,Group B with EA therapy,and Group C with a combination of EA and MIT.After 2 weeks of treatment,the numerical rating scale(NRS)score,swelling degree in the affected hand,passive range of motion(PROM),upper fugl-meyer assessment(U-FMA)score,Barthel index(BI)score,and clinical efficacy among the three groups were compared.Results(1)After treatment,the NRS score and hand swelling degree of all three groups decreased compared with those before treatment(P<0.05);the NRS score of Group C was lower than that of Group A(P<0.05),and there was no statistically significant difference in it between Group C and Group B(P>0.05);the hand swelling degree in Group C was lower than that in Group B(P<0.05),and there was no statistically significant difference in it between Group C and Group A(P>0.05);there was no statistically significant difference in the NRS score and hand swelling degree between Group A and Group B(P>0.05).(2)After treatment,the PROM of the shoulder joints in all three groups increased compared with that before treatment(P<0.01);the PROM in shoulder flexion,extension,abduction,and internal and external rotations in Group C increased compared with that in Group A and B(P<0.01),and there was no statistically significant difference in it between Group A and B(P>0.05).(3)After treatment,the U-FMA and BI scores of all three groups increased compared with those before treatment(P<0.05);the U-FMA and BI scores in Group C were higher than those in Group A and B(P<0.05),and there was no statistically significant difference in them between Group A and B(P>0.05).(4)The total effective rates of Group A,B,and C were 85%,90%,and 95%,respectively.There was a statistically significant difference in it between Group C and Group A and B(P<0.05),while no statistically significant difference between Group A and Group B(P>0.05).Conclusion All three groups showed significant improvements in pain,hand swelling,upper limb motor function,and daily living activities after treatment;compared with EA and MIT alone,the combination of EA and MIT has significant therapeutic advantages in treating SHS.