益肾解痉汤联合针刺治疗卒中后肩手综合征的临床研究

Clinical efficacy of Yishen Jiejing Decoction combined with acupuncture for post-stroke shoulder-hand syndrome

目的观察益肾解痉汤联合针刺在卒中后肩手综合征的临床疗效。方法选取2019年12月至2021年12月收治的120例卒中后肩手综合征患者为研究对象,按照随机数字表法分为3组,在均予西医常规康复治疗的基础上中药组40例加用益肾解痉汤治疗,针刺组40例加用针刺治疗,联合组40例加用益肾解痉汤联合针刺治疗。3组均治疗4周后统计疗效,比较3组治疗前及治疗2、4周肩关节上举活动度、肩关节外展活动度、肩手综合征评估量表(SHSS)评分及疼痛视觉模拟量表(VAS)评分变化情况,比较3组治疗前及治疗2、4周血清P物质(SP)及缓激肽(BK)水平变化情况,比较3组治疗前及治疗2、4周T淋巴细胞亚群CD3^(+)、CD4^(+)及CD8^(+)水平变化情况,比较3组治疗前及治疗2、4周尺神经与正中神经复合肌肉动作电位(CMAP)波幅及传导速度变化情况。结果联合组总有效率97.50%(39/40),中药组82.50%(33/40),针刺组80.00%(32/40),联合组总有效率高于中药组及针刺组(P<0.05)。与本组治疗前比较,3组治疗2、4周肩关节上举活动度、肩关节外展活动度均增大(P<0.05),SHSS评分及疼痛VAS评分均降低(P<0.05),且联合组治疗2、4周肩关节上举活动度及肩关节外展活动度均大于中药组及针刺组治疗同期(P<0.05),SHSS评分及疼痛VAS评分均低于中药组及针刺组治疗同期(P<0.05)。与本组治疗前比较,3组治疗2、4周血清SP及BK水平均降低(P<0.05),且联合组治疗2、4周血清SP及BK水平均低于中药组及针刺组治疗同期(P<0.05)。与本组治疗前比较,3组治疗2、4周T淋巴细胞亚群CD3^(+)、CD4^(+)及CD8^(+)水平均无明显变化,比较差异均无统计学意义(P>0.05)。结论益肾解痉汤联合针刺治疗卒中后肩手综合征临床疗效确切,可有效改善患者临床症状,促进神经修复,促进肢体功能恢复,其作用机制可能与降低血清SP、BK水平有关。

Objective To observe the clinical efficacy of Yishen Jiejing Decoction combined with acupuncture for post-stroke shoulder-hand syndrome(PS-SHS).Methods A total of 120 PS-SHS patients between December 2019 and December 2021 were selected.They were randomly assigned to receive routine Western medicine(RWM)+Yishen Jiejing Decoction(Chinese medicine group,n=40),RWM^(+)acupuncture(acupuncture group,n=40),or RWM+Yishen Jiejing Decoction+acupuncture(combination group,n=40).Treated for 4 weeks,the aim was to compare the shoulder range of motion(ROM)(including lifting and abduction),shoulder-hand syndrome scale(SHSS)score,visual analogue scale(VAS)score,substance P(SP),bradykinin(BK),T lymphocyte subsets CD3^(+),CD4^(+),CD8^(+),compound muscle action potential(CMAP)amplitudes and conduction velocity of ulnar nerve and median nerve on day 0 and at weeks 2 and 4.The curative effect was assessed.Results The overall effective rate in the combination group was better than that in the Chinese medicine group and the acupuncture group(97.50%[39/40]vs 82.50%[33/40]vs 80.00%[32/40],[P<0.05],respectively).The shoulder ROM(including lifting and abduction)at weeks 2 and 4 in the three groups was significantly increased than that on day 0,but SHSS and VAS scores were significantly decreased(all P<0.05),and the combination group was superior to the Chinese medicine group and the acupuncture group for shoulder ROM,SHSS and VAS scores at weeks 2 and 4(all P<0.05).The serum SP and BK at weeks 2 and 4 in the three groups were significantly decreased than those on day 0(P<0.05),which were significantly lower in the combination group than in the Chinese medicine group and the acupuncture group(P<0.05).The levels of T lymphocyte subsets CD3^(+),CD4^(+),CD8^(+)in the three groups at weeks 2 and 4 were comparable to those on day 0(P>0.05).Conclusion Yishen Jiejing Decoction combined with acupuncture has definite clinical efficacy in PS-SHS,and which can effectively improve clinical symptoms,promote nerve repair,and promote limb function recovery by lowering SP and BK levels.