经筋刺法与中药膏摩法联合常规康复训练治疗脑卒中后Ⅰ期肩手综合征临床研究

Curative Effect of Meridian Acupuncture Combined with Chinese Herbal Ointment Rubbing for Stage I Post-Stroke Shoulder-Hand Syndrome

目的:观察在常规康复训练基础上加用经筋刺法与中药膏摩法治疗脑卒中后Ⅰ期肩手综合征的疗效。方法:选择98例血瘀阻络型脑卒中后Ⅰ期肩手综合征患者作为研究对象,随机分为联合组和对照组各49例。2组均接受常规康复训练,联合组加予经筋刺法联合中药膏摩法治疗。2组均连续治疗4周。治疗前后测量患侧手部的肿胀程度、肩关节活动度和上肢静脉血流速度,评估患肢疼痛情况[视觉模拟评分法(VAS)评分]、上肢运动功能[Fugl-Meyer上肢运动功能评定量表(FMA-UE)评分]。比较2组的临床疗效。结果:治疗后,联合组总有效率高于对照组(P<0.05)。2组患肢的手部肿胀程度均较治疗前减轻,VAS评分均较治疗前降低,FMA-UE评分均较治疗前升高,差异均有统计学意义(P<0.05)。联合组患肢的手部肿胀程度较对照组减轻,VAS评分低于对照组,FMA-UE评分高于对照组,差异均有统计学意义(P<0.05)。2组患侧肩关节外展、内旋、前屈、后伸的活动度均较治疗前增大(P<0.05)。联合组患侧肩关节外展、内旋、前屈、后伸的活动度均大于对照组(P<0.05)。2组患肢的肘正中静脉、腋静脉、肱静脉血流速度均较治疗前加快(P<0.05)。联合组患肢的肘正中静脉、腋静脉、肱静脉血流速度均快于对照组(P<0.05)。结论:在常规康复训练基础上加用经筋刺法与中药膏摩法治疗脑卒中后Ⅰ期肩手综合征效果良好,可更好地减轻患肢疼痛,改善患肢的运动功能和肩关节活动度,原因可能与改善肢体的静脉血流速度有关。

Objective:To investigate the curative effect of meridian acupuncture combined with Chinese herbal ointment rubbing on stageⅠpost-stroke shoulder-hand syndrome.Methods:A total of 98 patients with stageⅠpost-stroke shoulder-hand syndrome were divided into the combination group(49 cases)and the control group(49 cases)according to random number table method.The control group received routine rehabilitation training,while the combination group was additionally treated with meridian acupuncture combined with Chinese herbal ointment rubbing on the treatment of the control group.The treatment lasted for four weeks.The swelling degree of the affected hands,the range of motion of the shoulder joint and the velocity of venous blood flow in the upper limbs were measured before and after treatment,and the pain[Visual Analogue Scale(VAS)score]and motor function of the affected limbs[Fugl-Meyer Assessment Upper Extremity Scale(FMA-UE)score]were evaluated.The clinical effects in the two groups were compared.Results:After treatment,the combination group had higher total effective rate than that in the control group(P<0.05).The swelling degree of the affected hands in two groups were respectively reduced when compared with those before treatment;VAS scores were decreased when compared with those before treatment,and the FMA-UE scores were enhanced when compared with those before treatment,differences being significant(P<0.05).When respectively compared with that in the control group,the swelling degree of affected hands in the combination group was released,the VAS score was lower,and the FMA-UE score was higher,differences being significant(P<0.05).The mobility of shoulder abduction,pronation,anterior flexion and posterior extension of the affected sides in both groups were increased when compared with those before treatment(P<0.05).The mobility of shoulder abduction,pronation,anterior flexion and posterior extension of the affected sides in the combination group were larger than those in the control group(P<0.05).The blood flow velocity of the median cubital vein,axillary vein and brachial vein in the affected limbs of both groups were elevated when compared with those before treatment(P<0.05).The blood flow velocity of median cubital vein,axillary vein and brachial vein in combination group were faster than those in the control group(P<0.05).Conclusion:On the basis of routine rehabilitation training,the combination of meridian acupuncture combined with Chinese herbal ointment rubbing has a great effect on stageⅠpost-stroke shoulder-hand syndrome,which can reduce pain better,improve upper limb motor function and shoulder joint motion,which may be related to the improvement of upper limb venous blood flow velocity.