益气活血通痹汤治疗气虚血瘀证卒中后肩手综合征Ⅰ期患者的临床疗效及对其疼痛缓解和上肢运动功能的影响

Clinical Efficacy of Yiqi Huoxue Tongbi Decoction on Pain Relief and Upper Limb Motor Function in Patients with Post-Stroke Shoulder-Hand Syndrome I of Qi Deficiency and Blood Stasis Syndrome

目的探讨益气活血通痹汤治疗气虚血瘀证卒中后肩手综合征Ⅰ期患者的临床疗效及对其疼痛缓解和上肢运动功能的影响。方法选取2019年12月—2021年12月期间安徽省六安市中医院收治的卒中肩手综合征患者100例,按随机数字表法分为对照组和观察组,每组各50例。对照组采用常规临床治疗,观察组在对照组治疗基础上联合益气活血通痹汤治疗。连续治疗4周后,观察比较两组患者临床疗效、安全性,治疗前后气虚血瘀证候积分、患肢肿胀程度评分、肩部活动疼痛VAS评分、Fugl-Meyer评估量表(FMA)评分、肩手综合征评估量表(SHSS)评分及肩关节活动度的变化改善情况。结果治疗后两组患者气虚血瘀证候积分和肿胀程度评分均较治疗前明显降低,差异有统计学意义(P<0.05),且观察组气虚血瘀证候积分和肿胀程度评分明显低于对照组,差异有统计学意义(P<0.05)。治疗后两组患者肩部屈曲、外展、外旋、内旋评分均较治疗前明显降低,差异有统计学意义(P<0.05);且观察组肩部疼痛评分均明显低于对照组,差异有统计学意义(P<0.05)。治疗后两组患者FMA评分较治疗前明显升高,SHSS评分较治疗前明显降低,差异有统计学意义(P<0.05);且观察组FMA评分高于对照组,SHSS评分低于对照组,差异有统计学意义(P<0.05)。治疗后两组患者患肩后伸、前屈、外展的角度均较治疗前明显升高,差异有统计学意义(P<0.05);且观察组肩关节活动度高于对照组,差异有统计学意义(P<0.05)。治疗后观察组临床总有效率92.00%(46/50)明显高于对照组76.00%(38/50),差异有统计学意义(P<0.05)。治疗前后两组患者血常规、尿常规、粪常规、肾功能、肝功能等指标均无明显异常变化,患者用药期间也未出现腹泻、呕吐、皮疹等不良反应。结论益气活血通痹汤能够有效缓解气虚血瘀证脑卒中后肩手综合征Ⅰ期患者肢体疼痛,提高患者肩关节活动度,降低水肿程度,有效促进患者上肢功能的恢复。

Objective To investigate the clinical efficacy of Yiqi Huoxue Tongbi Decoction in treating patients with post-stroke shoulder-hand syndrome I of qi deficiency and blood stasis syndrome,and its impact on pain relief and upper limb motor function.Methods A total of 100 patients with post-stroke shoulder-hand syndrome,admitted to Traditional Chinese Hospital of LuAn in Anhui Province between December 2019 and December 2021,were selected and randomly divided into a control group and an observation group according to a random number table,with 50 patients in each group.The control group received conventional clinical treatment,while the observation group was treated with Yiqi Huoxue Tongbi Decoction in addition to the conventional treatment.After 4 weeks of continuous treatment,the clinical efficacy and safety were observed and compared between the two groups.The scores for qi deficiency and blood stasis syndrome,limb swelling score,VAS score of shoulder pain,Fugl-Meyer Assessment(FMA)score,Shoulder-Hand Syndrome Scale(SHSS)score,and shoulder joint range of motion were measured and analyzed before and after treatment.Results After treatment,both groups showed significant reductions in qi deficiency and blood stasis syndrome scores and swelling scores compared to those before treatment(P<0.05).The observation group had significantly lower scores for qi deficiency and blood stasis syndrome and swelling than the control group(P<0.05).Scores for shoulder flexion,abduction,external rotation,and internal rotation significantly decreased in both groups after treatment(P<0.05),with the observation group showing significantly lower shoulder pain scores than the control group(P<0.05).FMA scores significantly increased,and SHSS scores significantly decreased in both groups after treatment(P<0.05).The observation group had higher FMA scores and lower SHSS scores than the control group(P<0.05).The range of motion for shoulder extension,flexion,and abduction significantly increased in both groups after treatment(P<0.05),with the observation group showing greater improvement than the control group(P<0.05).The overall clinical efficacy rate in the observation group was 92.00%(46/50),significantly higher than 76.00%(38/50)in the control group(P<0.05).No significant abnormalities were observed in routine blood,urine,stool tests,kidney function,or liver function in either group before or after treatment,and no adverse reactions such as diarrhea,vomiting,or rash occurred during medication.Conclusion Yiqi Huoxue Tongbi Decoction effectively alleviates limb pain in patients with post-stroke shoulder-hand syndrome I of qi deficiency and blood stasis syndrome.Furthermore,it improves shoulder joint range of motion,reduces edema,and effectively promotes the recovery of upper limb function.