浮针联合头针治疗脑梗死后肩手综合征Ⅰ期:随机对照试验

Fu's subcutaneous needling combined with scalp acupuncture for shoulder-hand syndrome phaseⅠafter cerebral infarction:a randomized controlled trial

目的:比较浮针联合头针与单纯头针治疗脑梗死后肩手综合征Ⅰ期的临床疗效。方法:将68例脑梗死后肩手综合征Ⅰ期患者随机分为联合组(34例,脱落1例)和头针组(34例)。两组患者均予内科治疗及常规康复训练。头针组予针刺于氏头针顶区和顶前区,每次电针30 min(疏密波,频率2 Hz/100 Hz,电流1 mA),留针6 h,每日1次,连续治疗14 d。在头针组基础上,联合组于头针留针期间于患肌行浮针疗法,前3 d每日1次,之后隔日1次,治疗4次后休息2 d,共治疗14 d。分别于治疗前后观察两组患者简化McGill疼痛问卷(SF-MPQ)、水肿程度、永久残损评定指南(GEPI)、上肢及手功能障碍问卷(DASH)评分,并于治疗后评定临床疗效。结果:治疗后,两组患者疼痛分级指数(PRI)、视觉模拟量表(VAS)、现在疼痛强度(PPI)评分及SF-MPQ总分均较治疗前降低(P<0.05),且联合组低于头针组(P<0.05)。治疗后,两组患者水肿程度及DASH评分较治疗前降低(P<0.05),GEPI评分较治疗前升高(P<0.05);联合组患者水肿程度及DASH评分低于头针组(P<0.05),GEPI评分高于头针组(P<0.05)。联合组总有效率为97.0%(32/33),高于头针组的91.2%(31/34,P<0.05)。结论:浮针联合头针与单纯头针治疗均能有效减轻脑梗死后肩手综合征Ⅰ期患者肩关节疼痛和手部肿胀程度,改善上肢功能,联合疗法疗效优于单纯头针治疗。

Objective To compare the therapeutic effect of Fu's subcutaneous needling combined with scalp acupuncture and simple scalp acupuncture for shoulder-hand syndrome phaseⅠafter cerebral infarction.Methods A total of 68 patients with shoulder-hand syndrome phaseⅠafter cerebral infarction were randomized into a combination group(34 cases,1 case dropped out)and a scalp acupuncture group(34 cases).Internal medicine treatment and conventional rehabilitation training were adopted in both groups.In the scalp acupuncture group,acupuncture was applied at parietal area and anterior parietal area of Yu's scalp acupuncture,electroacupuncture was connected for 30 min,with disperse-dense wave,in frequency of 2 Hz/100 Hz and in electric current of 1 mA,and the needles were retained for 6 h,once a day for continuous 14 days.On the basis of the treatment in the scalp acupuncture group,Fu's subcutaneous needling was applied at the affected muscles during needle retaining in the combination group,once a day in the first 3 days,once every other day in left days,2-day interval was taken after 4-time treatment,for 14 days totally.Before and after treatment,the scores of the short form of McGill pain questionnaire(SF-MPQ),edema degree,guides to evaluation of permanent impairment(GEPI),and disabilities of the arm,shoulder and hand(DASH)were observed in the two groups,respectively,and the therapeutic effect was evaluated after treatment.Results After treatment,the scores of pain rating index(PRI),visual analogue scale(VAS)and present pain intensity(PPI),as well as the total scores of SF-MPQ were decreased compared with those before treatment in the two groups(P<0.05),and the above indexes in the combination group were lower than those in the scalp acupuncture group(P<0.05).After treatment,the scores of edema degree and DASH were decreased compared with those before treatment(P<0.05),while the GEPI scores were increased compared with those before treatment(P<0.05)in the two groups;in the combination group,the scores of edema degree and DASH were lower(P<0.05)while the GEPI score was higher(P<0.05)than those in the scalp acupuncture group.The total effective rate was 97.0%(32/33)in the combination group,which was superior to 91.2%(31/34)in the scalp acupuncture group(P<0.05).Conclusion Both Fu's subcutaneous needling combined with scalp acupuncture and simple scalp acupuncture can effectively relieve the shoulder joint pain and edema degree of hand,improve the upper limb function in patients with shoulder-hand syndrome phaseⅠafter cerebral infarction,and the combination therapy has better therapeutic effect than simple scalp acupuncture.