内热针疗法治疗中风后肩痛有效性与安全性的随机对照研究
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摘要
目的:初步评价内热针疗法治疗中风后肩痛的有效性和安全性。方法:将中风后肩痛患者按照随机数字表法分为内热针组47例和温针灸组45例。取穴均以患侧肩髃、肩髎、肩贞、臂臑、阿是穴为主,分别对患者采用内热针及温针灸疗法治疗4周,记录两组患者的临床疗效(治愈率、有效率)、皮肤损伤发生率、生命体征、相关血液指标及治疗环境满意度,对内热针及温针灸疗法的有效性和安全性进行比较及评价。结果:在治愈率方面,内热针组(20/47,42.55%)明显优于温针灸组(5/45,11.11%,P<0.01)。在总有效率方面,内热针组(41/47,87.23%)明显优于温针灸组(31/45,68.89%,P<0.05)。在皮肤损伤发生率方面,内热针组(6.9%)明显低于温针灸组(11.9%,P<0.01)。两组治疗前及治疗后生命体征方面比较差异无统计学意义(P>0.05)。两组治疗后的血红蛋白、白细胞计数、血小板计数、D-二聚体及肌酶等检测结果与治疗前及组间比较差异均无统计学意义(P>0.05)。在治疗环境满意度方面,内热针组(95.74%)高于温针灸组(80%,P<0.05)。结论:内热针疗法对中风后肩痛有效,且安全可靠,在皮肤损伤发生率和治疗环境的满意度方面,内热针疗法明显优于温针灸疗法。
Objective To evaluate the effectiveness and safety of internal heat-type acupuncture needle(IHTAN)therapy in the treatment of post-stroke shoulder pain in apopletic patients.Methods According to the random number table,96 patients with post-stroke shoulder pain were divided into IHTAN group and warm needle moxibustion group(n=48 in each one).Jianyu(LI15),Jianliao(TE14),Jianzhen(SI9),Binao(LI14)and Ashi points(Extra)on the affected side were selected in the two groups.For patients of the IHTAN group,internal warmth controllable acupuncture needles were inserted into the above-mentioned acupoints,and then connected to an internal heat acupuncture apparatus for stimulating the acupoints at 42℃,20 min every time,once a week,for 4 weeks.For patients of the warm needle moxibustion group,the above mentioned acupoints were stimulated with filiform needles attached with an ignited moxa-stick,once every other day,for 4 weeks.If the shoulder pain disappeared or basically disappeared,it was considered to be healed,if the pain was relieved,it was considered to be effective,otherwise,it was considered to be ineffective.The incidence of local skin injury including burn,empyrosis,silt blue,hematoma and infection,the heart rate,respiration,blood pressure,oxyhemoglobin saturation,blood routine(hemoglobin level,white blood cell[WBC]count,platelet count),creatase and dipolymer levels were recorded or detected.Additionally,the patients' satisfaction rate about the treatment environment was recorded.Results Following the treatment,of the 45 and 47 cases in the warm needle moxibustion and IHTAN groups,5(11.11%)and 20(42.55%)were cured,26(57.78%)and 21(44.68%)experienced marked improvement,and 14(31.11%)and 6(12.77%)had no apparent changes in their shoulder pain severity,with the total effective rates being 68.89% and 87.23%,respectively.The curative rate and total effective rate of the IHTAN group were significantly higher than those of the warm needle moxibustion group(P<0.01,P<0.05).The incidence of skin injury of the IHTAN group was evidently lower than that of the warm needle moxibustion group(P<0.01),and the patients' therapeutic environment satisfaction rate was remarkably higher in the IHTNA group than in the warm needle moxibustion group(P<0.05).No significant differences were found between the two groups and between pre-and post-treatment in each group in the heart rate,respiration frequency,systolic and diastolic pressures,oxyhemoglobin saturation,hemoglobin content,WBC count,platelet count,and plasma dipolymer,creatine kinase,lactic dehydrogenase,and beta-hydroxybutyrate dehydrogenase levels(P>0.05).Conclusion The IHTAN therapy is effective,safe and reliable in the treatment of post-stroke shoulder pain.In terms of the incidence of skin injury and the satisfaction degree of therapeutic environment,the internal heat-type acupuncture needle therapy is obviously superior to the warm needle moxibustion therapy.
Objective To evaluate the effectiveness and safety of internal heat-type acupuncture needle(IHTAN)therapy in the treatment of post-stroke shoulder pain in apopletic patients.Methods According to the random number table,96 patients with post-stroke shoulder pain were divided into IHTAN group and warm needle moxibustion group(n=48 in each one).Jianyu(LI15),Jianliao(TE14),Jianzhen(SI9),Binao(LI14)and Ashi points(Extra)on the affected side were selected in the two groups.For patients of the IHTAN group,internal warmth controllable acupuncture needles were inserted into the above-mentioned acupoints,and then connected to an internal heat acupuncture apparatus for stimulating the acupoints at 42℃,20 min every time,once a week,for 4 weeks.For patients of the warm needle moxibustion group,the above mentioned acupoints were stimulated with filiform needles attached with an ignited moxa-stick,once every other day,for 4 weeks.If the shoulder pain disappeared or basically disappeared,it was considered to be healed,if the pain was relieved,it was considered to be effective,otherwise,it was considered to be ineffective.The incidence of local skin injury including burn,empyrosis,silt blue,hematoma and infection,the heart rate,respiration,blood pressure,oxyhemoglobin saturation,blood routine(hemoglobin level,white blood cell[WBC]count,platelet count),creatase and dipolymer levels were recorded or detected.Additionally,the patients' satisfaction rate about the treatment environment was recorded.Results Following the treatment,of the 45 and 47 cases in the warm needle moxibustion and IHTAN groups,5(11.11%)and 20(42.55%)were cured,26(57.78%)and 21(44.68%)experienced marked improvement,and 14(31.11%)and 6(12.77%)had no apparent changes in their shoulder pain severity,with the total effective rates being 68.89% and 87.23%,respectively.The curative rate and total effective rate of the IHTAN group were significantly higher than those of the warm needle moxibustion group(P<0.01,P<0.05).The incidence of skin injury of the IHTAN group was evidently lower than that of the warm needle moxibustion group(P<0.01),and the patients' therapeutic environment satisfaction rate was remarkably higher in the IHTNA group than in the warm needle moxibustion group(P<0.05).No significant differences were found between the two groups and between pre-and post-treatment in each group in the heart rate,respiration frequency,systolic and diastolic pressures,oxyhemoglobin saturation,hemoglobin content,WBC count,platelet count,and plasma dipolymer,creatine kinase,lactic dehydrogenase,and beta-hydroxybutyrate dehydrogenase levels(P>0.05).Conclusion The IHTAN therapy is effective,safe and reliable in the treatment of post-stroke shoulder pain.In terms of the incidence of skin injury and the satisfaction degree of therapeutic environment,the internal heat-type acupuncture needle therapy is obviously superior to the warm needle moxibustion therapy.
引文
[1]孟凡颖,温进.温针灸外关穴治疗脑卒中后肩手综合征Ⅰ期的临床观察[J].针刺研究,2014,39(3):228-231.
[2]段轶轩,张照庆,尹晶,等.内热针疗法治疗中风后肩痛的可行性及机制探讨[J].中医药临床杂志,2016,28(5):614-616.
[3]吕娟,贲定严,易展.内热针痛点治疗中风后肩痛随机对照研究[J].时珍国医国药,2017,28(7):1678-1680.
[4]庄君贤,刘牧军,钟印芹.39例温针灸治疗患者发生烫伤的原因分析及护理对策[J].护理学报,2014,21(5):67-69.
[5]杨旭明,汤家铭.一种模拟传统艾灸电子温灸仪的研制:应用安全及环保效应[J].中国组织工程研究,2016,20(42):6337-6342.
[6] BRADY S,MCEVOY J,DOMMERHOLT J,et al.Adverse events following trigger point dry needling:aprospective survey of chartered physiotherapists[J].J Man Manip Ther,2014,22(3):134-140.
[7]中华神经科学会.各类脑血管疾病诊断要点[J].中华神经科杂志,1996,29(6):379.
[8]国家中医药管理局脑病急症协作组.中风病诊断与疗效评定标准[J].北京中医药大学学报,1996,19(1):55-56.
[9]卓廉佳,张子强.温针灸结合中药熏洗对膝关节骨性关节炎患者IL-1、TNF-α、MMP-3的影响[J].中医药导报,2015,21(15):64-65.
[10]陈丽华,金远林,周鹏,等.温针灸结合益损液涂擦治疗中风偏瘫后肩痛临床观察[J].中国实用医药,2013,8(5):252-253.
[11]郑入文,任毅,胡慧.温针灸治疗卒中后肩手综合征的临床观察[J].世界中医药,2014,9(11):1535-1537.
[12]王飞,高谦,王刚,等.软组织内热治疗针体外温度变化的特点分析[J].军医进修学院学报,2010,31(1):78-79.
[13]王福根.银质针导热治疗软组织痛[M].郑州:河南科学技术出版社,2008:7-8.
[14]洪宗国,吕丰,魏海胜,等,艾条燃烧温度-时间-空间曲线研究[J].中国针灸,2012,32(11):1024-1028.
[15] DEMLING R H,LALONDE C,IKEGAMI K.Physiologic support of the septic patient[J].Surg Clin North Am,1994,74:637-658.
[16] CLARKSON P M,NOSAKA K,BRAUN B.Muscle function after exercise-induced muscle damage and rapid adaptation[J].Med Sci Sports Exerc,1992,24(5):512-520.
[17]汪丽,郑灵.外伤应激时机体血液生化指标与血常规的变化[J].医学信息,2015,28(z2):348.
[18]孟继懋.骨与关节损伤[M].北京:人民卫生出版社,1980:11.
[19]田羽玲,高谦,王刚,等.内热针治疗椎间盘退行性疾病过程中动态心电监护的结果分析[J].中华保健医学杂志,2016,18(1):34-37.
[20]赵越洋,李万瑶.临床艾灸烟雾对针灸医生患慢性咽喉炎的影响[J].时珍国医国药,2013,24(7):1801-1802.
[2]段轶轩,张照庆,尹晶,等.内热针疗法治疗中风后肩痛的可行性及机制探讨[J].中医药临床杂志,2016,28(5):614-616.
[3]吕娟,贲定严,易展.内热针痛点治疗中风后肩痛随机对照研究[J].时珍国医国药,2017,28(7):1678-1680.
[4]庄君贤,刘牧军,钟印芹.39例温针灸治疗患者发生烫伤的原因分析及护理对策[J].护理学报,2014,21(5):67-69.
[5]杨旭明,汤家铭.一种模拟传统艾灸电子温灸仪的研制:应用安全及环保效应[J].中国组织工程研究,2016,20(42):6337-6342.
[6] BRADY S,MCEVOY J,DOMMERHOLT J,et al.Adverse events following trigger point dry needling:aprospective survey of chartered physiotherapists[J].J Man Manip Ther,2014,22(3):134-140.
[7]中华神经科学会.各类脑血管疾病诊断要点[J].中华神经科杂志,1996,29(6):379.
[8]国家中医药管理局脑病急症协作组.中风病诊断与疗效评定标准[J].北京中医药大学学报,1996,19(1):55-56.
[9]卓廉佳,张子强.温针灸结合中药熏洗对膝关节骨性关节炎患者IL-1、TNF-α、MMP-3的影响[J].中医药导报,2015,21(15):64-65.
[10]陈丽华,金远林,周鹏,等.温针灸结合益损液涂擦治疗中风偏瘫后肩痛临床观察[J].中国实用医药,2013,8(5):252-253.
[11]郑入文,任毅,胡慧.温针灸治疗卒中后肩手综合征的临床观察[J].世界中医药,2014,9(11):1535-1537.
[12]王飞,高谦,王刚,等.软组织内热治疗针体外温度变化的特点分析[J].军医进修学院学报,2010,31(1):78-79.
[13]王福根.银质针导热治疗软组织痛[M].郑州:河南科学技术出版社,2008:7-8.
[14]洪宗国,吕丰,魏海胜,等,艾条燃烧温度-时间-空间曲线研究[J].中国针灸,2012,32(11):1024-1028.
[15] DEMLING R H,LALONDE C,IKEGAMI K.Physiologic support of the septic patient[J].Surg Clin North Am,1994,74:637-658.
[16] CLARKSON P M,NOSAKA K,BRAUN B.Muscle function after exercise-induced muscle damage and rapid adaptation[J].Med Sci Sports Exerc,1992,24(5):512-520.
[17]汪丽,郑灵.外伤应激时机体血液生化指标与血常规的变化[J].医学信息,2015,28(z2):348.
[18]孟继懋.骨与关节损伤[M].北京:人民卫生出版社,1980:11.
[19]田羽玲,高谦,王刚,等.内热针治疗椎间盘退行性疾病过程中动态心电监护的结果分析[J].中华保健医学杂志,2016,18(1):34-37.
[20]赵越洋,李万瑶.临床艾灸烟雾对针灸医生患慢性咽喉炎的影响[J].时珍国医国药,2013,24(7):1801-1802.