电针联合隔姜艾灸治疗缺血性脑卒中后肩手综合征的疗效及对CGRP、BK、SP水平的影响
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摘要
目的:观察电针联合隔姜艾灸治疗缺血性脑卒中后肩手综合征的疗效及对降钙素基因相关肽(calcitonin gene related peptide,CGRP)、缓激肽(bradykinin,BK)及P物质(substance P,SP)水平的影响。方法:选取本院2015年4月至2017年6月收治的缺血性脑卒中后肩手综合征患者130例,按照随机数字表法分为对照组和针刺组,每组65例。对照组给予西医肢体康复锻炼治疗,针刺组在对照组治疗的基础上加用电针联合隔姜艾灸治疗。观察两组患者近期疗效,治疗前后中医证候积分、疼痛水肿视觉模拟评分、肩手综合征(shoulder-hand syndrome,RSD)功能量表评分、肩关节功能独立性评分,Fugl-Meyer评分法(FMA)、CGRP、BK、SP水平。结果:针刺组有效率89. 23%,对照组有效率73. 85%,针刺组近期疗效显著优于对照组,差异有统计学意义(P <0. 05);针刺组治疗后中医证候积分和疼痛水肿视觉模拟评分均显著低于对照组,差异有统计学意义(P <0. 05);针刺组治疗后RSD功能量表评分、肩关节功能独立性评分、FMA评分均优于对照组,差异有统计学意义(P <0. 05);针刺组治疗后CGRP、BK、SP水平均优于对照组,差异有统计学意义(P <0. 05)。结论:电针联合隔姜艾灸治疗缺血性脑卒中后肩手综合征可显著缓解患者肩手疼痛肿胀症状,促进肢体活动功能恢复,改善CGRP、BK及SP水平。
Objective: To observe the curative effect of electro-acupuncture combined with ginger-separated moxibustion on shoulder-hand syndrome after ischemic stroke and its influence on the levels of calcitonin gene-related peptide( CGRP),bradykinin( BK) and substance P( SP). Methods: A total of 130 patients with shoulder-hand syndrome after ischemic stroke admitted to our hospital from April 2015 to June 2017 were randomly divided into the control group and the acupuncture group,with 65 cases in each group. The ones in the control group were treated with limb rehabilitation exercises of Western medicine,while the ones in the acupuncture group were treated with electro-acupuncture combined with ginger-separated moxibustion on the basis of the control group. The short-term curative effect of the two groups,the scores of TCM syndromes,pain and edema visual simulation,shoulder-hand syndrome( RSD) functional scale,shoulder joint functional independence,Fugl-Meyer score( FMA),CGRP,BK and SP levels before and after treatment were observed. Results: The effective rate of the acupuncture group was 89. 23%,and that of the control group was 73. 85%. The short-term effect of the acupuncture group was significantly better than that of the control group,and the difference was statistically significant( P < 0. 05). The scores of TCM syndromes and visual analogue of pain and edema in the acupuncture group were significantly lower than those in the control group,and all the differences were statistically significant( P < 0. 05). After the treatment,the scores of RSD functional scale,shoulder functional independence and FMA in the acupuncture group were better than those in the control group,and all the differences were statistically significant( P < 0. 05). After the treatment,the levels of CGRP,BK and SP in the acupuncture group were better than those in the control group,and all the differences were statistically significant( P < 0. 05). Conclusion: Electro-acupuncture combined with ginger-separated moxibustion in the treatment of shoulder-hand syndrome after ischemic stroke can significantly alleviate the symptoms of shoulder-hand syndrome,promote the recovery of limb function,and enhance the levels of CGRP,BK and SP.
Objective: To observe the curative effect of electro-acupuncture combined with ginger-separated moxibustion on shoulder-hand syndrome after ischemic stroke and its influence on the levels of calcitonin gene-related peptide( CGRP),bradykinin( BK) and substance P( SP). Methods: A total of 130 patients with shoulder-hand syndrome after ischemic stroke admitted to our hospital from April 2015 to June 2017 were randomly divided into the control group and the acupuncture group,with 65 cases in each group. The ones in the control group were treated with limb rehabilitation exercises of Western medicine,while the ones in the acupuncture group were treated with electro-acupuncture combined with ginger-separated moxibustion on the basis of the control group. The short-term curative effect of the two groups,the scores of TCM syndromes,pain and edema visual simulation,shoulder-hand syndrome( RSD) functional scale,shoulder joint functional independence,Fugl-Meyer score( FMA),CGRP,BK and SP levels before and after treatment were observed. Results: The effective rate of the acupuncture group was 89. 23%,and that of the control group was 73. 85%. The short-term effect of the acupuncture group was significantly better than that of the control group,and the difference was statistically significant( P < 0. 05). The scores of TCM syndromes and visual analogue of pain and edema in the acupuncture group were significantly lower than those in the control group,and all the differences were statistically significant( P < 0. 05). After the treatment,the scores of RSD functional scale,shoulder functional independence and FMA in the acupuncture group were better than those in the control group,and all the differences were statistically significant( P < 0. 05). After the treatment,the levels of CGRP,BK and SP in the acupuncture group were better than those in the control group,and all the differences were statistically significant( P < 0. 05). Conclusion: Electro-acupuncture combined with ginger-separated moxibustion in the treatment of shoulder-hand syndrome after ischemic stroke can significantly alleviate the symptoms of shoulder-hand syndrome,promote the recovery of limb function,and enhance the levels of CGRP,BK and SP.
引文
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[12]吴圣婕,雷迈,谭威,等.脑卒中后肩手综合征的病因机制及诊疗进展[J].广西医学,2015,31(7):953-955.
[13]吴雪良,于庆滨,赵合庆.浮针、中药泡洗配合康复训练治疗脑卒中后肩手综合征临床观察及对血浆BK、SP水平的影响[J].四川中医,2017,21(8):202-204.
[14]曹凤,狄振峰,陆雪琴.脑卒中后并发肩手综合征的研究进展[J].上海医药,2015,36(24):3-6.
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[16]刘未艾,吴清明,付磊,等.补虚泻实针刺法结合卒中单元模式对肩手综合征患者肩部疼痛的影响[J].上海针灸杂志,2012,31(8):558-561.
[17]李军,张晓路.针刺、推拿联合康复训练对脑卒中后肩手综合征患者肢体运动功能及生活质量的影响[J].现代中西医结合杂志,2016,25(26):2913-2915.
[18]滕秀英,王杨.针刺人迎穴为主治疗缺血性脑卒中后肩手综合征临床观察[J].上海针灸杂志,2012,31(8):562-563.
[19]尤阳.电针配合康复训练治疗脑卒中后肩手综合征的临床观察[D].济南:山东中医药大学,2011.
[20]郑婕.隔姜泥“重灸”法治疗脑卒中后肩-手综合征临床研究[D].郑州:河南中医学院,2015:9-10.
[21]郑婕,朱现民.隔姜泥重灸法治疗卒中后肩-手综合征的临床体会[J].中国民间疗法,2014,22(12):11-12.
[2]ALBRECHT P J,HINES S,EISENBERG E,et al.Pathologic alterations of cutaneous innervation and vasculature in affected limbs from patients with complex regional pain syndrome[J].Pain,2006,120(3):244-266.
[3]南登崑.康复医学[M].北京:人民卫生出版社,2012:4.
[4]马越,李澎.中风后肩手综合征临床研究进展[J].中华针灸电子杂志,2015,4(4):41-44.
[5]中华医学会神经病学分会脑血管病学组急性缺血性脑卒中诊治指南撰写组.中国急性缺血性脑卒中诊治指南[J].中华神经科杂志,2010,43(2):146-148.
[6]张伯臾.中医内科学[M].上海:上海科学技术出版社,2010:75.
[7]王玉龙.康复功能评定学[M].北京:人民卫生出版社,2008:74.
[8]国家中医药管理局.中医病证诊断疗效标准[M].南京:南京大学出版社,2012:20-21.
[9]缪鸿石,朱镛连.脑卒中的康复治疗和评定[M].北京:华夏出版社,1996:9.
[10]王雨燕,王显达,麻虹,等.脑卒中后肩手综合征发病机制的研究进展[J].中西医结合心脑血管病杂志,2008,6(9):1071-1072.
[11]彭玉,宁为民.降钙素基因相关肽与肩手综合征关系的研究进展[J].实用心脑肺血管病杂志,2016,24(7):4-6.
[12]吴圣婕,雷迈,谭威,等.脑卒中后肩手综合征的病因机制及诊疗进展[J].广西医学,2015,31(7):953-955.
[13]吴雪良,于庆滨,赵合庆.浮针、中药泡洗配合康复训练治疗脑卒中后肩手综合征临床观察及对血浆BK、SP水平的影响[J].四川中医,2017,21(8):202-204.
[14]曹凤,狄振峰,陆雪琴.脑卒中后并发肩手综合征的研究进展[J].上海医药,2015,36(24):3-6.
[15]郭昊睿,王新志.中医药治疗中风后肩手综合征思路[J].中医药通报,2015,14(5):45-46.
[16]刘未艾,吴清明,付磊,等.补虚泻实针刺法结合卒中单元模式对肩手综合征患者肩部疼痛的影响[J].上海针灸杂志,2012,31(8):558-561.
[17]李军,张晓路.针刺、推拿联合康复训练对脑卒中后肩手综合征患者肢体运动功能及生活质量的影响[J].现代中西医结合杂志,2016,25(26):2913-2915.
[18]滕秀英,王杨.针刺人迎穴为主治疗缺血性脑卒中后肩手综合征临床观察[J].上海针灸杂志,2012,31(8):562-563.
[19]尤阳.电针配合康复训练治疗脑卒中后肩手综合征的临床观察[D].济南:山东中医药大学,2011.
[20]郑婕.隔姜泥“重灸”法治疗脑卒中后肩-手综合征临床研究[D].郑州:河南中医学院,2015:9-10.
[21]郑婕,朱现民.隔姜泥重灸法治疗卒中后肩-手综合征的临床体会[J].中国民间疗法,2014,22(12):11-12.