二乌汤湿热敷联合康复训练治疗中风后偏瘫肩痛(风寒湿痹)随机平行对照研究
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摘要
[目的]观察二乌汤湿热敷联合康复训练治疗中风后偏瘫肩痛(风寒湿痹)疗效。[方法]使用随机平行对照方法,将90例住院患者按病志号抽签简单随机分为两组。对照组45例良肢位摆放:①仰卧位:头下垫枕头,不宜过高,肩胛骨下放一枕头,使肩上抬前挺,上臂外旋稍外展,肘、腕均伸直,掌心向上,手指伸直分开,整个上肢放在枕头上;②侧卧位:健侧肢体在下,患侧上肢肩向前伸,肘和腕关节保持自然伸展,手心向下自然伸展,腋下垫软枕,使肩和上肢保持前伸;③患侧卧位:患肢在下,肩和肩胛骨向前伸,前臂往后旋,使肘和腕伸展,手掌向上,手指伸开;④坐位:髋关节保持90°屈曲位,背部保持竖直,躯干伸展,上肢伸展放平;放松肩胛骨:①仰卧位,双臂举高伸直,手掌向下以能碰到床垫为宜;②坐位:肩胛骨上下运动,尝试肩胛骨向内缩3cm,让肩胛骨向脊椎骨靠近,接着上下移动肩胛骨;③坐位:肩胛骨旋转运动,顺时针慢慢旋转手肘。治疗组45例二乌汤湿热敷(川乌、草乌、乳香、没药、羌活、透骨草、羌活、麻黄、芍药、甘草、附子、细辛、桂枝、姜~干各等分),研磨成末,黄酒调成糊状,加热至40℃,清洁疼痛处皮肤,医用纱布湿热敷于痛处,1h/次,1次/d;康复训练同对照组。连续治疗30d为1疗程。观测临床表现、VAS疼痛评分、简化FuglMeyer评分、Barthel指数、不良反应。治疗1疗程(30d),判定疗效。[结果]VAS疼痛评分、简化Fugl-Meyer评分、Barthel指数两组均有改善(P<0.01),治疗组改善优于对照组(P<0.05,P<0.01)。[结论]二乌汤湿热敷联合康复训练治疗中风后偏瘫肩痛(风寒湿痹),疗效满意,无严重不良反应,值得推广。
[Objective] To observe the curative effect of Erwu decoction wet-hot compress combined with rehabilitation training on shoulder pain(wind-cold-dampness arthralgia) of hemiplegia after apoplexy.[Method] Ninety inpatients were randomly divided into two groups by drawing lots according to the disease sign. In the control group, 45 cases were placed in good limb positions: ① Supine position: head under pillow,not too high, shoulder under a pillow, so that the shoulder is raised forward, upper arm rotation slightly outward, elbow, wrist are straight, palm upward, fingers stretched apart, the whole upper limb on the pillow;② Lateral decubitus position: the healthy side of the lower limb, the affected side of the upper limb shoulder forward extension, elbow and wrist joint to maintain natural extension, palm down natural extension, underarm cushion soft pillow, so that the shoulder and upper limb keep forward extension; ③ Side decubitus position:lower limb, shoulder and scapula forward, forearm backward, elbow and wrist extension, palm upward,finger extension; ④ Sitting position: hip joint flexion 90 degrees, back vertical, trunk extension, upper limb extension flat. Relax scapula: ①Supine position, arms raised and straight, palms down to touch the mattress is appropriate; ②Sitting position: Move up and down the scapula, try to retract the scapula 3 cm inward, bring the scapula closer to the spine, and then move the scapula up and down; ③Sitting position: Scapular rotation,clockwise slow rotation elbow. In the treatment group, 45 cases of Erwu decoction were treated by wet-hot compress(Chuanwu, Caowu, Ruxiang, Moyao, Qianghuo, Tougucao, Mahuang, Gancao, Fuzi, Xinxi, Guizhi,Ganjiang, etc.) and ground to the end. Yellow rice wine was pasted and heated to 40 C to clean the painful skin.Medical gauze was wet-hot compressed on the painful area, once a day; rehabilitation training was the same as the control group. Continuous treatment for 30 days is a course of treatment. Clinical manifestations, VAS pain score, simplified Fugl-Meyer score, Barthel index and adverse reactions were observed. One course of treatment(30 days) was used to determine the curative effect. [Results] VAS pain score, simplified Fugl-Meyer score and Barthel index were improved in both groups(P<0.01), and the improvement in treatment group was better than that in control group(P<0.05, P<0.01). [Conclusion] Erwu decoction wet-hot compress combined with rehabilitation training in the treatment of post-apoplectic hemiplegia shoulder pain(wind-cold-dampness arthralgia) has satisfactory curative effect and no serious adverse reactions, which is worthy of promotion.
[Objective] To observe the curative effect of Erwu decoction wet-hot compress combined with rehabilitation training on shoulder pain(wind-cold-dampness arthralgia) of hemiplegia after apoplexy.[Method] Ninety inpatients were randomly divided into two groups by drawing lots according to the disease sign. In the control group, 45 cases were placed in good limb positions: ① Supine position: head under pillow,not too high, shoulder under a pillow, so that the shoulder is raised forward, upper arm rotation slightly outward, elbow, wrist are straight, palm upward, fingers stretched apart, the whole upper limb on the pillow;② Lateral decubitus position: the healthy side of the lower limb, the affected side of the upper limb shoulder forward extension, elbow and wrist joint to maintain natural extension, palm down natural extension, underarm cushion soft pillow, so that the shoulder and upper limb keep forward extension; ③ Side decubitus position:lower limb, shoulder and scapula forward, forearm backward, elbow and wrist extension, palm upward,finger extension; ④ Sitting position: hip joint flexion 90 degrees, back vertical, trunk extension, upper limb extension flat. Relax scapula: ①Supine position, arms raised and straight, palms down to touch the mattress is appropriate; ②Sitting position: Move up and down the scapula, try to retract the scapula 3 cm inward, bring the scapula closer to the spine, and then move the scapula up and down; ③Sitting position: Scapular rotation,clockwise slow rotation elbow. In the treatment group, 45 cases of Erwu decoction were treated by wet-hot compress(Chuanwu, Caowu, Ruxiang, Moyao, Qianghuo, Tougucao, Mahuang, Gancao, Fuzi, Xinxi, Guizhi,Ganjiang, etc.) and ground to the end. Yellow rice wine was pasted and heated to 40 C to clean the painful skin.Medical gauze was wet-hot compressed on the painful area, once a day; rehabilitation training was the same as the control group. Continuous treatment for 30 days is a course of treatment. Clinical manifestations, VAS pain score, simplified Fugl-Meyer score, Barthel index and adverse reactions were observed. One course of treatment(30 days) was used to determine the curative effect. [Results] VAS pain score, simplified Fugl-Meyer score and Barthel index were improved in both groups(P<0.01), and the improvement in treatment group was better than that in control group(P<0.05, P<0.01). [Conclusion] Erwu decoction wet-hot compress combined with rehabilitation training in the treatment of post-apoplectic hemiplegia shoulder pain(wind-cold-dampness arthralgia) has satisfactory curative effect and no serious adverse reactions, which is worthy of promotion.
引文
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[3]中华人民共和国卫生部.涉及人的生物医学研究伦理审查办法(试行)[S].(2007-03-26)[2016-07-01].http://www.moh.gov.cn/qjjys/s3581/200804/b9f1bfee4ab344ec892e68097296e2a8.shtml.
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[5]严广斌.视觉模拟评分法[J].中华关节外科杂志(电子版),2014,8(2):34.
[6]高谦,卓大宏.一种新的脑卒中患者运动功能评测方法──简化Fugl-Meyer运动功能评测表的制订[J].中国康复医学杂志1994,9(6):244-249.
[7]侯东哲,张颖,巫嘉陵,等.中文版Barthel指数的信度与效度研究[J].临床荟萃,2012,27(3):219-221.
[8]张学文.论中风病的防治与调护[J].世界中医药,2006,1(1):35-36.
[9]孙磊,宁志杰.肩关节的稳定机制与肩关节不稳的评估处理原则[J].中国矫形外科杂志,2009,17(3):206-209.
[10]蒋鹏.良肢位摆放在偏瘫患者中的重要作用和实际应用[J].中国社区医师,2012(23):27.
[11]张明,周敬杰,张玉明,等.肩胛骨运动控制训练在改善肩关节活动障碍中的影响[J].中国康复医学杂志,2014,29(8):768-770.
[12]张仲景.金匮要略方论[M].北京:人民卫生出版社,2012:21.
[13]高学敏.中药学[M].北京:中国中医药出版社,2007.
[14]王金成,史晓燕.对“治风先治血血行风自灭”的认识[J].天津中医药,2009,26(4):310-311.
[15]夏成军.中药透骨草的化学成分和药理活性分析[J].现代医学与健康研究电子杂志,2018,16(7):164-165.
[16]杨晨晨,纪小凤,郑丽维.中药湿热敷在脑卒中康复护理中的应用[J].福建中医药,2017,48(1):67-69.
[2]朱晓军.康复运动疗法配合中医传统疗法治疗中风偏瘫后肩痛的效果观察[J].世界最新医学信息文摘,2015,15(12):85-86.
[3]中华人民共和国卫生部.涉及人的生物医学研究伦理审查办法(试行)[S].(2007-03-26)[2016-07-01].http://www.moh.gov.cn/qjjys/s3581/200804/b9f1bfee4ab344ec892e68097296e2a8.shtml.
[4]周仲瑛.中医内科学[M].北京:中国中医药出版社,2004:365.
[5]严广斌.视觉模拟评分法[J].中华关节外科杂志(电子版),2014,8(2):34.
[6]高谦,卓大宏.一种新的脑卒中患者运动功能评测方法──简化Fugl-Meyer运动功能评测表的制订[J].中国康复医学杂志1994,9(6):244-249.
[7]侯东哲,张颖,巫嘉陵,等.中文版Barthel指数的信度与效度研究[J].临床荟萃,2012,27(3):219-221.
[8]张学文.论中风病的防治与调护[J].世界中医药,2006,1(1):35-36.
[9]孙磊,宁志杰.肩关节的稳定机制与肩关节不稳的评估处理原则[J].中国矫形外科杂志,2009,17(3):206-209.
[10]蒋鹏.良肢位摆放在偏瘫患者中的重要作用和实际应用[J].中国社区医师,2012(23):27.
[11]张明,周敬杰,张玉明,等.肩胛骨运动控制训练在改善肩关节活动障碍中的影响[J].中国康复医学杂志,2014,29(8):768-770.
[12]张仲景.金匮要略方论[M].北京:人民卫生出版社,2012:21.
[13]高学敏.中药学[M].北京:中国中医药出版社,2007.
[14]王金成,史晓燕.对“治风先治血血行风自灭”的认识[J].天津中医药,2009,26(4):310-311.
[15]夏成军.中药透骨草的化学成分和药理活性分析[J].现代医学与健康研究电子杂志,2018,16(7):164-165.
[16]杨晨晨,纪小凤,郑丽维.中药湿热敷在脑卒中康复护理中的应用[J].福建中医药,2017,48(1):67-69.