针刺联合康复训练对脑卒中后肩手综合征急性期患者的疗效研究
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摘要
目的观察针刺联合康复训练治疗脑卒中后肩手综合征(shoulder-hand syndrome,SHS)急性期患者的临床疗效和意义。方法将符合诊断和纳入标准的98例脑卒中后SHS患者随机分成观察组和对照组,每组49例。对照组采取常规治疗并配合康复训练,观察组在对照组的基础上采用针刺穴位疗法,观察治疗后的临床疗效,比较两组患者治疗前后的肩痛视觉模拟评分(visual analogue scale,VAS)、患侧手肿胀评定、上肢功能评定表评分(disabilities of the arm,shoulder and hand,DASH)和Fugl-Meyer评分(Fugl-Meyer assessment scale,FMA)。结果治疗后,两组患者肩膀VAS评分、患侧手肿胀评分和DASH评分均较治疗前有所下降,FMA评分均较治疗前升高,差异有显著统计学意义(P<0.01),且观察组VAS评分、患侧手肿胀评分和DASH评分均低于对照组,FMA评分高于对照组,差异有统计学意义(P<0.05或P<0.01);观察组临床总有效率为83.7%,与对照组的73.5%比较,差异有统计学意义(P<0.05)。结论针刺联合康复训练对脑卒中后肩手综合征急性期患者的疗效显著,显著改善患侧上肢运动功能,值得临床推广。
Objective To observe the clinical effect and significance of acupuncture combined with rehabilitation training in the treatment of patients with shoulder-hand syndrome(SHS) after stroke. Methods 98 patients with SHS after stroke were randomly divided into the observation group and control group, with 49 cases in each group. The control group was received routine treatment and rehabilitation training, the observation group was given acupuncture therapy on the basis of control group. The clinical curative effect after treatment was observed. The visual analogue scale(VAS), ipsilateral hand swelling score, disabilities of the arm,shoulder and hand(DASH) and Fugl-Meyer assessment scale(FMA) in the two groups were compared. Results After treatment, the shoulder VAS score, ipsilateral hand swelling score and DASH score decreased after treatment, FMA scores were higher than that before treatment, the difference was statistically significant(P<0.01), and the VAS score, ipsilateral hand swelling acore and DASH score in the observation group were lower than the control group, FMA score after treatment was higher than the control group,the difference was statistically significant(P<0.05 or P<0.01). The total efficiency of the observation group was 83.7%, compared with73.5% in the control group, the difference was statistically significant(P<0.05). Conclusion Acupuncture combined with rehabilitation training has a significant effect on patients with acute shoulder-hand syndrome after stroke, could significantly improve the motor function of the affected side of the upper limb, which is worthy of clinical promotion.
Objective To observe the clinical effect and significance of acupuncture combined with rehabilitation training in the treatment of patients with shoulder-hand syndrome(SHS) after stroke. Methods 98 patients with SHS after stroke were randomly divided into the observation group and control group, with 49 cases in each group. The control group was received routine treatment and rehabilitation training, the observation group was given acupuncture therapy on the basis of control group. The clinical curative effect after treatment was observed. The visual analogue scale(VAS), ipsilateral hand swelling score, disabilities of the arm,shoulder and hand(DASH) and Fugl-Meyer assessment scale(FMA) in the two groups were compared. Results After treatment, the shoulder VAS score, ipsilateral hand swelling score and DASH score decreased after treatment, FMA scores were higher than that before treatment, the difference was statistically significant(P<0.01), and the VAS score, ipsilateral hand swelling acore and DASH score in the observation group were lower than the control group, FMA score after treatment was higher than the control group,the difference was statistically significant(P<0.05 or P<0.01). The total efficiency of the observation group was 83.7%, compared with73.5% in the control group, the difference was statistically significant(P<0.05). Conclusion Acupuncture combined with rehabilitation training has a significant effect on patients with acute shoulder-hand syndrome after stroke, could significantly improve the motor function of the affected side of the upper limb, which is worthy of clinical promotion.
引文
[1]PERTOLDI S,DI BENEDETTO P.Shoulder-hand syndrome after stroke A complex regional pain syndrome[J].Eura Medicophys,2005,41(4):283-291.
[2]周国平,李江山.全经针刺法治疗中风偏瘫的理论探讨[J].湖南中医学院学报,2003,23(5):57-58.
[3]DAVENPORT RJ,DENNIS MS,WELLWOOD I,et al.Complications after acute stroke[J].Stroke,1996,27(3):415–420.
[4]郭根平,沈丰庆,王钰,等.综合疗法治疗肩手综合征[J].中国康复,2005,20(2):30-31.
[5]蔡亦强,余兢兢.肩——手综合征康复治疗疗效观察[J].中国康复理论与实践,2005,11(4):304.
[6]王野,白一辰.中药蜡疗结合推拿手法治疗中风后肩手综合征临床观察[J].中华中医药学刊,2017(2):306-309.
[7]中华医学会神经病学分会.脑血管疾病防治指南(节选)[J].中国现代神经疾病杂志,2017(2):40.
[8]缪鸿石,朱辅连.脑卒中的康复评定与治疗[M].北京:华夏出版社,1996:149.
[9]付莉.肩手综合症的综合康复48例[J].中国冶金工业医学杂志,2010,27(1):98-99.
[10]中华人民共和国卫生部医政司.中国康复医学诊疗规范(下册)[M].北京:华夏出版社,1998:384.
[11]KARABEGOVIC A,KAPIDZIC DURAKOVIC S,LJIUCA F.Laser therapy of painful shoulder and shoulder-hand syndrome in treatment of patients after the stroke[J].Bosn J Basic Med Sci,2009,9(1):59-65.
[12]恽晓平.康复疗法评定学[M].1版.北京:华夏出版社,2005:393-396.
[13]王诗忠,张泓.康复评定学[M].北京:人民卫生出版社,2012:414-416.
[14]NANCY H.Diepenbrock,杨涛,施惠斌.华盛顿护理技术快速考[M].2版.天津:天津科技翻译出版公司,2005:108.
[15]蒋天裕,王兴林,张立宁,等.偏瘫后肩手综合征的临床分析及康复治疗[J].四川医学,2010,31(4):415-417.
[16]王晓艳,张通,李敬.脑卒中后反射性交感神经营养不良的针极肌电研究[J].中华医学杂志,2006,86(37):2632.
[17]MAIHOFNER C,BARON R,DECOL R,et al.The motor system shows adaptive changes in complex regional pain syndrome[J].Brain,2007,130(10):2671.
[18]费立凤,张俊.肌电触发电刺激配合康复训练治疗脑卒中后肩手综合征的疗效观察[J].中国康复医学杂志,2009(8):757-758.
[19]廖燕锬,林滨.脑卒中后肩——手综合征中西医治疗进展[J].中国康复理论与实践,2008,14(1):41-42.
[20]范江.脑卒中后肩手综合征的中医康复治疗[J].中国中医急症,2015,24(12):2206-220.
[21]孙远征,马彤艳.循经远取动法治疗中风后肩手综合征疗效观察[J].上海针灸杂志,2011,30(1):17-19.
[2]周国平,李江山.全经针刺法治疗中风偏瘫的理论探讨[J].湖南中医学院学报,2003,23(5):57-58.
[3]DAVENPORT RJ,DENNIS MS,WELLWOOD I,et al.Complications after acute stroke[J].Stroke,1996,27(3):415–420.
[4]郭根平,沈丰庆,王钰,等.综合疗法治疗肩手综合征[J].中国康复,2005,20(2):30-31.
[5]蔡亦强,余兢兢.肩——手综合征康复治疗疗效观察[J].中国康复理论与实践,2005,11(4):304.
[6]王野,白一辰.中药蜡疗结合推拿手法治疗中风后肩手综合征临床观察[J].中华中医药学刊,2017(2):306-309.
[7]中华医学会神经病学分会.脑血管疾病防治指南(节选)[J].中国现代神经疾病杂志,2017(2):40.
[8]缪鸿石,朱辅连.脑卒中的康复评定与治疗[M].北京:华夏出版社,1996:149.
[9]付莉.肩手综合症的综合康复48例[J].中国冶金工业医学杂志,2010,27(1):98-99.
[10]中华人民共和国卫生部医政司.中国康复医学诊疗规范(下册)[M].北京:华夏出版社,1998:384.
[11]KARABEGOVIC A,KAPIDZIC DURAKOVIC S,LJIUCA F.Laser therapy of painful shoulder and shoulder-hand syndrome in treatment of patients after the stroke[J].Bosn J Basic Med Sci,2009,9(1):59-65.
[12]恽晓平.康复疗法评定学[M].1版.北京:华夏出版社,2005:393-396.
[13]王诗忠,张泓.康复评定学[M].北京:人民卫生出版社,2012:414-416.
[14]NANCY H.Diepenbrock,杨涛,施惠斌.华盛顿护理技术快速考[M].2版.天津:天津科技翻译出版公司,2005:108.
[15]蒋天裕,王兴林,张立宁,等.偏瘫后肩手综合征的临床分析及康复治疗[J].四川医学,2010,31(4):415-417.
[16]王晓艳,张通,李敬.脑卒中后反射性交感神经营养不良的针极肌电研究[J].中华医学杂志,2006,86(37):2632.
[17]MAIHOFNER C,BARON R,DECOL R,et al.The motor system shows adaptive changes in complex regional pain syndrome[J].Brain,2007,130(10):2671.
[18]费立凤,张俊.肌电触发电刺激配合康复训练治疗脑卒中后肩手综合征的疗效观察[J].中国康复医学杂志,2009(8):757-758.
[19]廖燕锬,林滨.脑卒中后肩——手综合征中西医治疗进展[J].中国康复理论与实践,2008,14(1):41-42.
[20]范江.脑卒中后肩手综合征的中医康复治疗[J].中国中医急症,2015,24(12):2206-220.
[21]孙远征,马彤艳.循经远取动法治疗中风后肩手综合征疗效观察[J].上海针灸杂志,2011,30(1):17-19.