针刺联合艾灸治疗缺血性中风后肩手综合征临床研究  

Clinical Study on Acupuncture Combined with Moxibustion in Treating for Shoulder-hand Syndrome after Ischemic Stroke

作　　者：王瑞红[1] 何亚楠[1] 黄涛[2] WANG Ruihong HE Yanan HUANG Tao(Aerospace Central Hospital,Beijing China 100049 Acupuncture and Moxibustion of China Academy of Chinese Medical Sciences,Beijing China 100700)

机构地区：[1]航天中心医院,北京100049 [2]中国中医科学院针灸医院,北京100700

出　　处：《中医学报》2017年第7期1329-1332,共4页Acta Chinese Medicine

基　　金：国家科技支撑计划项目(2013BAI05B09)

摘　　要：目的:探讨针刺联合艾灸治疗缺血性中风后肩手综合征的临床疗效。方法:将120例符合诊断标准的患者按随机数字表法分为对照组和观察组各60例,对照组除内科基础治疗外,给予康复训练,包括正确摆放体位、被动运动和主动运动等。观察组在对照组治疗基础上加用针刺和艾灸。采用肩手综合征(shoulder-hand syndrome,SHS)量表、上肢FuglMeyer功能量表(upper limb Fugl-Meyer assessment scale,U-FMA)、日常生活活动能力量表(activity daily living scale,ADL)、神经功能缺损程度(national institute of health stroke scale,NIHSS)、风痰瘀阻证评分评价两组患者的症状改善情况,并比较两组患者降钙素基因相关肽(calcitonin gene-related peptide,CGRP)、P物质(substance P,SP)和血浆缓激肽水平及临床疗效。结果:(1)治疗后两组患者疼痛、痛觉过敏、远端水肿和肩部活动运动3个维度评分及SHS量表总分均较治疗前明显降低(P<0.01),治疗后观察组SHS量表3个维度评分及总分均低于对照组(P<0.01)。(2)与治疗前相比较,治疗后两组患者U-FMA和ADL评分均明显升高(P<0.01),NIHSS和风痰瘀阻证评分均明显下降(P<0.01);治疗后观察组U-FMA和ADL评分高于对照组(P<0.01),NIHSS和风痰瘀阻证评分均低于对照组(P<0.01)。(3)与治疗前比较,治疗后两组患者CGRP水平升高,SP和缓激肽水平下降(P<0.01),治疗后观察组CGRP水平高于对照组,SP和缓激肽水平低于对照组(P<0.01)。(4)观察组有效率为96.43%,对照组为83.64%,两组比较,差异有统计学意义(χ2=5.085,P<0.05)。结论:针刺联合艾灸治疗缺血性中风后肩手综合征疗效显著。Objective：To investigate the clinical efficacy of acupuncture combined with moxibustion in treatment of shoulder-hand syndrome after Ischemic stroke.Methods：120 patients who met the diagnostic criteria were randomly divided into control group and observation group,with 60 cases in each group.The control group was given basic internal medical therapy and rehabilitation training,including correct placement of body,passive movement and active exercise.The observation group was treated with acupuncture and moxibustion in addition to that of the control group.The symptom improvement of the two groups were evaluated by the evaluation of the shoulder-hand syndrome scale,the upper limb Fugl-Meyer function scale,the daily living activity scale,the degree of neurological deficit and the Wind Phlegm Stasis Syndrome score.The Calcitonin gene-related peptide（CGRP）,Substance P（Substance P）and plasma bradykinin level and the clinical efficacy of both groups were also evaluated.Results：（1）After treatment,the three dimensions of pain,hyperalgesia,distal edema and shoulder movement were significantly lower than those before treatment（P〈0.05）.After treatment,the scores of the three dimensions of SHS scale and the total score were lower than those of the control group（P〈0.01）.（2）Compared with that before treatment,the scores of upper limb Fugl-Meyer assessment scale（U-FMA）and activity daily living Scale（ADL）in the two groups were significantly higher（P〈0.01）.The national institute of health stroke scale（NIHSS）and the Wind Phlegm Stasis Syndrome score of the observation group was lower than those of the control group（P〈0.01）.The scores of U-FMA and ADL in the observation group were higher than those in the control group（P〈0.01）,NIHSS and wind phlegm stagnation score were lower than those in the control group（P〈0.01,P〈0.01）.（3）Compare with that before treatment,the level of CGRP in the observation group was higher than that in the control group,while the level

关 键 词：缺血性中风 肩手综合征 针刺疗法 艾灸 康复训练 

分 类 号：R255.2[医药卫生—中医内科学]