“筋骨三针疗法”结合醒脑开窍针刺法治疗脑卒中后复杂区域疼痛综合征临床观察  

Clinical observation of Jingu three-needle therapy combined with Xingnao Kaiqiao acupuncture on complex regional pain syndrome after stroke

作　　者：王文熠[1] 万福铭 丁淑强[1] WANG Wen-yi;WAN Fu-ming;DING Shu-qiang(Acupuncture-Moxibustion Clinical Department,First Teaching Hospital of Tianjin University of TCM,Tianjin 300193,China)

机构地区：[1]天津中医药大学第一附属医院针灸临床部

出　　处：《中国针灸》2019年第12期1262-1266,共5页Chinese Acupuncture & Moxibustion

摘　　要：目的:观察"筋骨三针疗法"结合醒脑开窍针刺法治疗脑卒中后复杂区域疼痛综合征Ⅰ型(CRPS-Ⅰ)的临床疗效。方法:将96例脑卒中后CRPS-Ⅰ患者随机分为观察组和对照组,各48例。在常规治疗基础上,对照组应用单纯醒脑开窍针刺法治疗,主穴取内关、水沟、三阴交,每日1次,每周6次,共治疗3周;观察组在对照组基础上,加用"筋骨三针疗法"治疗,取喙突骨点、肱骨大结节、盂下结节行筋膜扇形分离法,松解3~6针,隔日1次,每周3次,共治疗3周。采用视觉模拟量表(VAS)评分、手部肿胀值、Fugl-Meyer运动功能评分及Barthel指数评分对患者治疗前后的疼痛、水肿、运动能力及日常生活能力进行评价。结果:①治疗后及治疗后40 d,两组患者的VAS评分、手部肿胀值、Fugl-Meyer运动功能评分及Barthel指数评分均较治疗前改善(P<0.01)。②治疗后,观察组的VAS评分优于对照组,治疗后40 d观察组的VAS评分及Fugl-Meyer运动功能评分优于对照组(P<0.01)。③治疗后及治疗后40 d两组比较,手部肿胀值及Barthel指数评分差异无统计学意义(P>0.05)。结论:"筋骨三针疗法"结合醒脑开窍针刺法可更有效地改善脑卒中后CRPS-Ⅰ患者的疼痛症状,提高患肢运动能力,且疗效可长期持续;本治疗方案对患者的末梢水肿可能无明显治疗效果。Objective To observe the clinical therapeutic effect of Jingu three-needle therapy combined with Xingnao Kaiqiao acupuncture on complex regional pain syndrome typeⅠ(CRPS-Ⅰ)after stroke.Methods A total of 96 patients with CRPS-Ⅰafter stroke were randomized into an observation group and a control group,48 cases in each one.In the control group,based on the routine treatment,Xingnao Kaiqiao acupuncture was applied at Neiguan(PC 6),Shuigou(GV 26),Sanyinjiao(SP 6)and other supplementary acupoints,once a day,6 times a week for 3 weeks.Based on the treatment in the control group,Jingu three-needle therapy was added at coracoid process,greater tuberosity of humerus and infraglenoid tubercle,the muscular fascia was released by fan-shaped separation technique for 3-6 times,and the treatment was given once every 2 days,3 times a week for 3 weeks.Visual analogue scale(VAS)score,hand swelling level,Fugl-Meyer assessment(FMA)score and Barthel index score were observed to evaluate the pain and swelling severity,motor function and living ability of patients before and after treatment.Results①Compared before treatment,the VAS score,hand swelling level,the FMA score and the Barthel index after treatment and 40 days after treatment were improved in both of the two groups(P<0.01).②After treatment,the VAS score in the observation group was superior to the control group(P<0.01),40 days after treatment,the VAS and FMA scores in the observation group were superior to the control group(P<0.01).③There were no significant differences after treatment and 40 days after treatment of the hand swelling level and the Barthel index between the two groups(P>0.05).Conclusion Jingu three-needle therapy combined with Xingnao Kaiqiao acupuncture can improve the pain severity and the motor function of affected limbs in patients with CRPS-Ⅰafter stroke,and the therapeutic effect may be sustained for a long term.However,the treatment seems to be ineffectual on extremity swelling.

关 键 词：复杂区域疼痛综合征 脑卒中 筋骨三针疗法 醒脑开窍针刺法 随机对照试验 

分 类 号：R246.6[医药卫生—针灸推拿学]